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DEPARTMENT OF BUILDING AND SAFETY APPLICATION FORPERMIT
COUNTY OF LOS ANGELES Im
� ®�
pzmm- WM. J. FOX, CHIEF ENGINEER
" FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING DISTRICT NO. PLAN CK. NO. PERMIT NO.
ADDRESS P 6r - 4$111106
LOCALITY RECEIVED BY DATE OF APPL. DATE ISSUED
NEAREST
ICROSSST, `f It Q v 1p. d•- Cy I met BUILDING / ••��
- ,. ADDRESS
OWNER +f A �
i MAIL LOCALITY
�c
ADDRESS, NEAREST
�•.1 TEL. CROSS ST.
CITY 71 I7�ki \ NO. FIRE NO. OF I TYPE I GROUP
ARCHITECT OR TEL. ZONE PLANS \f
ENGINEER «.s��! 1lE.A..c? NO. BLDG. /�— e/ ORD. NO.
SETBACK LINE
ADDRESS •'e-. APPROVED
TEL BY DATE
CONTRACTOR• sf J NO. USE APPROVED
ZONF •r/ BY DATE
ADDRESS r HOUSE NUMBERING
AL
DESCRIPTION I LOT NO. � BLOCK MAP NUMBER FIELD CHECK BY
TRACT � � NO. ASSIGNED BY DATE
t• �° NO. OF BLDGS. .n�� CORRECTIONS
SIZE OF LOT I NOW ON LOT
USEOF I NO. OF
EXISTING BLDG. i1 i 4 1,+t1 CSM FAMILIES
DESCRIPTION OF WORK
NEW I ALTERATION I I ADDITION I
REPAIRI tt__ I DEMOLITION
SQ. FT. \ 3 �.1±� .110OF
OMS ( •--�
SIZE v.! STORIES Y
EXT.WALL (t ECROOF /��
COVERING 0 .e1,• . ' I COVERINGS ''0 AS10,.t!�, o �� r—��� r
USE OF STRUCTURE•-1
,,,Fay-• f t
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APPROVAL
INSPECTOlyS SIGNATURE DATE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION
PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALSL�
CORRECT.
I
AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRESTOPS,C/
HEREON AND WITH ALL COUNTY ORDIN4kNCES AbIp STA E BRACING, BOLTS / a-,• Y a'—
LAWS REGULATI NG CONSTRU TON
FURNACE: LOCATION,
SIGNATURE OF rr GAS VENT, DUCTS
PERMITTE moh
` LATH, INT.
ADDRESS
i LATH, EXT.
AUTHORIZED AGT.
PLASTER, INT.
76ASS",DBW 10-50 $ P. C. $
® 1 &0 FEE / PLASTER, EXT. J'J
VALUATION � `; FEE
' I
FGA638A Di9r9iAPPLICATION FOR 13U-ILDING PERMIT ],
If•BS •
DIVISION•OF BUILDING AND.SAFETY
BUILDING�S
Deportment of'County Engineer
County of Los Angeles LOCALITY
JOHN A.LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST.
FOR APPLICANT TO FILL IN D,srRlcr GRQUP TYPE SBK
MAP
j 1 1CONST.41
Ok
BUILDING 7 /la, �� �� �d�C MAP �C v STATE YES, NO
ADDRESS /[ /J' NUMBER HWY
LOT NO.'► � BLOCK USE ZONE SPECIAL
??��{{ ��•�� CONDITIONS'
TRACT\ ,4- 'J y 7 I
SIZE OF LOT 11
/(/ //I //Q fl NOW ON LOTS BUILDINGEXIST.
YARD" HWY STREET NAME
USE ��// //' SETBACK WIDTH
EX STOING,BLDG.`/6S.- e! 4^46, FPRONT I
L.
OWNER /%/¢'/�ID/{� •'�� / /I rAN/ All SIDE
MAIL
••�� Q /f/J P. L.
ADDRESS �J/i(�.� di %��1VAA /1d y� O TRACT DWELL. I UNIT
TEL. C-,4ry 5 INDUSTRIAL '
CITY •/C �•� �/TY NO.&O,O � 1 DWELL. 1 UNIT g PUBLIC BLDG.
ARCHITECT OR TEL. 2 DUPLEX 2UNITS.
ENGINEER NO. 7 ADDN..ALT.. ETC.
3 APT. UNITS 8 MISCEL.' .
ADDRESS. 4 ,COMMERCIAL
lj•,/ TEL.
CONTRACTOR NO.
a _�a � INSPECTION RECORD 'fit
• l.0/y
ADDRESS Flif�,•
DESCRIPTION OF WORK
X
L�•,�
NEW ADD /\-ALTER • REPAIR DEMOLISH
SQ.FT• NO.OF NO.OF
SIZE STORIES FkF ILIES /
USE OF STRUCTURE f
ATH R-�+� -�D/ro
SIGNATURE OF
APPLICANT AP ROVALS
ADDRESS FI'•• EkTE INSPECTOR'S SIGNATURE
ram FOUNDATION:LOCATION
O ® FEE $ FORMS,MATERIALS
FRAME: FIRE STOPS. - U
VALUATION S 7 0 � BRACING.BOLTS - // 7 �'
FEE - `- FURNACE: LOCATION.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT,DUCTS
APPLICATION AND STATE THAT THE ABOVE ,S CORRECT .
AND AGREE TO COMPLY WITH ALL COUNTY ORD\ ANCES LATH,INT.
AND STATE LAWS REGULATING BUILDINGCO UC-
TION. , LATH. EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE' RECT AND POSTED
ADDRES ,XI.r' FINAL 6 '.7�+/1,C
JOHN A.LAMBIE.COUNTY ENGINEER VA ATI-Pa CLYDE N.DIRLAM, CHIEF BLDG. INSPECTOR
CK /CA6H
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