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APPLICATION FOR. BUILDING PERMIT -
COUNTY OF LOS ANGELES BUILDING �'
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN SUPT or BUILDING CROSS ST:
DISTRICT NO. GROUPTMPE__[ ESSED BY
FOR APPLICANT TO FILL IN .� CONST. .
I
NG g7� STATISTICAL CLASS FICATION S R MAP
BUIL ESS
KA Aft LCI . �Q. BK PG
CLASS.NO. DWELL.UNITS
. BLOCK WATER NOT REQUIRED ❑ RECEIVED
CERTIFICATE:
MAP HIGHWAY
NO.OF BLDGS. N ICIRCLE) STATE MAJOR SECOND, CAL"LOT. �X /�8 NOW ON-LOT USEZONE SPECIAL
CONDITIONS
NG BLDG. TEL.a r3/� NO. `-k . BUILDING EXIST.
SETBACK YARD• HWY STREET NAME1. � WIDTH'
SS S9� 1 Gds/OLE G�� 6��• FRONT
ECT OR TEL. P.L.
EER NO. SIDE
..P.L. d
ADDRESS pp tt--II�� r.� TEL p ,INSPECTION RECORD ,� O
CONTRACTOR 4 yr GG�6F� U��� NO." 6.�I0" J� # � %,a �' � �•.F�
-ADDRESS `LIv y f/F�. Im
DESCRIPTION OF WORK
��';f � ,- °^•� 'y•"" '� G
U)
ADD ALTER REPAIR DEMOLISH Z
Q.FT. NO.OF NO.OF
IZE 1�3��� STORIES FAMIL"IES
USE OF
STRUCTURE
b11'-bl�•,I lis '�' ..`-r � - - - , .
SIGNATURE OF ,• ,}PT `
APPLICANT ,r�
VALUATION$/a���v �/d(J I Zi (�Q
APPROVALS IDATE' INSPECTOR%S SI•GWURE
D FOUNDATION:.
P.C. PMT. LOCATION
FEE $ FEE $ FORMS,MATERIALS ISI
FRAME:FIRE STOPS, c
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS4*
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE:LOCATION, '4 r „ l;•'°'��
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK ,}
AUTHORIZED.HEREBY 1 WILL NOT EMPLOY ANY PERSON-IN VIOLA. LATH.INT. ��I
TION OF THE LABOR CODE OF THE STATE OF C- IFORNIA RELAT- A,f.
ING TO WORKMENy
E ATION SU AN LATH,EXT.
SIGNATURE OF HOUSE NUMBER COR- /I r�
PERMITTE RECT AND POSTED / P ZJ
ADDRESS Zd, j ® � FINAL
'CLYDE N. DIRLAM,. RINCIPAL SIRURAL ENGINEER
PLAN CHECK VALIDATION M.O. CASA ; PERNIIT VALIDATION cK. M.O. CASH
Ll" 6 6 2 5 0 NOY '7 2 3 D 2 1.5 0,&
LAC0 7 3 1,5" NOV 2 3 1 D 4650
,76A63BA..G'E0803 1-84 APPLICATION FOR -BUILDING PERMIT
COUNTY OF LOS ANGELES BL+ILDI.Nc Z
DEPARTMENT OF COUNTY ENGINEER aDOREss
BUILDING AND SAFETY DIVISION - LOCALITY
JOHN A. LAMBIE.COUNTY ENGINEER NEAREST
COLEMAN W .1ENKINS,SUP'T.OF BUILDING- CROSS ST.
DI'STUCT. GR T-YPE. � PROCESSED BY
FOR APPLICANT T O FILL IN ���� CONST:.
BUILDING" ^ ,a i STATISTICAL ASSIFICATION' SEWER MAP •.
ADDRESS .G+�Jj. BK PG
CLASS NO'. DWELL UNITS
LOT NO. �f�/ BLOCK USE ZONE MAP
NO.
TRACT D /G SPECIAL
iA
id.,OF SLOGS.-� CONDITIONS
SIZE OF LOT �jy.-..JL}Dy� %NOW ON LOT-
USE OF f MS/fith 4�,i EXISTING BLDG. SETBACK FROM
(� EL. FRONT PROP. LINE OF (STREET) -
OWNER ES O. / � TYPE OF EXISTING SETBACKLHIGHWAY + YARD - TOTAL
ADDRESS �iS''// ( HIGHWAY I F M C. .
