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TeAnaeA CEnaDR 8-63APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENG24M ADDRESS gS8
BUIMING AND SAFETY DIVISION LOCALITY T-4- K L'
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST ��<
DISTRICT NO GROUP TYPE P ESSE BY
FOR APPLICANT TO FILL IN 3- p �/ CID I/ ,
BUILDING O ( / ,✓O STATISTICAL CLASSIFICATION SEWER bAAp.
ADDRESS I J CLASS NO DWELL UNITS i'
r � � /
LOT NO ��' Iq 6OKhf WATER NOT REQUIRED RECEIVED
CERTIFICATE
TRACT MAP '^ HIGHWAx
NO OF BLDGS NO �+ (CIRCLE) STATE MAJOR SECOND LOCAL
SIZE OF LOT 70NOW ON LOT USE ZONE SPECIAL
USE OF �/ CONDITIONS �/—
E%(STING BLDG 1
TEL
OWNER /COJN NO U>4G BUILDING EXIST
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS S f✓(/ FRONT
ARCHITECT OR TEL P L
ENGINEER -- NO SIDE
P L
ADDRESS
TEL 0
CONTRACTOR NO U
ADDRESS
DESCRIPTION OF WORK
6
ADD ALTER REPAIR DEMOLISH N
so FT NO OF NO OF
SIZE GA o STORIES FAMILIES
USEOF I,
STRUCTURE le O '
SIGNATURE OF
APPLICANT
VALUATION $ 3 IV D
APPROVALS DATE INePECTo s61c
PC PMT
FOUNDATION LOCATION 0
/
FEE $ FEE $ �� FORMS MATERIALS
CO
FRAME FIRE STOPS ,�pp
1 HEREBY THAT
THE
IS 1 HAVE READ THIS APPLICATION BRACING BQLTI
AND BALL THAT THE ORDINANCES
IS CORRECT AND AGREE E LATING FURNACE LOCATION
WITH ALL COUNTY TION 3NCER ANO HAAT[ LAWS REGULATING WORK GAS VENT DUCTS ------
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORN
TION
THE
HEREBY I WILL NOT EMPLOY ANY CALIFORNIA IN VIOLA
TION OF TH[ LABOR CODE OF ITHEON STATE OF ALIFOREI-AT _
INO TO WORKMEN B COMPENSATION INSURANCE "ASH EM
SIGNATURE HOUSE NUMBER COR O MFJ
PERMITT RECT AND POSTED I
ADDRESS FINAL
PLAN CHECK VALIDATION CK w o CASH JOHN F LEWIS PRINCIPAL ST RAL ENGINEER
PERMIT VALIDATION cK No CASH
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T9.B=.1 DE NEO]=B] APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS I
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY'ENGINEER /
NEAREST
WILLIAM A JENBEN BUR T of BUILDING CROSS ST '
DIS T NO GROUP TYPE P SSED BY
FOR APPLICANT TO FILL IN coNfir
BUILDING // r � ) STATISTICAL CLASSIFICATION SE ER MAP
ADDRESS 7 V /[� — •t/OK G
CLASS NO DW ELL'UNITS
LOT NO 64� WATER
CERTIFICATE NOT REQUIRED RECEIVED
TRACT MAP HIGHWAY
NO OF BLOG6 NO 1-7 ICIRCLE) STATE MAJOR SECON L CAL
SIZE OF LOT 2 ' j.pO NOW ON LOT Ilcc TINE PE IAL
USE OFJL?17 J7-� TIONS
EXISTING BLDG TELR/
OWNER //.(/ NO Q 2/ BUILDING / I EXIST
SETBACK YARD HWY TREET AME WIDTH
ADDRESS A-11J I FRONT
ARCHITECT _ TEL P L
ENGINEER � NOf SIDE
P L n d
ADDRESS ;ia2 �(// O
TEL (J
CONTRACTOR — NO - Y
• 7 1•
ADDRESS O
DESCRIPTION OF WORK
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w
ADD ALTER REPAIR DEMOLISH � Z
SO FT NO OF NO OF
SIZE STORIES ILIES
USE }j
STRUCTURE W.E
1 ale
C
SIGNATURE OF
APPLICANT
VALUATIONS U L/
APP&OVAL D TE N*FRcTpR BSI n
Q FOUNDATION LOCATION
FE E PMT FEES �IV FORNIS MATERIALS
FE
FRAME FIRE STOPS
I HER EIY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS
499
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 WILL NOT EMPLOY ANY THAT IN DOING THE WORK 3C
AUTHORIZED HEREBY I NEPERSON IN VIOLA LATH INT
TION OF THE LABOR COpE OF THE STATE OF CALIFORNIA RELAY
ING TO WORKMEN 6 COMIAENSATION INSURANCE LATH EXT a.
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE RECT AND POSTED V L/Y
ADDRESS FINAL D wo(
PIAN CHECK VALIDATION MG CASH JOHN F LEWIS PRINCIPAL ST BHCT6IRAL ENGINEER
PERMIT VALIDATION(/ CK MO CASH
LI+Lo 7 8 0 6 APR 17 2 3 0 2 1 .5 0 A
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DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES BUILDING
• WM. J. FOX. OHIEr ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILD ' T w DIHTRIOT NO. PLAN Cr- NO P/[,RMrr No.
♦\I!1 � / �F (0 415
LOCALITY OM'\Q-y RQ IVSD BY DAT[ Or ADPLr OATS 19MLO
NEAREST • . , L5 — (. - J - LF l.D
BUILDING
OWNER �. W • —O e W a e,s c ADDRESSMAIL
ADDRESS J FZ NO• 14 kAx Dye /f I,u LOCALITY t
(� L//, o NEAREST
CITY ) O TOL //"• O O CROSS GT V tic
fP
ON NO Or TYP[/a GROUP
AROHIT[OT O TEL ZONE � I PLANS .\/Y P
ENBIN[ER NC
BLOB ORD. NO
DR SETBACK LINE
APPROVED
TEL BY DAT[
CONTRACTOR NO
USEn APPROVED
ADDRESS ZONQ/"�'-/ SY DAT[
LEGAL
DESCRIPTION LOT NO /5) BLOCK CORRECTIONS
TRACT 9, 57, S� — — 1 u
1
elzE or Lor ' How oN oT& c 2 f. r
URE or I NO or I NO Or
.
EXISTING OLDS r" ." ROOMS �• '
DESCRIPTION OF WORK �,, d ae, 30 _y7 /E✓a•F s
NEW ALTERATION ADDITION ' 1
0
A
REPAIR I MOVING DENOLISH O_
Bq !"r NO Or -
BIZ[ ROOMS STORIES
WALL ROOT A f
COVERING Y���AL(,6 COVERING As. S k
USE Or NEW
BUILDING`` �}'\
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT rOUNOATION LOCATION. INSPECTOR DAT[
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS
AND STAT[ LAWS REGULATING BUILDING CONSTRUCTION
FRAME FIR[ STOPS.
SIGNATOR[ Or
BRACING. BOLTS AP7 4
^ �1
OWNER �' LATH. INT
AUTHORIZED AST-U -•oA.TI/-1/yR=J\1Ja LATH. aT 1
P o s PLASTER. IMT.
VALUATION l rE[ PLASTER. [X .
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