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76A638ACE06032_63 APPLICATION FOR BUILDING PERMIT
r . COUNTY OF LOS ANGELES BUILDING ¢I NAS
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY C M 194- E (2f/l Y
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST //1� // v/�
WILLIAM A.JENSEN. SUPT OF BUILDING CROSS ST. HA L � >_A
DISTRICT NO. GROUP TYPE P OCESSED BY.
FOR APPLICANT TO FML IN 5, G CONST.
BUILDING STATISTICAL CLASSIFICATION SE ER MAP
ADDRESS �"
��JJ CLASS. NO. ; DWELL.UNITS LBK PG JO
LOT NO. A- BLOCK WATER NOT REQUIRED RECEIVED ❑
44 CERTIFICATE: ���xxx���
TRACT M. oZQoZ —4-7-4-9AY
NO.OF BLDGS..$� NO. / U ('CIRCLE) STATE MAJOR SECOND LOCAL
SIZE OF LOT Q X NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG. O ZJ_/
TEL
OWNER NO. O BUILDING EXIST.
jj�� SETBACK YARD HWY STREET NAME WIDTH
ADDRESV6 FRONT A�► /
ARCHITECT OR TEL. P. L. p(� MI LQ AI V ST � o
ENGINEER.)' , T SIDE a
/ '- P. L. O
ADDRES?/�O Sly
TEL. 11- 2`64- T'�Gw
- CONTRACTOR NO. - �
ADDRESS t Q
DESCRIPTION OF WORK o n. 'rc { a
T J + > z
NEW ADD ALTER REPAIR DEMOLISH
SQ.FT. ¢ NO. OF NO OF
SIZE a Q O STORIES FAMILIES
USE OF ,� t
STRUCTURE -Q
UT. r.
SIGNATURE OF
APPLICANT
VALUATION $ Sd 0. �• 2 v V
v APPROVALS DATE INSPECTOR'S SIGN TURF
P.0 14. �Q PMT. FOUNDATION: LOCATION n n
FE $ FEE $ FORMS, MATERIALS
—^ FRAME: FIRE STOPS, �•
I H EBY-ACKiJOWLED HAVE READ THIS A PL ATION BRACING. BOLTS !� / l�iG' ,•-o
AND STATE THAT THE ABOVE IS CORR ICRb AGREE TO COMPLY FURNACE: LOCATPQNY. ,
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS
�e BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK /`
AUTHORIZED HEREBY i WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. • �r.=c..•; '�,
TION OF THE LABOR CODE OF THE TATE CALIFO IA RELAT-
ING TO WORKMEN'S MPENSATIO INSUR /
{� ` LATH.EXT. I'Z ;cy,,,f„
151 NATLRE HOUSE NUMBER COR.
P_RMITTEE �v RECT AND POSTED
ADDRESS FINAL
1 JOHN F. LEWIS. PRINCIPAL ST CT RAL ENGMEE".
AAN CHECK VALIDATION CK. M.O. CASH L PERMIT VALIDATION CK. O. CASH
'r ' 'ILo 3 7 2 2:a, SEP 14 D 14.5 U�'
L);Lo 26 3 CCT 2 6 I D 2 9.0 0
ts•76AG38A
CE/803(&V e!7p)
• �' APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
BUILDING
FOR APPLICANT TO FILL IN c ADDRESS C
LDING
ADDRESS /✓ S� (_�
LOCALITY
NEAREST
CITY ZIP CROSS ST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARC
TRACT/-/O DISTRICT GROUP TYPE FIRE PRO SED BY
/ ,j.� BLOCK LOLNO. / • � ' - � CONST�-. ZO;E
OWNER &- . 1A`, "GJ
STATIST CA/LL CLASS) ICATION SEW
ADDRESS ® yy CL o. DWELL.UNITS G
CITY 7 G� ZIP 1957,VA If
ARCHITECT OR TEL
ENGINEER NO _16th VALUATION a o C)
ADDRESS FRONT PROP..LINEFOFI J ll-eh 6'J `S (STREET)
CONTRACTOR NO. 6- TOTAL SETBACK FROM TYPE OF EXISTING
LICA HIGHWAY t YARD = FRONT PROP.LINE HIGHWAY WIDTH
ADDRESS , NO.
