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• DEPARTMENT ENGINEERBUILDING
DIVISION OF BUILDING
AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER " !!
CASSATT D. GRIFFIN, SUPT OF SUIL ��APPLICATION➢INO 5-5 '/
F?2 8aj,4C4ETO FILL IN FOR OFFICE USE ONLY
DISTRICT NO. PUN CK.OR R[C.No. PERMIT NO.
BUILDING it 7 r `
ADDRESS N L.
LOCALITY
RECEIVED SY DATE OF APPL. DAT[ISSU[D
I I
NEAREST .`,V --J r
CROB9 BT. BUILDIN
OWNER c)n r V S p v r • ADDRESS
MAIL4. LOCALITY
ADDRESS NEAREST
CITY NEL ` r / CROSS ST. IY2
ARCHITECTOR TEL .i /I FIR[ NO.OF GROUP
ENGINEER NO. 7 IJ ZONE
ADDRE r BLDG. Q
BLDG. LIN[
TEL. USE _ PPROVED 5J F
CONTRACTOR NO. ZONE BY -/.: .ERIN DATE
-"� HOUSE NUMBERING
ADDRESS
n
LEGAL MAP NUMBER NO. ASSIGNED BY
DESCRIPTION I LOT NO. BLOCK
- CORRECTIONS
TRACT
SIZE OF LOTNO. OF BLDG9.
NOW ON LOT _
USE OF - NO. OF
EXISTING BLDG. FAMILIES L C
- DESCRIPTION OF WORK B 1 / r Li PCE o -
NEW ALTERATION ADDITION T.�s — crvcr-� t'/- £ •N F'Y�oB
REPAIR DEMOLITION
r.
$O. FT. NO. OF
SIZE ROOMS Z4 STORIES '
EXT. WALL ROOF
COVERING Mao I COVERING(CO"RING (2AI to
_
USE U TUBE ) I / , ---
APPROVALS
INSPECTOR'S SIGNATURE DATE
FOUNDATION: LOCATION
FORMS. MATERIALS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRESTOP9.
PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS
CORRECT.
I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION. C 3
AND STATE LAWS REGULATING BUILDING CON TRUCTION. GAB VENT. DUCTS !O
SIGNATURE OF �/ J' ��� QD�7 ; ���/ - LATH. INT. Y
PERMITTE ///�TT, LATH. EXT.
ADDRESS �J544w '�
PLASTER. INT.
AUTHORIZED AGT.
PLASTER, EXT. <y /
S - J P. C. 1 j
FEE HOUB[NUMBER COR-
` y RECT AND POSTED
VALUATION FE!
76A"8A OROS FBI
16A63HAF,<.RG3 K Ti4PPLICATION FOR BUILDING PERMI�
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COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING
STAKE CHECKS PAYABLE TO: ADDRESS
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN NEAREST
riot orf onl CROSS ST.
BUILDING /.�r DISTRjCOT NQ G P CONST. PRO 5 �bY
ITYPE
ADDRESS 1 S ✓y
r .7 STATISTICAL ,CS I FICA TI ON SEWER MAP
LOT NO. (�-y(/ -��OCK // q�
CLASS NO.C� DWELL.UNITS_ SK(T PG/iJ
TRACT USE ZONE MAP O
NO.OF BLDGS. (� NO. /41
SIZE OF LOTVIA NOW ON OT /Y SPECIAL
USE OF '1 CONDITIONS
EXISTING LDG.
,/I E.
OWNER - N OL-w. BLDG.SETBACK FROM
ADDRESS !342 A M L FIR NTPROP.LINEOF )STREET)
TYPE OF E%I STING SETBACK HIGHWAY + YARD = TOTAL
CITY `�' ` J �� HIGHWAY WIDTH FROM C.L.
ARCHITECT OR TEL. + _
ENGINEER NOiv ov .
BLDG.SETBACK FR
ADDRESS SIDE PROP.LINE OF (STREET) V
TEL. TYPE OF E%)STING SETBACK HIGHWA YARD = TOTAL C
CONTRACTOR NO. HIGHWAY WIDTH FROM C.L. Co
IV LIC. + = W
ADDRESS NO. d
LIC. Z
CITY CLASS CORNER CUTOFF YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL AP PRO ALS
ADDRESS ju
SO. FT.6ZV NO. OF NO. OF NEW 1:1
SIZE STORIES FAMILIES -
USE OF ADD •L RL
STRUCTURE
ALTER ❑ QL
SIGNATURE O EPAIR❑ 12-12-
APPLICANT DEMOL ❑
VALUATIONS iPPR0,VAI S DATE IxsP[ TDR's swxAroRe
P.C. PMT. FOUNDATION: LOCATION
FEE S FEE S �6. O FORMS, MATERIALS
FRAME: FIRE STOPS,
HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION BRACING BOLT$ p
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL ORDINANCES AND LAWS REGULATING, BUILDING CON- GAS VENT, DUCTS rl
STRUC TION. CERTIFY THAT IN 001 XG THE RK AUTHORIZED
HEREBY I WILL NOT PLOY Y PER N IN 10LATION OF THE T
LABOR CODE OF T ST F C ANI IN RELATING TO LATH, INT.
WORKMEN'S CO N .TIO 1 RAH
LATH, EXT,
SIGNATURE HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS_. f Al biI I FINAL
PLAN CHECK VALIDATION CN. N.D. CASH _ PERMIT VALIDATION cK. N.o. CASH
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