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79AG38A cr#80]- 1-61 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 OF BUILDING CROSS ST.
DISTRICT N G P TYPE / PR BY
FOR APPLICANT TO FILL IN CONST.
BUILDING / �[T STATISTICAL CLASSIFICATION S KR MAP
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ADDRESS [�/�m�-�I N t?"I, meacz T(.. a �
CLASS. NO. DWELL.UNITS —
LOTNO. (� BLOCK WATER NOT REQUIRE RECEIVED
CERTIFICATE:
TRACT MAP /� HIGHWAY
TATE MAJ
NO.OF BLDG
S NO. L/ (CIRCLE) OR SECOND, LOCAL
SIZE OF LOT �x/�s NOW ON LOT 2 h Lo- USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG.
�^ J TEL. �/
OWNER NO. �" BOIL INC EXIST.
SE'�BACK YARD HWY STREET NAME WIDTH
ADDRESS S FRONT _
ARCHITECT OR > TEL. P. L. p6j _
ENGINEER NO. FIDE
P.L.
ADDRESS
CONTRAC R NEL' _ , INSPECTION RECORD 0
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ADDRESS p:
DESCRIPTION F WORg ---- O
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NE ADD ALTER REPAIR DEMOLISH C
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Q.FT. pp NO.OF NO.OF Z
$IZE �/ 40 STORIES FAMILIES
USE OF
STRUCTURE •Qy" ��If�.�_
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SIGNATU51
APPLICAN
VALUATION YAZI
APPROVALS DATE INSPECTOR'S SIGNATURE
FEE $.�( FEE $ '� FOUNDATION: LOCATION
FORMS,MATERIALS
FRAME: FIRE STOPS, f
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ERACING, BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- („ATH, INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKM 'S COMPENSATION INSURANCE.
LATH,EXT.
SIGNATURE O HOUSE NUMBER COR:__._ -
PERMITTEE RECT AND POSTED
ADDRESS i�77
FINAL
/ ' CLYDE N. DIRLA , PR CIPAL STIR?
RAL ENGINEER
PLAN CHECK VALIDATION ( Cllr/ M.O. CASH PERMIT V ATION cK M.O. CASH
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6p'fi}¢A'CM 0903 4/70
FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY 9
FOR APPLICANT TO FILL IN NEAREST
Print or tvoe onl CROSS ST. /
DISTRICT NQ. I GRO60 ITYPE I/ PR D BY
BUILDING � D CONST. V
ADDRESS _ _ `' , V
LOT NO. L BLOCK STATISTICAL CLASSIFICATION SEWER MAP
CLASS NO, DWELL,UNITS BKE7 PG /
TRACTUSE ZONE MAP /�
NO.OF BLDGS. NO. �/D
SIZE OF LOT NOW ON LOT p SPECIAL
USE OF � !f CONDITIONS
EXISTING BLDG, _
OWNER i I ^ / NOL'1p/- BLDG.SETBACK FROM
ADDRESS .6 c
FRONT PROP.LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
CITY HIGHWAY WIDTH FROM C.L.
ARCHITECT OR VL TEL. � + _
ENGINEER NO.
BLDGS BACK FROM
ADDRESS SIDE PROP.LINE OF (STREET)
TEL. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
CONTRACTOR /-A C 2 Z HIGHWAY WIDTH FROM C.L.
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ADDRESS LI { = C
LIC.
V
CITY CLASS CORNER CUTOFF YES ❑ NO ❑
CONSTRUCTION LENDER c
NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS I`L'
CL
ADDRESS - Z
SQ. FT. NO. OF NO. OF NEW
SIZE STORIES FAMILIES
AO
USE OF D
STRUCTURE ALTER ❑
SIGNATUR REPAIR ,
APPLICAN DEMOpie r L ❑ �� 3 g
VALUATION 5 � A PROVA LS DATE INSPECTOR'S SIGNATURE
C. PMT. .� FOUNDATION: LOCATION
F E S FEE$ ,5 FORMS, MATERIALS
FRAME: FIRE STOPS,
I
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS
STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT.
LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO
WORKMEN'S COMPENS TION INSURANCE. LATH, EXT,
SIGNATURE O ? HOUSE NUMBER COR-
PERMITTEE _ RECT AND POSTED
ADDRESS r �E • 1� FINAL lob
y JOHN F. LEWIS. P NCIPAL STRUCTURAL ENCA.
R
PLAN CHECK VALIDATION CK. M.O. CASH /- PERMIT VALIDATION CK. M.O.
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