.00LIC. 'F �_j
_
CITY CLASS ��t'
CONSTRUC I N LEN E BLDG.SETBACK FROM
NAME AND BRANCH SIDE PROP.LINE OF ISTREETI
HIGHWAY t YARD = TOTAL SETBACK FROM TYPE OF EXISTING
ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH
SQ.FT NO.OF NO.OF CHECK t
SIZE STORIES FAMILIES ONE
DESCRIPTION OF OORK NEW P.C.Fee$ Permit Fee
D ❑ �,
/ Issuance Fee
ALTER ❑ /�
` REPAIR ElTotal Fee [7��
USE OF DEMOL ❑
EXISTING BLDG. /� �� J
APPLICANT TEL (!2
(PRINT) NO. L ye,v� k,Aall_
BY(SIGNATURE) f t>G 7 a 3 8 ,p a
IHEREBY ACKNO GE THAT I HAVE READ THIS APPLICATION AND STATE Y
THAT THE ABOVE IS RRECT AND AGREE TO COMPLY WITH ALL ORDINANCES W
AND LAWS REGUL G BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE V
WORK AUTHORIZ EREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE PENSA IONCODEINSURANCE THE STATE OF CALIFORNIA IN RELATING RKME SCOM• Q
PENSATION INSURANCE
SIGNATURE OF
PERMITTEE
ADDRESS d Z
O
TEL.
CITY NO. r
USE ZONE MAP
NO. i./ >
ISPECIAL ~-
CONDITIONS
� m
FINAL+j / . •.; r BY a d
DATP-r `� '
bs 76A638A
CE#803(REV.11/78)
r' APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
I BUILDING
FOR APPLICANT TO FILL IN ADDRESS
BUILDING -!
ADDRESS vy LOCALITY
NEAREST b
CITY / ZIP CROSS ST.
O.OF BLDGS. ASSESSOR
SIZE OF LOT Q /'V NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE PR CESSED BY
TRACT BLOCK LOT NO. Q' CO�� ZONE "
OWNER N L' X00 '31
V
STATISTICAL CLASSIFICATION / SEWER
MAP
ADDRESS D CLASS NO. vX I DWELL.UNITS L BKS(9 PG
CITY '�AgZIP
ARCHITECT OR TEL. VALUATION
ENGINEER NO. q a S+
ADDRESS BLDG.SETBACK FROM
TE . S L. FRONT PROP.LINE OF (STREET)
CONTRACTOR N0HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
LIC. FRONT PROP.LINE HIGHWAY WIDTH
ADDRESS o NO O
LIC. + = o 0 �o O
CITY / , CLASS - BLDG.SETBACK FROM
CONSTRUCTION LENDER SIDE PROP.LINE OF / [STREET)
NAME AND BRANCH
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE EXISTING
ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH Q
u
SQ.FT NO.OF NO.OF CHECK + =
SIZ�7 STORIES FAMILIES ONE
❑ USE ZONE MAP �y `
I NO
DESCRIPTION OF WORK "Gf NEW SPECIAL or ItL�
ADD ❑ e-/ CONDITIONS y
ALTER ❑ FINAL
BY z
REPAIR ❑ DATE j
USE OF JJ DEMOL ❑
EXISTING BLDG /t� 4 /li C
APPLICANT TEL /
IPRINT) �! NO .7-
C
BY(SIGNATURE y 2 7 8 4,2 R
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP ION A D STATE Y
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDI ES bd 0a
o 0 0
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING T V
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF q 9.00
l I�
THE LABOR CODE OF THE STATE OF CALIFO N RELATING TO WORKMEN S COM- z P a o 1 T.O 0
PENSATION INSURANCE.'
d a a aSIGNATUR
PERM TTEEE OF 1. 1 9—79
ADDRESS G b
Z
TELO
CITY N0!S�Y3-
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P.C.Fee$ Permit Fee 6d0 >
Issuance Fee .60 W
F- Total Fee
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