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79AG38A CIE#603 1- 1 APPLRCAT90N FOR BURL®ING PERMiT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDREss- Cr
BUILDING AND SAFETY DIVISION LOCALITY i
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN BUP'T OF BUILDING CROSS ST37
" DISTRICT NO. OUP T.P SED BY
FOR APPLICANT TO FILL IlY coNsr.
BUILDING STATISTICAL CLASSIFICATION SE ER MAP
ADDRESS �� S I� / oa-k K _e,,PG
CLASS NO DWELL UNITS `'
LOT NO. l_ BLOCK WATER NOT REQUIRED fU RECEIVED
CERTIFICATE Vit
TRACT MAP HIGHWAY:ZV STATE MAJOR SECOND, L CAL
NO OF BLDGS. NO C! (CIRCLE)
SIZE OF LOT .�. Q I NOW ON LOT USE ZONE SPECIALUSEp�
EX STOF BLDG. S' � / CONDITIONS o -I
4. O G TNEL l(
OWNER O 3.7 ILDING YARD HWY EET NAME EXIST
SETBACK ).
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ADDRESS WIDTH
vJ {� D �• T FRONT •'t
ARCHITECT OR TEL. P L
ENGINEENO SIDE '
ADDRESSCL
CONTRACTOR O WK h NO ` SP CTION CO p
ADDRESS
DESCRIPTION OF WORK
I W
EW ADD ALTER REPAIR DEMOLISH / N
FT. NO OF NO OF -
IZE /7 .J Z STORIES FAMILIEUSE OF c'
STR CTURE & '
=a /t
^ SIGNATURE OF 1� G _®il.'"' �JIf/�,f-
APPLICANT—
VALUATION
PPLICANT ��
.a VALUATION$ �J � _
APPROVALS ISATE INSPECTOR'S SIGN'AWRE
PC
J� PMT. FOUNDATION LOCATIO I) /G�
FEE L! �. FEE $ (J FORMS,MATERIALS / 7Q
FRAME FIRE STOPS, '
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS /7
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE' LOCATION, c.s1t t0 •j
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHOR r'ZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOL LATH, INT. 6x
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT.
ING TO WORKMEN S COMPENSATION INSURANCE r
LATH,EXT t
SIGNATURE OF HOUSE NUMBER COR- Z
PERMITTE 5 RECT AND POSTED (//11(/,?J _
ADDRESS ^•� FINAL
CLYDE N DIRLAM, PRINCIPAL STRU RAL ENGINEER
PLAN CHECK VALIDATION cK M.O. CASH PERMIT VALIDATION cK M.O. CASH
[A-o,'" 3:6% "27 _, 1 ® 6 0-50,
APPLICATION EOR-';BUILDING PERMIT
FOR APPLICANT TO FILL IN'(P,,rt,or type only)
BUILDING ---•-- COUNTY OF LOS ANGELES
ADDRESS 10512'Live Oak DEPARTMENT OF COUNTY ENGINEER
CITY Temle- Cit - ZIP BUILDING AND SAFETY DIVISION t
NO OF BLDGS _ BUILDING
SIZE OF LOT NOW ON LOT ADDRESS /45'/a2- (!f
TRACT BLOCK- LOT NO LOCALITY
TEL NEAREST
-OWNER Albert" NOelte' NO CROSS ST
ASSESSOR
ADDRESS 5342 La Madera _ _ _ MAP BOOK PAGE ": RCEL
DISTRICT I GROUP ITYPE FIRE PROC SSED BY
CITY E1 Monte ZIP CONSTi ZONE
ARCHITECT OR TEL &D i I`� -
ENGINEER - NO
_ STATISTICAL
^CLASSIFICATION SEWER 101AP
ADDRESS CLASS NO. DWELL UNITS ..� PG
CONTRACTOR Rigid Mfg. CO. NOL'263-5181 USE ZONE MAP
LIC. NO
-ADDRESS 337 S. Woods Ave, NO 159496 + SPECIAL
LIC CONDITIONS
CITY Los Angeles CLASS C-39
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER _
NAME AND BRANCH BLDG STT-BACK FROM �.
FRONT ROP LINEOF (STREET) a
O
ADDRESS CITY HIGHWAY } YARD _ TOTAL SETBACK FROM TYPE OF EXISTING C')
SQ FT NO OF NO. OF - CHECK FRONT PROP LINE HIGHWAY WIDTH �
SIZE STORIES FAMILIES ONE O
DESCRIPTION OF WORK
NEW }
ADD ❑ BLDG,SETBACK FROM N
Re-roof with CO1T1 OSltlOn SIDEPROP LINEOF STREET) z
LTER ❑ HIGHWAY } YARD = TOTAL SETBACK FROM TYPE EXISTING
REPAIR❑
SIDE PROP LINE HIGHWA WIDTH
USE OF } _
EXISTING BLDG - DEMOL ❑
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) - NO.
BY (SIGNATURE) IN OPEN,SPACE - YES ❑ NO ❑
Q, IN COASTAL ZONE YES ❑ NO ❑
VALUATION$ 1 000:00 CATEGORICAL EXEMPTION YES❑ - NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
_
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
"LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING-TO
WORKMEN'S CO MPE NSATION'MIB k}RAN G. / OMPAT,N
SIGNATURE OF iC llT llJ V 1�V11r A1`IL
PERMITTEE
ADDRESS 337 S Woods fienue
- FINAL BY
TEL DATE
CITY LOS Angeles No 26 - / —
P.CPMT
11 1/\E CHLChS RI))BLL 10 FEE � ` � FEE $15.00
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN CHECK VALIDATION -CK M o CASH a PERMIT VALIDATIONCH� M o CASH
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