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76A538A CE#803 5-65 APPLICATION FOR BUILDING PERMIT LJ
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY r
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS,SUP'T OF BUILDING CROSS ST. ce
DIS ICT NO. GRO TYPE/00 , PROCESSED BY
FADDR
APPLICANT TO FILL IN c coNsr.
STATISTICAL C ASSIFICATION SEWER MAP /
P'ff . CLASS NO.. DWELL UNITS BKPG/Z
f�� / BLOCKy��( USE ZONE MAP G/
TRACT /..i.�-%Q� 6c �j d SPECIAL
CONDITIONS �J
NO. OF SLOGS.
SIZE OF LOT NOW ON LOT
USE OF
EXIS INC DG. BLDG. SETBACK FROM AO iHyi�
L. FRONT PROP. LINE OF `C/ (STREET)
OWNE TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FR OM C.L.
CITY j +
ARCHITEC " EL. BLDG. SETBACK FROM
ENGINEER O, SIDE PROP. LINE OF - (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
COIC O
AD
r/.t� CORNER CUTOFF YES NO U
CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS O
DESCRIPTION OF WORK u
.- P.
NEW ADD ALTERREPAIR DEMOLISH h
j� r ✓
SQ.FT. NO. OF NO. OF
SIZE • STORIES FAMILIES
USE OF K
STRUCTURE
G
SIGNATURE OF ' "'
APPLICANT i
i
s42-
VALUATION$ r� pppROVALS DATE INSP OR'S SIGNAT,RE
FOUNDATION, LOCATION
FEE
P.C. PMT.$ FEE$ FORMS, MATERIALS
�.d
FRAME, FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTIJ
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
9UILDI NG CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK
AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S cnMPENSATION INSURANCE. LATH. EXT.
SIGNATURE OFSte.
PERMITTEE HOUSE NUMBER COR-
RECT AND POSTED f
ADDRESS F I NAL P— " �f ✓, �.
JOHN F. LEWIS. PRINCIPALSPCK.
RAL ENGINEER
PLAN CHECK VALIDATION . CK. M.G. CASH _ PERMIT VALIDATIONM.O CASH
LALo3 0 7 4% JUN27� 2 1 D 3.75NAU0 3 0 7 5 JUN 2 7 1 DX 5.0 0