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APPLICATION FOR BUILDING PERMIT 0
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING f
ADDRESS
COLEMAN W. JENKINS, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST _
Print or tyDe only) CROSS ST.
BUILDING - DIST_RICT NO GROUP GROUP TYPE PROCESSED BY
CONST.
ADDRESS 1 - - -
STATISTICAL CLASSIFICATION SEWER MAP
LOT NO. BLOCK -Z r J
CLASS NO. '", . DWELL.UNITS ` BK PG
TRACT .. - USE ZONE MAP r
NO.OF SLOGS. -. NO.
SIZE OF LOT NOW ON LOT SPECIAL
USE OF ? CONDITIONS
EXISTING BLDG.
OWNER TEL. ,
NO. BLDG.SETBACK FROM
ADDRESS i. FRONT PROP,LINE OF (STREET)
TYPE OF EXISTING.SETBACK HIGHWAY } YARD = TOTAL
CITY HIGHWAY WIDTH 1 OM C.L.
ARCHITECT OR TEL. } _
ENGINEER NO.
BLDG.SETBACK FROM }
ADDRESS SIDE PROP.LINE OF (STREET) a
C
TEL...., TYPE OF EXISTING1 SETBACK HIGHWAY YARD = TOTAL
CONTRACTOR _ NO. HIGHWAY WIDTH FROM C.L. Lr.
ADDRESS No t = �'-
LIC.
CITY CLASS ` CORNER CUTOFF YES ❑ NO ❑
CONSTRUCTION LENDER C
NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS
LL
ADDRESS r
SQ. FT, NO. OF NO. OF NEW ❑
SIZE STORIES FAMILIES El
OF ADD
STRUCTURE
ALTER ❑
SIGNATURE OF REPAIR❑
;APPLICANT DEMOL.�
VALUATION $ APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. t NDATION: LOCATION
FEE $ FEE $ —' ORMS, MATERIALS
ME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIORACN , BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLNACE: LOCATION,
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT.
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATION INSURANCE, LATH, EXT,
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE _ RECT AND POSTED
ADDRESS FINAL
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
3