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78A636A CE.$x'803 IO-.56 O-\ tl I M A I O'N,�J .�O ■ I' V '..Nm®� d 'fJ hi7- 9 ,'..i -
BUILDING•.-
BUILDING AND'SAFETY DIVISION ADDRESS L: ►'V`'Z
Department.'6 County Engineer '7--
County of Log Angeles r LOCALITY-, 7' 1
JOFIN'A.LAMBIE.-COUNTY ENGINEER, NEAREST
„CASSATT D. GRIFFIN, SUPT OF-BUILDING - CROSS ST. --f•��--[J UL/L- l _ ��
DISTRICT NO. GROUP, .� SEWER MAP
YPE ..
BK PG
FOR APPLICPiNT TO FILL IN CDIvsT:
s Z, �: .
BUILDING ,t STA T.ISTICAL.CLASSIFICATION�
.ADDRESS I/�7 l�7 -�, �/
��** '.CLASS NO':�-'DWELL:�UNITS I +
COT.'NO'" V- BLOCK MAP STATE., Y
�qQ. yn NUMBER -• UD - `HWY
TRACT US ES O -
SIZE OF".LOT /(JC7 -I-'NOW:ON LOT'- EZONE _ - SPECIAL -
NO OF BLDGS. 'C
T� - '� CONDITIONS
- a ��
EXISTING BLDG. • BUILDING - EXIS .(
- YARO. 'HWY STREET NAME-
' SETBACK•. - - WIDTH'
_.OWNER .. ., FRONT �... __
MAIL - - .P_L. - -
"' ADDRESS IDE
EL
CiTY,: NO INSPBCTION RECORD'
ARCHITECT OR; - - '-TEL.
'ENGINEER NO:
:ADDRESS' `•. _ -
' TEL.
-Z3 J- jai• X%I T
CONTRACTOR - NO. _
ADDRESS'
DESCRIPTI6N- OF WORK
NEW. ,&DALTER REPAIR DEMOLISH
SQ. FT. .'_~ NO. OF' NO.,OF
.SIZE - `- STORIESFAMILIES -
USE OF STRUCTURE -
�lr�
-- - APPROVALS'_ •' _
SIGNATURE OF — -i - -
:.APPLICANT _ DATE''.' - INSPECTOR`S.SIGNATURE .
ADDRESS - - .FOUNDAtiON:LOCATION'
FORMS—MATERIALS.. _
$•••-
P. $ FRAME: FIRE_STOPS.. -
' FEE BRACING. BOLTS-- - -
FURNACE: LOCATION;.
VALUATION .� ^�-• '$ /. �_ GASVENT. DUCTS" - -
- ,. ... _
71 HEREBY ACKNOWLEDGE THAT.1 HAVE READ•THIS AP- LATH..INT." _ -
PLICATION,ANDSTATE`THAT THE ABOVE IS CORRECT AND
I
ORDINANCES. AND
AGREE TOCOMPLYWITH ALL COUNTY O.C.ONSTRUCTION. LATH. '• -
.STATE LAWS.. RE EATING, B�1L/DING•SIGNATURE OF_ U �,..� �� //�� HOUSE NUMBER COR-
PERMITTEE•- LJK. RECT AND POSTED' _
'ADDRESS' fINAL;
i6kN.A.LAMBiE:''COUNTY ENGINEER; CLYDE N.DIRLAM.'PRINCIPAL.STRUCTURACENGINEER
PLAN CHECK VALIDATION CK. .,M.O.' -CASH - 'PERMIT VALIDATION Cf'. m.o.'• cASH ;`i
..... -
. . .
-76A638A,CE#8033-66 APPLI•CATION..FOR '.BUIL®I G PEIf'CMI-..
COUNTY, OF',LOS ANGELES BUILDING
DEPARTMENT CIF-COUNTY ENGINEER.. ADDRESS. �: , r ' . 6''h'�•C'c
BUILDING. AND SAFETY. DIVISION LOCALI_TY
JOHN A. LAMBIE. COUNTY ENGINEMER . NEAREST _ r
•- COLEMA.N'W. JENK.INS,SuP"•TOF BUILDING GROSS ST, •
DISTRICT N ,GRO TYPE, ` P B-
FOR APPLICANT TO F'ILL IN: , _."' p. CONST: GJ
BUILDING , STATISTICAL C AS IFICATION. SEWER MAP,, ''77
r�. ADDRESS / �.07 ( gK. P.l! > CLASS NO.- %5_;`DWELL UNITS. �.
LOT NO. Q :'BLOC, I USE ZONE MAP = /j
.,TRACT •D - NO ,.SPECIAL
CONDITIONS
SIZE OF-LO T Q "NOW ON LOT' • ."' ; ,
- . .c
USE OF
EXISTING '
B
L
DG
.
SETBACK FROM
_ TEt FRONT PROP. LINE:O F.' tl (STREET)
.
OWNER ..�C✓NO... .�. TYPEOF EXISTING SETBACKe HIGHWAY + " YARD ir= '.TOTAL
ADDRESS,
HIGH WAY_ WIDTH'' FROM.iCa - '... . .'.
CITY BL
" ARCHITECT ,OR . 'DG. SETBACK;FROM.. _
h TEL• SIDE PROPr LINE OF '-f (STREET)
-
ENGINEER.' NO.
- TYPE OF EXISTING SETBACK._.HI,GHWAY .+ ,..YARD TOTAL '
ADDRESS' • : HIGHWAY WIDTH. FROM C.L.
..-, TEL. - ..+ _ — -
CONTRACTOR, i NO
LIC
ADDRESS . CORNER CUTOFF YES, NO. V
-. -'. C
CITY" cLA ; SEE REVERSE SIDE FOR SPECIAL APPROVALS o
DESCRIPTION OF WORK W
N
. NEW' -_� ADD • ALTER E P A R DEMOLIS H Z
'. SQ.FT. - � � NO. OF ,. NO. OF.
SIZE _ -.-. STORIES' FA M6L'I F_SUSE
_
ST10,
RUCTURE
.SIGNATURE OF - .D
APPLICANT - /Lt. �, -V - -
JON$, - � " � [/ I" •
VA,LU_ATQ0 APPROVALS - DATE �I NSPECTOR'S SIGNATURE
P C. PMT. "FOUNDATION, LOCATION
,F.EE$ FEE$ 7 'FORMS, MATERIALS
.. FRAME, FIRE STOPS,. ,-
I HEREBY.ACKNOWLEDGE THAT I HAVE READ, THIS APPLICATION BRACING BOLT • - -
AND STATE.THAT.THE ABOVE IS CORRECT AND AGREE-TO COMPLY FURNACE: LOCATION
WITH ALL COUNTY-ORDINANCES-AND STATE LAWS REGULATING ;GAS VENT. DUCTS
9UIL'DING' 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 REL AT-
'ING.TOWORKMEN'S COMPENSATION INSURANCE. '..LATH: EX T.
,SIGNATURE�OF "`-S/1. �{.� HOUSE NUMBER'COR - -
PERMITTEE RE T'ANDPOSTED.
ADDRESS G7" v/ I FF N AL e!p —✓ f
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENG
PLAN. CHECK VALIDATION CK. M.O.. CASH' PERMIT VALIDATION CK. M.D CASH
'OCT26