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COUNTY OF LOS ANGELES BUILD NG
DEPARTI�VT OF COUNTY ENGINEER ADDaesB
RUEMING AND SAFETY DIVISION LOCALITY Ji
JOHN A LAMBIE.COUNTY ENGINEER NEAREST
G86ATT D GRIFFIN SUF T OF BUILDING CROSS ST
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FOR APPLICANT TO IN Z CONST
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ADDRESS
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C ASe NO HLL NIT
LOT NO MAP STATH
NUMBER HWy YES NO
TRACT USEZONE SPECIAL
NO OF BL' CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
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DES ON OF WORK
NEW ADD ALTER REPAIR � DEMOLISH
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SIGNATURE OF APPROVALS
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ADDRESS FOUNDATION LOCATION
S ^ FORMS MATERIALS
L� P C S FRAME FIRESTOPS,
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VALUATIO 1 �� 6 FURNACE LOCATION
FEE OAS VENT DUCTS
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH INT•
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE XLATING BUILDING CONSTRUCTION LATH EXT
SIGNATURE OFHOUSE NUMBER COR-
PERMITTE \ RECTANDPOSTED -S
ADDRESS FlNA
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11
C YDEN DIRLM PRINCIPAL ST RAL ENGINEER
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7aAG38A CEABOS S-64APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST /
COLEMAN W JENKINSAUP T OF BUILDING CROSS ST
Dlj�lC N OUP TYPE P BY
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FOR APPLICANT TO FILL IN _ CONST
BUILDING T e1 STATISTIC C ASSIFICATION SE ER MAP
All M CLASS NO DWELL UNITS BK PG- D
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SIZE OF LOT MOW ON LOT
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CITY 0 } _
ARCHITECT OR TEL RLDD SE TRAtx IAOM xle
ENGINEER NO [IDE PROP LIN[ 01 (STREET)
TYPE OF lKl[TINR [[TRACK XISXWAY } YARD = TOTAL
ADDRESS HISMWAY IWIDTH I FROM C L Y
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CONTRACTOR NO V
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ADDRESS NO CORNER CUTOFF YES NO O
IL SEE REVERSE SIDE FOR SPECIAL APPROVALS
DESCRIPTION OF WORK H
Z
NEW ADO REPAIR DEMOLISH
SO FT NO OF NO OP
SIZE STORIES FAMILIES
USE OF
STRUCTURE
O O
SIGNATURE OF
APPLICANT
VALUATION$ Qa� APPROVALS DATE INSPECTOR'S SIGNATURE
P C PMET FOU DATON F ORMSI ON `��-
FEE$ FE $ MATERIALS
FRAME, PIKE STOPS. / ;
I NEREE ACKNOWLEDGE THAT I CORRECT
HEAD THIS APPLICATION BRACING BOLT
AND GALL TNAT THE
DIVA 15 CORRECT AND AWS E EATING FURNACE LOCATION
WITH ALL COUNTY ORDINANCE] AND STATE LAWN REGULATING UT IND 0A9 VENT DUCTS
SUILDINO CONSTRUCTION CERTIFY THAT IN DOING THE WORK /
AUTHORIZED HERESY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR CODC OF THE STAT[ OF CALIFORNIA RELAY
IND TO WORKMEN a COMPENSATION INSURANCE LATH EXT T-1
SIGNATURE OF h /� / AA HOUSE NUMBER COR- I ` -
PERMITTEE r /~ 40,4..-_iAl[{ RE N POS v
ADDRESS 92� F C /017dOYlZ ! FI NAL
JOHN
PLAN CHECK VALIDATION CK M D CASH PERM VALIDATION rRClruRM o N CASH R
LLo9 3 6 6�- MAR 9 1 D 6.00~
APPLICATION FOR BUILDING PERMIT (�
FOR APPLICANT TO FILL IN (P„De 0. +Yoe oDIY)
BUILDING G JLW COUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
CITY ~�C , ZIPBUILDING AND SAFETY DIVISION
NO OF BLD BUILDING
SIZE OF LOT NOW ON LOTADDRESS cI
TRACT BLOCK LOLOCALITYTNEARESTOWNER � y NROSS STASSESSORADDRESS MAP BOOK PAGE PARCEL
DISTRICT GROUPTYPE FIRE ESSED BY
CITY LE El/ ZIPCONurr ZONE
ARCHITECT OR TE '`''"�/TNGINEER NSTATISTICAL UFLCATION SEWS MAP
ADDRESS CLASS NO WELL UNITS 8� P�CONTRACTOR 0% TE'40USE ZONE ^/U/ADDRESS NSPECIAL
CITY LIONDIIONS
C COAD OE PARTMENT APPROVAL REQUIRED YES❑ NOCONSTRUCTION LENDERNAME AND BRANCH LOC SETBACK FROM
RONT PROP LINEOFADDRESS CITY SO FT NO OF NO OFHIGHW YARD o TOTAL SETBACK FROM TYPEOFEXISTING IDz
FRONT PROP LINE
512E STORIES FAMILIES ONE _ _ O
+ _
DESCRIPTION OF WORK IV NEW
D-1 d
�' LE� 4 pOBLDPROP L NEOFSETBACK OM (STREET) Z
ALTERAY + YARD TOTAL SETBACK ROM TYPE OF EXISTING
REPAIR[-] SIDE PROP LI HIGHWAY WIDTH
USE OF + '
EXISTING BLDG EMO
APPLICANT TELCORNER CUTOFF YES ❑ NO ❑
(PRI NTI ND
BY (SIGNATUREI PEN SPACE YES ❑ NO
OASTAL ZONE YES ❑ NO I]
VALUATIONS CATEGORICAL EXEMPTION YES[] NO ❑
I HERESY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLICAR ONM[NTAL
AND
STAT[ THAT THE ABOVE IS CORRECT AND AGREE TO COMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING IMPACT REPORT PROCE98E0 (DATE)
BT RUCTION ICEA TI FYTHAT IN DOING THE WORK AUTHORHEREBY I WILL NOT EMPLOY ANY PERSON IN VIATOFLASOR COD[ 0! TX! !T T[ OF 44;
ELATIN
WORKMEN a COMPSNSATI I UA SIGNATURE OF
PERMITTEADDRESS
TEL �Q (NAL BY
CITY G NO �p DAPMT
TEt
tI 1hE C HL! h Y i1.1 tl1.L 10 FEE 5 FEE b
HARVEY T BRANDT. COUNTY ENGINEER G.J\
PLAN CHECK VALIDATION cK M, CASH / $RMIT VALIDATION cH ' .,o CAB.
1 l�
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TanaaeA cEReDD 12/72 _