CITY
ARCHITECT'OR TEL. BLDG. SETBACK"FROM _
ENGINEER NO. SIDE PROP. LINE OF (STREET)
- TYPE OF EXISTING SETBACK 'HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L. a
TEL. + = 0
CONTRACTOR OV
'LI.C. CORNER CUTOFF YES NO El
ADD NO. ad
0
CITY LCLAQQ IC SEE REVERSE SIDE FOR SPECIAL APPROVALSW
DESCRIPTION OF WORK e a
9_ r 7 Z
NEW ADDI/ ALTER REPAIR DEMOLISH
SQ.FT. / -NO. OF NO. OF
SIZE �Z STORIES FAMILIES
USE OF. /
STRUCTURE
SIGNATURR OF
APPLICANT
VALUATION$ f
APPROVALS -DATE INSP FACTOR'S SIGNATUjiE
' .P..C. PMT. Qr1 FOUNDATION,LOCATION �� �(„
FEE$ - F•EE$ � S,
FORM ,.MATERIAL$ U �p
FRAME, FIRE STOPS, �-
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY :FURNACE: LOCATION -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
'9UILDI NG CONSTRUCTION: I CERTIFY THAT. IN DOING THE'WORK -
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH,INT. -
TION OF THE LABOR CQDE_OF THE STATE OF.CALIFORNIA RELAT-
ING TO WORKMEN'S GnMP SATION INSURANCE. LATH. EXT:
SIGNATURE OF HOUSE NUMBER COR-•
PERMITTEE - RE ND POSTED-
.,
ADDRESS F I NAL
JOHN F. LEWIS. PRINCIPAL' TRUCTURAL EN
- PLAN CHECK VALIDATION CK. M.D. CASH- PERMIT VALIDATION .CK. M.O. �CASH
G, —0=.2 %.M . `7. 1 D &.00" '�
®S°/BA838A
CV803(REV.'6/78)
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APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN ADBUILDING
DRESS
/ =
LDING
ADDRESS J L9s [Ck OCALITYNEAREST
CITY e e l' ZIP eFL 7 e O CROSS ST.
OF BLDGS. ASSESSOR
SIZE OF LOT ' ?iC� NOW ON LOT MAP BOOK PAGE I PARCEL
DISTRICT GROUPTYPE FIRE CESSED BY
TRACT d / zz
BLOCK / LOT NOTEL. . /� 3 CONS ZONE
Jp
OWNER Or run
STATISTICAL CLASSIFICATION SEWER MAX
ADDRESSIO 2--3 3 F,
` b6 CLASS NO.ro2r DWELL.UNITS BK PG
CITY GL r ZIP "Z 7cp
ARCHITECT OR TEL. VALUATION $
ENGINEER NO..
ADDRESS / BLDG.SETBACK FROM
TEL. FRONT PROP.LINE OF (STREET)
CONTRACTOR NO. HIGHWAY + YARD __ TOTAL SETBACK FROM TYPEOF EXISTING
LIC. FRONT PROP.LINE HIGHWAY WIDTH
ADDRESS NO.
v LIC. +
CITY CLASS
BLDG.SETBACK FROM
CONSTRUCTION LENDER
NAME AND BRANCH SIDE PROP.LINE OF (STREET)
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH O
SQ.FT. NO.OF NO.OF CHECK + = V
SIZE STORIES FAMILIES ONE O
DESCRIPTION OF WORK NEW ❑ P.C.Fee$ Permit Fee
ADD
tiZ ❑ Issuance Fee N
ISL ALTER ❑ Z
e REPAIR Total Fee
USE OF -"r�iz° DEAOL ❑
EXISTING BLDG. (/��11.7' ZO
APPLICANT TEL
(PRINT) NO.
O
BY(SIGNATURE)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES• Si
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V '
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-, / Z
PENSATION INSURANCE. s ;25827A
/'yea � �f� d
SIGNATURE OF /"�+" K. Pi1sv` # 0 0 0 0 0
PERMITTEE 2 0 0 Q Q
ADDRESS ¢¢ Z
TEL. ��Jl 0 0 o o 1 6 0 O
"ZONE
NO. G
NO.
OP7 ! O < 7,3 1 7 9
( SPECIAL �-
"� CONDITIONS
FINAL B
ATE