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711A63SACE#.0. 6-62 APPLICATION FOR BUILDING PERMIT LI
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS L/} IL01A
BUILDING AND SAFETY DIVISION LOCALITY -0wPL6 G(-
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. 61--(G K' E/FN
DIS,Tp ICT NO. GROUP TYPE T PR¢CESSEO BY
FOR PPLICANT TO FELL IN S, p g T CONST. I/ (mol p yl<6
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LDING �./ STATISTICAL CLASSIFICATION .--JJJ��� SEWER MAP
SS Q��p . q-S CLASS. NO._I DWELL. UNITTS I L �.
NO. /�/ yr L ,Z:BLOCK (� WATER NOT REDUIRED IXI RECEIVED
CERTIFICATE: rr Y.II
CTQ ZI MAP HlcewnvNO.OF SLOGS. NO. ICIRCLEISTATE MAJOR SECON , LOCAL
E OF LOT O NOW ON LOT -'–� USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG, n
OWNER ,.7tt / ,"<, ,,/1
NO. BUIL/ING /O / L� Bf
FH--Y_ EXIST.
/ SETBACK YARD STREET NAME WIDTH
ADDRESS;Z .3SV 1tt-/ �tirG•`7Gn _ FRONT 7v `A /f OSR !q
ARCHITECT OR - "TEL, P. IL
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ENGINEER n--sCt_ NO. SIDE Y
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ADDRESS Ep O
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CONTRACTOR .J' r v NO ,J' "- / /
ADDRESS. � �f, J ,.[.,.r-. t!- -
DESCRIPTION OF WORK
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EW ADD ALTER REPAIR DEMOLISH '�P- ? Z
SQIZ FT. _ ST OF NO, OF
USE OF �'STORIES FAMILIES�
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SIGNATURE
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APPLICAN
VALUATIONS I3/ .tea -- I.✓ / ^J'c-LYtfi✓WG ( Gv�l:"I
APPROVALS (/ ATE INSPECTqFKS SIGZATUYfE
P.C. 'T / 75 PMT. - FOUNDATION: LOCATION n
FEE S –LD•— FEE $ O FORMS. MATERIALS r+ h ,
FRAME: FIRE STOPS. / O
I HEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION BRACING. BOLTS K
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. �' -r�i-r• r'" I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
BUILDING CONSTRUCTION, I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT.
ING TO WORKMENS CO MPENEATION INSURANCE. LATH. EXT, f
SIGNATURE OF Q/� //Ii HOUSE NUMBER COR- C a
PERMITTEE �L,P,lz%'f .r 4I K•{A --{''L – RECT AND POSTED 0 (•�v �+�
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ADDRESS•'... �sy Jl. •ae�c_ % I FINAL V�JU1 /i..
JOHN F. LEWIS. PRINCIPAL ST TURALIENGINEER
PLAN CHECK VALIDATION CK. MID
.D. CASH _ PERMIT VALATION CK M.G. EASNV
;tp 2 8 7 U^ APR 3 2 3 c 2 6.7 5
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