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APPLICATION FOR BUILDI G PERMIT
COUNTY OF LOS ANGELES ABUILDING
DDRESS /sem 3 Syr r
DEPARTMENT OF COUNTY ENGINEER ��
BUILDING AND SAFETY DIVISION LOCALITY � ' .VG. , ,a
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST I
WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST.
FOR APPLICANT TO FILL JIN DISTRICT(JNO. G P TYP PRO SSED BY
61 CONS
BUILDING J STATISTICAL CLASSIFICATION a SEWER MAP
A �QR�EySS �O 3 }� CLASS.NO.�DWELL.UNITS U BK
L TAOL CK // NUMBER HWYMAP . YES NO
TRACT y y v USE ZONE SPECIAL
SIZE OF LOT. S' ,( � r I NO.OF BLDGS. J - CONDITIONS
NOW ON LOT I
USE OF
EXISTING BLDG. )�Re-,s4/VT- BUILDING YARD HWY STREET NAME EXIST.
TEL./ SETBACK WI TH y
OWNER �31I/ /�/jjV +JUS(y/V NO.l7I _73 TD FRONT
P.L. SCJ U
ADDRESS 61A.? /y SIDE
ARCHITECT OR TEL. P.L.
ENGINEER NO. INSPECTION RECORD
ADDRESS c 4.
CONTRACTOR -5 NO. O
ADDRESS
O
DESCRIPTION OF WORK ri
W
- a
NEW ADD ALTER REPAIR 1QEMOLISH N
SO.FT. NO.OF uoO eF� ?
SIZE STORIES FAMILIES
USE OF
STRUCTURE
SIGNATURE OF�`9J
1�
APPLICANT J/ 1 rin► w /L�'�
VALUATIONS I
APPROVALS DATE INSPECTOR'S SIGNATURE
FEE $ I FEMT.E $ �� FOUNDATION:LOCATION
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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION. I CERTIFY THAT IN THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I SHALL NOT LATH,INT. '
EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBUECT
TO THE WORKMEN'S COMPENSATION LAWS OF CALIFORNIA. '
LATH,EXT. -
5GNATURE OF /� HOUSE NUMBER COR- /
RMITTE ��� RECT AND POSTED
PE
ADDRESS—A5 3-"—' J IV S FINAL A"
CLYDE N. DIRLAM, P INCIPAL STR RAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK M.D. cast+
�j 7 0 7 6Z' ;-inY 15 1 0 2.00
8A896A Ci 1180&9D6U APPLICATION FOR' E§UIL®I G PERMIT
COUNTY OF LOS ANGELES BUILDING
ADDRESS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY &mpz4w d., -Y-
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. �vlv 6 &.7V
{1DIST$jCT N GROUP TYPE PR CF'.S B
FOR APPLICANT TO FILL INp I,CONST.
BUILDING /� �/ ` "SCLAISS�NO.CLASSIFICATION SEWER
I' SEWER MAP
ADDRESS (p /v If
LOT NO. LOCK H MAP_, STATE YES O'
NUMBERS
60 HWY.
` 'USE ZONE
TRACT i,11 SPECIA
NO.OF LDGS. i~ CONDITIO P.
SIZE OF LOT I NOW ON LOT : r
,i•i
USE OF POW
'
EXISTING BLDG. B ILti1NG' EXI
TEL YARD STREET NAME
''// 'SET.BACK WIDTH
OWNER VIP 1/ Yi4N f7CJSI f4 NO.( rZ:72. ,OTIS 1 /
{F.CL.. , _g D.
ADDRESS G 3.,;-'rN SAA-7&A- A Ae- SDE.
ARCHITECT IN
`•P�.L•
ENGINEER $ NO �� INSPECTION RECORDCL
ADDRESS S S`k!,W !MGr.NO 0 '
S, TEL 1�� �/ i r/ .�% ![7. S i .� /7`-J..�o.�-._ u
CONTRACTOR "�
ADDRESS
3�3t/V
� :'�• r• }�..� s_
DESCMPTION OF WORg
NW ADD. ''(.ALTER REPAIR DEMOLISA, a L
SO.FT. NO.OF ) NO.OF �19 _
SIZE d STORIES ). FAMILIES,.`'l'
USE OF � ) 4 it ./L9 l " t f A pZHy"E h 1.
STRUCTURE
SIGNATURE O J ��� �`�• �! _
APPLICANT^-�
VALUATION$ �� �. 1. ,'._��•. -._
APPROVALS PATE 1NSPECr R'S SIGNATURE
FOUNDATION:LOCATION ,J
FEE $ FEE $ � s�v 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.
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT
BUILDING CONSTRUCTION. I CERTIFY THAT IN THE PERFORMANCE
OF THE WORK FOR WHICH TIUS PERMIT IS ISSUED I SHALL NOT LATH,INT. n /f �A!/ 'J•//Hf'/! '
EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBUECT
TO THE WORKMEN'S COMPENSATION LAWS OF CALIFORNIA. ,
LATH,EXT.
SIGNATURE OF HOUSE NUMBER COR.
PRECT AND POSTED
PERMITTEE.- {
ADDRES la Zr N S11_ FINAL k y
CLYDE N. DIRLAM. PRINCIPAL STR URAL ENGINEER
PLAN CHECK VALIDATION cK M.O. CASH PERMIT VALIDATIONCK , M.o. CASH
7 p 7 :o ; tlY '� Jr 1 D 4.8 .G '"