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?"938A CC HG,2/90 APPLICATION FOR BUILDING PERMIT 1
COUNTY OF LOS ANGELES BUILDING [�
DEPARTMENT OF COUNTY ENGINEER ADDRESS 7
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. L.AMBIE. COUNTY ENGINEER NEAREST
WI IAM A. JENSEN Su ,T of Buiumma I CROSS ST.
DIST ICT ROUP TyOE SED BY
FOR APPLICANT TO FILL IN !3 CONST.
BUILDING / STATISTICAL CLASSIFICATION S ER MAP
ADDRESS ! a. K
CLASS.NO. DWELL.UNITS --
LOT NO. BLOCK MAP STATE yE3 O
NUMBER z HWY,
TRACT OCi 7 USE ZONE SPECIAL
NO.OF BLDGS. CONDITIONS
SIZE OF LOT I NOW ON LOT C -;2,
USE OF
EXISTING BLDG. BUILDING YARD HWY . STREET NAME EXIST.
TEL. SETBACKWIDTH
OWNER O. FRONT
P.L,
ADDRESS ! SIDE
ARCHITECT OR TEL. P.L.
ENGINEER NO. SPEC17ON RECORD
ADDRESS
CONTRACTOR NO. YocO
' '> V
ADDRESS
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SO.FT. NO.OF NO.OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE
� I
SIG RE OF
APPLI CANT
VALUATIONU
APPROVALS DA INSPECTOR'S SIGNATURE
P.C. PMT. �� FOUNDATION: LOCATION
FEE $ FEE �� FORMS, MATERIALS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS,
BRACING BOLTS
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION,
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS
STATE LAWS REGULATING BUILDING CONSTRUCTION.
1 CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH, INT.
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
WORKMEN'S COMPENSATION LAWS OF CALIFORNIA. LATH,EXT.
SIGNATURE O HOUSE NUMBER COR-
PERMITTE RECT AND POSTED
ADDRE3 FINAL
CLYDE N. DIRLAM, WNI.IALSTRUCTL6AL EN R
PLAN CIECK VALIDATION m m.o. cases PERM VALIDATION cK. ..o. casts
Ap
L! �0 4 8 7 91�0 AFF 4 1 0 5.0 0 T Or
76A638A CE 0803 1/71 s //
R APPLICATION FOR BUILDIIN4G P MIT
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DMSION ADDRESS -
COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY �
R APPLICANT TO FILL IN NEAREST
Prir t r11' CROSS ST.
nt 1^ f/ `/
DISTRICT NO. GROUP TYPE PROCESSED BY
BUILDING IADDRESS Q S4 CONST. J
STATISTI AI CLASSIFICATION SEWER MAP
LOT NO 73 BLOCK
CLASS N0.9,2_DWELL,UNITS BK PG
TRACT / C USE ZONE MAP
NO.OF BLDGS, NO. L7
SIZE OF LOT NOW ON LOT SPECIAL
USE OF CONDITIONS
EXISTING BLDG. '0 f
L
NO /
OWNER BLDG.SETBACK FROM
ADDRESS FRONT PROP.LINE OF (STREET)
r TY OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
CITY NIGH Y WIDTH FROM C.L.
ARCHITECT OR C TEL. + _
ENGINEER E NO.
BLDG.SETBACiC FROM
LAPPLICANT
ESS SIDE PROP.LINE (STREET)
r
TEL. 'TYPE OF EXISTING SETBA I2 G`HWAY + YARD = TOTAL 0
RACTOR �� NO. ' HIGHWAY WIDTH FROM C.L. '� C�
LIC. `+ _
ESS NO, + — vwrr CD
LIC. t3
CLASS CORNER CUTOFF YES ❑ ❑
RUCTION LENDER Z
AND BRANCH A16*E SEE REVERSE SIDE FOR SPECIAL APPROVALS
ESS
. NO. OF NO. OF NEW ❑
STORIES FAMILIES
F A/ ADD
CTURE iu�y//V 6_
ALTER ❑
REPAIR❑
TURE OF
ICANT ^ �G(�-(/L` DEMOL ❑
TION $ VDrD APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION
FEES FEES FORMS, MATERIALS
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS
STRUC TI ON. IC
THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT-.
LABOR CODE OF TME STATE OF -CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATION INSURANCE. LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL
t JOHN FF.' A.
LEWIS. PRINCIPA TR TURL:.. tfi R
PLAN CHECK VALIDATI CK. M.O. CASH _ rLi11-lil VALIDATI CK. M.O. CASH
i t ?
52 3 0 6 8 5;40"4 1 0 �� .0 0 A*