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76A638A CEN803 1-67PPLICATION FOR BU LDI G PERMrIT
COUNTY OF. LOS ANGELES BUILDING /
DEPARTMENT OF COUNTY ENGINEER ADDRESS (.
BUILDING AND SAFETY DIVISION LOCALITY -
JOHN A. LAMBIE.COUNTY ENGINEER NEAREST /
COLEMAN W. JENKINS.SUP•T OF BUILDING CROSS ST.
DIS11 4CT NO. GROTYPE PR E D
FOR APPLICANT TO FILL IN CONST. o
BUILDING CTAS STICAFICA TION SEWER MK
ADDRESS 4929 CC CLASS NO.-=DlELL UNITS BK
LOT NO. BLOCK USE ZONEMAP
NO.
TRACT SPECIAL
NO. OF BLOGS. CONDITIONS
SIZE OF LOT NOW ON LOT%
USE OF
E XISTING BLDG. BLDG. SETBACK FROM
TEL. FRONT PROP. LINE OF (STREET)
OWNER Z NO. - TY OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHW WI TH FROM C.L.
CITY
ARCHIT C L BLDG. SETBACK FROM
ENGINEER NO. SIDE PROP. LINE OF (STREET)
TYPE OF EXISTING SETBACK 4tIG7AY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
TEL. _
CONTRACT NO
ADDRESS 529 E . Valley NO 186086 CORNER CUTOFF YES OEl
CITY San GabrielLILAss C-39 C SEE REVERSE SIDE FOR SPECIAL APPROVAbg1
t
DESCRIPTION OF WORK �J
NEW ADD ALTER RE' IR DEMOLISH /!� / j� f •;'�
SQ.FT. NO. OF NO. OF .5 ����� Ltc!.'. -�!/lr1 L�✓L
SIZE STORIES FAMILIES
USE OF Z-I �a I�+r 'J�'� L.0
STRUCTURE �} n� � `�/ �-� �n� � �� �J�^✓�t��
Re-roofing
SIGNATURE OF
APPLICANT
VALUATION$ 468 .00, •00 pppROVALS `DATE INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION, LOCATION
FEE$ FEE$ FORMS.MATERIALS
FRAME, FIRE STOPS,
I HEREBY ACKNOWLEDGE TWAT 1 HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
9UILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMP Y ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR COD G F HE A E F f���iiALIFORNIA RELAT.
ING TO WORKMEN'S Cr7 P S IN
LATH. EXT.
SIGNATOR OF HOUSE NUMBER COR-
PERMITTEE REC AND POSTED 1 r
ADDRESS 529 F _ Valley RI-1yd SantaOFIkAL
JOHN F. LEWIS. PH 114 ST URAL ENGINE:EfR
le
PLAN CHECK VALIDATION CK. M.D. CASH _ PERMIT VALIDATION CK. M.O CASH
LACO 3 8 0 3`0 -MAR 2 7 1 D 18-0':0-
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