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7GA638A CE#803 2-63APPLICATION FOR BUILDING PERMIT•''�
COUNTY OF LOS ANGELES BUILDINGADDRESS .l3 L
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY' DIVISION LOCALITY T
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN, SUPT OF BUILDING CROSS ST.
DISTRI T GROUP TYPE OCES D BY
FOR APPLICANT TO FILL IN - coNsT.'�
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BUILDING ,� STATISTICAL CLASSIFICATION EWER MAP
ADDRESS J` %Z-x �� BK p
CLASS. NO. DWELL.UNITS
LOT NO. .� , BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE:
TRACT MAPHIGHWAY STATE MAJOR SECOND, A
NO. BLDGS. NO. (CIRCLE>
SIZE OF LOT NOW ON LOT USE zONESPECIAL
USE OF j. •CONDITIONS
EXISTING BLDG. Tl
• EL.
OWNER • SETBACK WIDTH
NO. B I ING YARD HWY STREET NAME EXIST.
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ADDRESS FRONT f... J t�
ARCHITECT OR TEL. P. L. ZI _
ENGINEER NO. SIDE
ADDRESS P. L. O.
TEL. 1 A Q
CONTRACTOR NO .S' .� ••'
ADDRESS s+3 O G er
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a. 0
DESCRIPTION OF WORK
N
NEW ADD ALTER REPAIR DEMOLISH _ Z
FT. NO.OF 'NO. OF
SIZE STORIES. FAMILIES .
USE OF
STRUCTURE �'f ,•
SIGNATURE OF
APPLICANT
VALUATION $
�J APPROVALS JDACE INSPECTOR'S SIGNf1TllRE-
P.C. PMT. FOUNDATION: LOCATION G1 / } p
FEE $" ��� FEE $ -- FORMS, MATERIALS CJ If'f ;'!�. j/ti•r'r.+
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS !J /
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYFURNACE: LOCATION.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS ,{,�'
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK '
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE. •a a,S ~- '°"'�+�`A`yw�s"' v f/:{
LATH,EXT. 71S/
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED e7 f AAI •ff p
ADDR ss FINAL j lwpL'v F
JOHN F. LEWIS. PRINCIPAL ST CT AL ENGINEER
PLAN CHECK VALIDATION CK, M.D.. CASH _ PERMIT VALIDATION I CK. , M.O. CASH
;76A636A CEIJB03 B-64 APPLICATION BUILDIrGRFPERMIT
COUNTY OF LOS ANGELES BUILDING _ s_ C-
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DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE'. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS,SUP'T.oF BUILDING CROSS ST.
DISTRI T- N G TYPP SSED BY
FOR APPLICANT TO FILL IN CONST
BUILDING STATISTICAL LASSIFICATION' SE ER MAP
ADDRESS , J CLASS NO. ELL UNITS BK/1' PG'
LOT NO. , B/LOCK USE ZONE MAP j�`/ U
h NO. C��' f�JO
TRACT C/IP SPECIAL
�) N0. OF SLOGS. CONDITIONS
SIZE OF LOT 15 NOW ON LOT
USE OF
EXISTING EILDG. /� BLDG. SETBACK FROM (:
TF,L. FRONT PROP. LINE OF (STREET)
OWNER aA- ANO. "'s0 TYPE OF EXISTING' SE_T_BACK HIGHWAY 'F YARD = •TOTAL
ADDRESS i �f HIGHWAY WIDTHFROM C.L.
+
CITY r- BLDG. SETBACK FROM -
ARCHITEC OR TEL. SIDE PROP. LINE OF (STREET)
ENGINEER NO.
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L. a
TEL. -} = O
CONTRACTOR NO u
114 LIC.
ADDRESSA NO. CORNER CUTOFF YES El NO 0
L/ LIC
CITY CL SEE REVERSE SIDE FOR SPECIAL APPROVALS v
• W
DESCRIRTIOI� OF WORK y
Z
NEW I ADD ALTER REPAIR DEMOLISH
SQ.FT. NO. OF NO. OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE
-
SIGNATURE OF
APPLICANT c
VALUATION$
-v APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION, LOCATION /�'� f•�
FEE$ FEE$ - FORMS,_:MATERIALS_
FRAME, FIRE STOPS,' `1
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 1
BUILDING CONSTRUCTION. 1 CERTIFY THAT. IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. I
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE. LATH. EXT.
SIGNATURE CF/ e-
HOUSE NUMBER COR
PERMITTEE �' RECT AND'POSTE ' w is
ADDRESS T- Fl NAL
JOHN F. LEWIS. PRI CIFAL STRUCTURAL ENG R
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CABH
Lh'Go 3 3 3 6 JUL 6 - 1. 0 4.0