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APPLICATION FOR BUILDING PECJRMI: j
=� COUNTY OF �OS ANGELES �
,L BUILDINGt; 111q ,
DEPARTMENT OF COUNTY ENGINEER ADDRESS I0 '2-3'2- v VQ
BUILDING AND SAFETY-DIVISION LOCALITY' __I �/Le �;`
JOHN A. LA MBI E, COUNTY.ENGINEER
COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST
CROSS ST. , C-1 '//
cc- 6/
FOR APPLICANT T0:FILL IN DISTRICT NO. GROUP TYPE PROCESSED BY
(Print or type.ori.ly) .O �' ' CONS r` P�e
BUILDING STATISTICAL CLASSIFICATION SEWER MAP�/�////
ADDRESS p2 OLI v CLASS NO_. � DWELL.UNITS BK P194
LOT NO. UgLE ZONE MAP /,
NO. V
TRACT � SPECIAL
NO.OF BLOGS. O CONDITIONS
/
SIZE OF LOT NOW ON LOT
USE OF I
EXISTING BLDG. ��� D /1! C BLDG.SETBACK FROM
TEL. FRONT PROP.LINE OF O/ / y (STREET)
OWNER
N'O. TYPE OF. EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS Q,2,3a IF er. j9L/v ,E, /HIGHWAY WIDTH FROM G.L.
CITY r �li� I�L7" LO(_. ed! +
ARCHITEC R TEL: BLDG.SETBACK FROM
ENGINEE 'NO. SIDE PROP.LINE OF (STREIET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS _eS J9LF_X ,V/Q'� vll HIGHWAY WIDTH FROM C.L.
TEL. t�b_ � + - a
CONTRACTO
p 11/�/& OL.S NO, ( YC3 p
LCPLICANT
000F ,_Vt r16 NO CORNER CUTOFF YES ❑ NO CO
/amu I/- CLASS G'S3 SEE REVERSE SIDE FOR SPECIAL APPROVALS In
DESCRIPTION OF WORK 6 y
G e G�• O G z
ADD ALTER REPAIR DEMOLISH
NO. OF NO. OF
STORIES FAMILIES
URE
ol
RE OF ID
NT
ION S O
APPROVALS AT IN PE TOR'S SI TU RE
2SO PMT. �� FOUNDATION: LOCATION
/✓b� FEE S ?/Zy FORMS, MATERIALS MM
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL COUNTY DINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS
BUILDING CONSTRU TI I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HERES 1 ILL.NOT EMPLOY ANY PERSON IN'VIOLA- LATH, INT.
TION OF THE LABOR O E OF T E OF CALIFORNIA RELAT-
ING TO WORKMEN'S EN I RANCE.
LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITT A4 RECT AND POSTED
ADDRESS FINAL
JOHN F. LEWIS. PRI CIPAL ST 7cK—
AL ENGINEER
PLAN CHECK VALIDATION CK M.o. CASH _ PERMIT VALIDATION M.O. CASH
888."o ITIY 923 D 1 .3.
L Arr'9 a 8 9•c' MAY 9 il"I D 2 2.5 QN v
. �2��zz-�/ •
APPLICATION FOR BUILDING PERMIT
F100 APPLICANT TO FI LL I N (Print or type only)
B DING 2 COUNTY OF LOS ANGELES
ADDRESS ll903 oZ 01r U tf-I DEPARTMENT OF COUNTY ENGINEER
CITYe IP 17
BUILDING ND SAFETY DIVISION
NO.OF BLDGS. BUILDING '
SIZE OF LOT 5 NOW ON LOT ADDRESS I a J
TRACT/0 6 BLOCK LOT NO. LOCALITY IG,
` TEL. NEAREST
OWNER O. ..3� CROSSST. Ar
ASSESSOR
ADDRESS /(J' c MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE I FIRE CESSED BY
CITY / C " ZIP ! � CONST ZONE.
ARCHITECT OR TEL. •
ENGINEER O. t
STATISTICAL CLASSIFICATION SEWER P
ADDRESS CLASS NO. C L-DWELL.UNITS �/`]//B� G
CONTRACTOR „ O. USE ZONE NOP
LIC.
