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i ' _1 APPLICATION PORE BUILDING PERMIT / r,IILJIIII
•COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS r-* Ave
BUILDING AND SAFETY DIVISION LOCALITY �e
JOHN A LAMBI E, COUNTY ENGINEER A
COLEMAN W JENKINS, SOP T OF BUILDING NEAREST 1
CROSS ST
FOR APPLICANT TO FILL IN DISTRICT NO GROUP I TYPE PROCESSED BY
PAN or a only) I 1 11
CONST
ON
FA
LDING !� r �6 A^ STATISTICAL
NO L�OWIE LL(UNITS SEWER
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E OF LOT pp NOW ON LOT / 1
USE OF
EXISTING BLDG Re 4CiIo BLDG SETBACK FROM I/ �
FRONT PROP LINE OF �,Gh/a
H d (STREET)
TEL
OWNER 44nAL NO TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL
ADDRESS HIGHWAY WIDTH` FROM C L
r f
f n .S'1' + O = 2-0CITY CAVE BLDG SETBACK FROM
ARCHITECTOR L SIDEPROP LINEOF EETI
ENGINEER NO �-
TYPE OF EXISTING SETBACK YARD = TOTAL
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CONTRACTO ( NOLIC
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ADDRESS j/I r NO .CORNER CUTOFF YES 11 NO ❑ U
LC
CITY ` CLASS 46 SEE REVERSE SIDE FOR SPECIAL APPROVALS
DESCRIPTIOtq OF WORK ti
, z
NEW ADD ALTER REPAIR DEMOLISH
SQ FT NO OF NO OF /
SIZE STORIES FAMILIES
USE OF
STRUCTURE l�V�
SIGNATURE OF
APPLICANT
VALUATION $ 0�0
APPROVALS DATEIKSPE trot 3 SIGNATURE
PC S FFIAT EES A P_ FOUNDATION LOCATION /— 1q1 / y 6144.
/ /II AM,/
FORMS MATERIALS tO// I/
FRAME FIRE STOPS 6 Y
1 HEREIY ACNNOWLCOGE THAT,1 HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE 16 CORRECT AND AGRCC TO COMPLY FURNACE LOCATION -/
WITH ALL COUNTY ORDINANCES AND STATE LAWS REG ULAT IND GAS VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK r
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAY
INC TO WORKMEN S COMPENSATION INSURANCE V
LATH EXT
SIGNATURE OF .HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED I�
ADORE45 fao F FINAL
JOHN F LEWIS PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK NO CASH _ PERMIT VALIDATION CK M D CASH
A, 11725,
76AG35A CE 9003 II ET APPLICATION FOR BUILDING PERMIT 1,
COUNTY OF LOS ANGELES BUILDINGa3
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LocpuTY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATTD GRIFFIN 9UPTOFBmtDING CR095 ST
DISTRICTNO GROUP TYPE SEWER MAP
FOR APPLICANT TO FILL IN w B
_ CONST
BUILDING
ADDRESS � A E' ?FT STATISTICAL SSI FICATION
LOTNO Gv BLOCK CLASS NO DW EgLL UNITS
MAP 2 D�V HWYSTATE YES 4 NUMBER O'er
TRACT USE ONE SPECIAL
SIZEOFLOT O / 90 , & NOW ON LOTS 'oO8 CONDITIONS
USE OF
EXISTING BLDG BUILDING YARD HWY STREET NAME EXIST
T"6Af'4 x S R T/a GJ �F SETBACK WIDTH
OWNER FRONT
MAIL P L ,
ADDRESS �^�j 'QM�y TD�
SIDE
NO P L
,ARC TEL - L/ 't INSPECTION RECORDS
ENGINEER NO
ADDRESS
CONTRACTOR H <' NOL/D 'f0d/
ADDRESS //IVA A/.I4C47 J91y 9019/j
DESCRIPTION OF WORX
NEW ADD ALTER REPAIR DEMOLISH
SO FT NO OF NO OF
SIZE / STORIES FAMILI E9
BE STRU URE
SIGNATURE APPROVALS
APPLICANT
ADDRESS �/ DATE INSPECTOR 5 5 GNATURP '
FOUNDATION LOCATION
Envi FORMS MATERIALS � wz"// ( /`A ./ T
S FEE s FRAME BRACINGR BOLTSS �yC e.. �.ol
VALUATION a[O jt S FURNACE LOCATION
FEE `� GAS VENT DUCTS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LATH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL C UNTY ORDINANCES AND -
STATE LAWS ULA ING B LDING CONSTRUCTION LATH EXT
SIGNATURE O HOUSE NUMBER COR-
PERMITTE RECT AND POSTED
ADDRESS C� FINAL
CLYDE N DIRLAM PRINCIPAL STRU URAL ENGINEER
PLAN CHECK VALIDATION CK w o u H PERMIT VALIDATION c w o CASH
L0 3'2 1 1 m JUL 2 5 1 A g,5 p v m,
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