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DIVISION OF BIIII.DIN t V AND SAFEPY B� I a LD I N
Dopae�at of Como EbBfaesr Y v v
VI/M J DF VJ`0UNT E�NOINHHR ApI.I TION
FOE APPLWJW TO M IN ABUILDING
DDRESS Slo? Z/ R
BUILDING LOCALITY f G
AODREBB A
LOCALITY eXV CROSS ST
NEAREST DISTRICT NO PLANCK On Rib.NO PERMIT NO
OWNER G _ RE 7Y DATE OF APPL DA ISSU
MAIL ,, I t I I // 1el S3
ADDRESS USE ZON NO ORTY�G. GROUT I FIRE ZONE
II TEL PLANSCITY NO Do 7AW5
ARCHITECT OR TEL ZONING -DATm
ENGINEER NO �GSO A KovmBY-
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ne No
ADDRESS SETBACK LINE,
Tm.. APPROVER DAT[
CONTRACTOR NO BT
ADDR998 e HOUSE NUMBERING
LEGAL
MAP NUMBER P-QG % NO ASSIGNED SY
DESCRIPTION I LOT NO 11112, BLOCK /�/�p�� ��p
DATE yyLyLTy�LLQLTp INSPECTOR
TRACT
SIZE OF LOT NO OF OLD"NOW ON LOT
USE OF NO OF /
G FAMILINN O
DESC MION OF WOES `
D
NEW A THRATION ADDITION ,
REPAIR DEMOLITION
BG FTNO OR
SIZE ROOMS STORIES /
MRI!INAL Ge I ROVEi11NG L) • I
OP BTRU RE
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APPHOV
INSPECTOR' SIGNATUR DATE
FOUNDATION LOCATION FORMS MATERIALS �O
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP PRAMB FIRE STOPS,
PLICATION AND STATE THAT THE INFORMATION GIVEN IB BRACING, BOLTS
CORRECT
1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION, q
AND STATE LAWS REGULATING BUILDING CONSTRUCTION GAS VENT DUCTS
SIGNATURE OF LATH INT
PERMITTER—
ADORRSS,�
PLASTER INT
AUTHORRED AOT
PLASTM MIT
HRECE NUMBER COR-
RECT AND POSTED
VALU ON re S d FINAL -3
7u " O 3 tM
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DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES BUILDING
WM. J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
/ DISTRICT Ijp. PLANCK. NO. PERMIT NO.
ADDRESS
LOCALITY RECEIVED BY OAT APPL GATE ItBUp�p
N HAREST 1 •�"i./rte /
CROSS ST. 4 IVZoA Ir BUILDING
D� ADDRESS
OWNER T
=MAIL /� LOCALITY
EBB ��TNEAREST
/` TEL, r+� CROSS ST.
CITY J NO. S,•� FIRE NO. OF L TYPE_ / GROUP I
ARCHITECT OR TEL ZONE PLANS
ENGINEER NO. BLDG. __``
SETBACK LINE y-_V
ADDRESS ��� APPROVED
TEL. BY DATE
CONTRACTOR NO. - USE APPROVED
^ ZONE BY DATE
ADDRESS ' •V /i - HOUSE NUMBERING
LEGALd
DESCRIPTION L07N ` _ BLOCK MAP NUMBEFL FIELD CHECK BY
c
TRACT _ NO. ASSIGNED BY OAT
I I
NO. OF BLDGS. - CORRECTIONS
SIZE OF LOT OW ON LOT � • / ' fl
_ USE OF j NO. OF AVO
EXISTING BLDG, // ' T PAMILIEe 0 �, D 7„ ar / `T,Q
DESCRIPTION OF WORE
NEW I I ALTERATION I ADDITION -
REPAIR I I DEMOLITION I I TR1 I u TO U
90. FT. NO. S
1 T
SIZi ROOMS STORIES / �GQ T PA�Y'✓r'd >
EXT. WALL ROOF^ r
COVERING COVERING - 1 �'�
USE
OF BTRU R
•• 'r4ref-V4 rce A'1 F 7PESt
" / N L t R '' Tie`
' � 147 rEG � ! �•. ? r r1M
aJe�/Iz' APPROVALS
INSPECTOR'S SIGNATURE DATE
i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION
PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS `7 y L yy
CORRECT.
1 AGREETO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, Q
HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTSLAWS REGULATING REGULATING BUILDING CON$KRUCTION. FURNACE: LOCATION.
SIGNATURE OF / Y' I GAG VENT, DUCTS
PERMITTE -� /
-r` LATH, INT.
ADDRESS •J
LATH, EXT.
AUTHORIZED AGT. -
PLASTER. INT.
>ewooA� Deft fo-w s P. C. E
'J rl/0� - FEE - pLASTER, EXT.
VALUATION / E —�
FEE FINAL