ADDRESS NO. SPECIAL
�J LIC. CONDITIONS
CITY (� �D�- CLASS ROAD SNARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDE
NAME AND BRANCH J leach LDG.SETBACK FROM
RONT PROP.LINE OF (STREET)
ADDRESS �z CITY , TOTAL SETBACK FROM TYPE OF EXISTING
SQ.FT. NO.OF NO.OF CHECK IGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH
SIZE U STORIES FAMILIES ONECL
}
DESCRIPTION OF WORK NEW ❑ + O
ADD BLDG.SAtAQEROM cz
SIDE PROP.LINE (STREET) O
ALTER ❑ ETBACK FROM TYPE OF EXISTING w
HIGHWAY + YARD = SID LINE HIGHWAY WIDTH N
USE OF REPAIR ❑ Z
EXISTING BLDG.Ace DEMOL ❑ +
APPLICAN TEL CORNER CUTOFF YES ❑ NO
IPRINT) fZ ,qNO.� .,
� IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATOR
Q@ IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION p d
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE -
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-
PENSATION IN NCE.
SIGNATURE O
PERMITTEE
ADDRESS ]
TEL. DATEL .! BY
CITY NO.
MME CHECKS PAY E TO: FEE $ FET $ '
HARVEY T.BRANDT,COUNTY ENGINEER l/ ✓
PLAN CHECK VALIDATIONC '
K. M.O. CASH PERMIT VALIDATION CK, M.O. CASH
`� 0 6 1 SEP 3 1 D 11625A%
2 1 6"jUL •2.3 2 3 0 69.75
®s 76A63BACE#8033.75'
' I
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR MIT
COUNTY OF LOS ANGELES m U i OG
WM. J. FOX, CHIEF ENGINEER �1
;F7O1RAPPLICANT TO FILL IN FOR OFFICE USE ONLY
DISTRI NO. PLAN C P. PERMIT NO,
rILOCALITY
DING / } ,y 7
RESS �T ^•� �i - 1 r Ji " �, ! 6
EIV DBY DATE OF APPL. DATE ISSUED
AREST
CROSS ST. r' 4'j -�;� -`J BUILDING
r p ADDRESS
, OWNER C � ,� •i �� '' � O�
• MAIL ®� t7 LOCALITY
ADDRESS 16
y /y� pp NEAREST /� I
* CITY � �IP` ie),-r)/
'� NO. V CROSS ST. �eL�
FIRE NO. OFI TY I GP
ARCHITECT OR TEL. ZONE PLANS
ENGINEER NO. BLDG.
'
q
SETBACK LINE 3,10
ADDRESS APPROVED
L
r }� p TELBY DATE
L
CONTRACTOR L L A AID NO.. O7-7,32/ I ZONE BY DATE DATE
ADDRESS 112-3 'A J-67 M P, A It 6,12HOUSE NUMBERING
1 LEGAL
DESCRIPTION I LOT NO. BLOCK .5 MAP NUMBER :2co/ Io FIELD CHECK BY
TRACT ® ® NO. ASSIGNED BYDATF'
NO. OF BLDGS. CORRECTIONS
SIZE OF LOT FOX •3 I e NOW ON LOT
a° EX STING BLDG, ����Ri Gds!� I FAMILOIE9
h
DESCRIPTION OF WORK t
NEW I I ALTERATION I I ADDITION
0
REPAIR I I DEMOLITION I I I Z
3 SQ. FT. NO. OF 0
SIZE ROOMS STORIES i Z
EXT. WALL h ROOF BVI g f p �ra/q� r
COVERING ()Q C,1 S B�6 `d��'COVERIH
USE OF STR CTURS,
S ®d AA JD �'6
.1
APPROVALS
INSPECTOR'S SIGNATURE DATE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- . FOUNDATION: LOCATION
PLICATION AND STATE THAT THE INFORMATION GIVEN IS ' FORMS, MATERIALS
CORRECT.
I AGREE TO COMPLY WITH THE CORRECT ONS LISTED FRAME: FIRE STOPS, �� Z
HEREON AND WITH ALL CONN ORDINAIJCES�AND ST TE ' BRACING, BOLTS L
LAWS REGULATING ILDINGSTRUC f0 FURNACE: LOCATION,
SIGNATURE OF GAS VENT, DUCTS
PERMITTE `'rah=%¢'
- r LATH, INT.
ADDRESS �'
LATH, EXT. +I ,'.e) 1g-4
AUTHORIZED AGT. LIZ
t n
PLASTER, INT.
1 76ABSBA• 0052 W-00 .$ P. C. S
(p) O� FEE PLASTER, EXT.
VALUATION
1 �� FEE S 7 FINAL L 'T+y•>, �' ��•
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