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76A638A CE#8032-63 APPLICATION FOR BUILDING PERMIT . �-
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRES$ . `3.6
,BUILDING AND SAFETY DIVISION L:OCALIr
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST '
WILLIAM A.JENSEN.SUPT OF BUILDING CROSS ST.
DISTR T N GRO TYPE =CD BY
FOR APPLICANT TO FILL IN CONsr.
BUILDING STATISTICAL•CLASSIFICATION SEWER MAP
ADDRESS � � CLASS.•NO.�WDWELL.UNITS K
LOTT CERTIFICATE:BLOCK WATER NOT REQUIRED RECEIVED&SX ❑
•
TRACT MAP HIGHWAY STATE MAJOR'SECON ,LOCAL
NO.OF BLDGSIZE OF LOT NOW ON LOTS l NO. �J Q (CIRCLE)
USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG.
I TEL
OWNER 1 NO...-871 BUILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS FRONT
ARCHITEC .�� TE P. L.
ENGINEER NO. SIpE >'
P. L. a'
ADDRESS ftu LL TEL y O
7 1
CONTRACTOR NO. / 1��• I
1 O
ADDRESS I
W
DESCRIPTION OF WORK
i H
NEW ADD ALTER REPAIR i DEMOLISH
• L
SQ.FT. NO.OF
SIZE STORIES FA ILIES
USE OF a
M Ala
STRUCTURE
SIGNATURE
APPLICANT
VALUATION $ IdLd
APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION: LOCATION
FEE FEE $ 400 FORMS, MATERIALS AFRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS t,7
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 H REBY WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. f
TION OF THE B DE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORK 'S PENSATIO INSURAN LATH.EXT. , ,y
SIGNATURE HOUSE NUMBER COR.
PERMITTEE RECT AND POSTED _-
ADDRESS FINAL .f� %t 1"5�_,_,
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGI R
PLAN CHECK VALIDATION CK. M.G. CASH _ -PERMIT VALIDATION CK. M.O. CASH
'� _ U - 9 6 5%a JUL29 1 D 4.0 ON
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`�EMPL CRIT
re,l.,.,(ahos.I-el APPLICATION FOR BUILDING
PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS 5 Z 3 4 Ro«c- At
BUILDING AND SAFETY DMSION LOCALITY , l
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST //��
WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. L7' v Qj
DISTR�NO RO P O BY
FOR APPLICANT TO FILL IN TYPE S`j coNs
BUILDING �J STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS S5 3b A . ICfl[u L Al N A BK PG
CLASS.NO.4&2Z_DWELL.UNITS-
7
LOT NO.7 S /=D '� lV i g/ 9 BLOCK WATER
CERTIFICATE: NOT REQUIRED RECEIVED
TRACT MAP HIGHWAY
NO.OF BLDGS. NO. 2 7 (CIRCLE) STATE MAJOR SECOND LOCAL
SIZE OF LOT 1 pp-A'j 7b f' I NOW ON LOT USE Z NE SPECIAL
USE OF i'a X[rB n�� CONDITIONS Z -
EXISTING BLDG.qC L/r[2GF4� !'4AF09rf S[ 41 y
OWNER FIRST /3 /' TEL.
AasT[1Tc.M4 K&CAX NO. BUILDING EXIST.
YARD HWY STREET NAME
SETBACK WIDTH
ADDRESS 6-1[SG /sl. o W c ssNn f w FRONT $.4pc-Oau•M 7 r
ARCHITECT OR TEL. P.L.
ENGINEER NO. SIDE T V�/ooi� uvF bo
P.L. [o >-
ADDRESS CL
TEL. INSPECTION RECORD p
CONTRACTO NO. U
ADDRESS O
D SCRIPTION OF WORK W
• o.
NEW ADD ALT REPAIR DEMOLISH h
Z
SQ.FT. D NO.OF
IZE /,0170 STORIES FAMILIES
USE OF
STRUCTURIE /,t T$i►pT_
S[/No ✓t Gift r I1�Mnt.s
SIGNATURE OF
APPLICANT
VALUATION$ 3 b O
APPROVALS DATE INSPECTOR'S SIGNATURE
rte, FOUNDATION:LOCATION
F E $ r FEE $ FORMS,MATERIALS
FRAME:FIRE STOPS,
1 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 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.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING 70 WORKMEN'�...ANCE. LATH.EXT.
SIGNATUREOF `� HOUSE NUMBER COR-
PERMITTEE �' - ! RECT AND POSTED
ADDRESS t:r2 c/e A/i �n w+ syCri•�-r FINAL
r CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERNIIT VALIDATION CK, M.O. CASH
13 1 D6.00--
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