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96A03M CC#110&1-61 APPLICATION DING FOR I P RMIT LI
BUILDING E
COUNTY OF LOS ANGELES~ BUILDING
DEPARTMENT OF COUNTY ENGREM ADDRESS
BUILDING AND SAFETY DMSION LOCALITY kf
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST ( �
WILLIAM A.JENSEN SUPT or BUILDING CROSS ST.
FOR APPLICANT TO FILL IN DISTRICT N GRA_ TYPE P J SED BY
CONST.
BUILDING STATISTICAL CLASSIFICATION BE ER MAP
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ADDRESS L' CLASS.NO.�DWELL.UNITS / J
LOT NO. G •°-^BLOCK WATER " NOT REQUIRED ❑ RECEIVED
CERTIFICATE:
TRACT' rP 0.MAP 4 G 3 HIGHWAY
STATE OR JECOND, LOCAL dal
NO.OFSIZE OF LOT (at K �� I NOW ON LOTS US'e ZONE SPECIAL ?
USE OF CONDITIONS (J 110
EXISTING BLDG. 7—
OWNER
OWNER LAA O. BUILDING' YARD HWY BEET NAM EXIST.
SETBACK WIDTH
ADDRESS FRONT
ARCHITECT OR TEL. P.L.
ENGINEER NO. SIDE
P.L. }
ADDRESS; CL
TEL. INSPECTION RECORD O
CONTRACTOR wmaw.- NO. V
ADDRESS
DESCRIPTION OF WORK
cif/)�J :-•-�.:�i�C .Gll I' '�.�� � n.
NEW ADD ALTER REPAIR DEMOLISH / cf / Q/[/� j //yy�
NO.OF NO.OF � `' 6.�''I_._"�i4L�� /:"" � VI�/� al-`GO' Z
IZE STORIES FAMILIES
SUSE 01
TRUCTURE rj L Ci
4(00
SIGNATURE OF /
APPLICANT
VALUATION$ 13-1 6a
Q APPROVALS / DATEINSPEJCTJ(R'S%SIGNATURE
� FOUNDATION: N.'
FFORMSMATERIALS
I/II�ih/10 f� ✓�/:/l
FRAME:FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT 1 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 CONSTEBY I 1 CERTIFY THAT IN DOING THE WORK LATH,INT.
AUTHORIZED HEREBY I 1 L NOT EMPLOY ANY PERSON IN VIOLA- Y p✓J J /
TION OF THE LABOR D OF THE ST OF CALIFORNIA RELAT- LATH,EXT. ��171�/�'•J �� //�.�� �
ING TO WORKMEN'S ENSATION 1 RA E.
SIGNATURE O d"IHOUSE NUMBER COR-
PERMITTE RECT AND POSTED I. �ry
ADDRESS FINAL {/"
CLYDE N. DIRLAM, PRINCIPALS RAL ENGI EER
PLAN CHECg V A c M.D( CABH PERNIIT VALIDATION r cK. � M.O. CASH
::1• 3 9 5 2 � i,°l; ? D G 6.7 5-$ �.� .
Ll iv0 , .
LACO 5 4 4 2 IMAY 31 1 D 53.50--
COUNTY OF LOS ANGELES
APPLICATION FOR DEPARTMENT OF COUNTY ENGINEER
z BUILDING PERMIT BUILDING AND SAFETY DIVISION
BUILDING
QRE
R APPLICANT TO FILL IN ADDRESS
--�
I'2 o LOCALITY
,L Ip NEARESTlCROSS ST.i NO OF BLDGS. ASSESSOR
NO ON LOT MAP BOOK PAGE PARCEISTRICT GRO4�P TYPE FIRE C S D BY
LOCK LOT NO. crO / ) E
�eTEL fC•Vaf� p Z ate' 3 NO, STATISTICAL CLASSIFICATION
C—AWER
ADDRESS `� ) CLASS NO. NN ^^10DWELL.UNITS G BA PG
CITY ZIP USE ZONE MAP NO. A Q a3
ARCHITECT OR TEL. SPECIAL
ENGINEER NO. CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑
CONTRACTOR JI&I
T L. -1 BLDG.SETBACK FROM
f/✓ LI tl FRONT PROP.LINE OF (STREET)
ADDRESS' Q i` NO. a`, HIGHWAY + YARD TOTAL SETBACK F M H HIGHWAY EW WIDTH
LIC. FRONT PROP. E
CITY ` CLASS _
CONSTRUCTION LENDER +
NAME AND BRANCH Y(! BLDG.SETBACK FROM Q
ADDRESS CITY SIDEPROP....LINEOF (STREET) v
SQ. FT. NO. OF NO. OF CHECK HIGHWAY _+'r YARD = TolryL SETBACK FROM TYPE OF EXISTING a
SIZE STORIES FAMILIES ONE I IDE PROP. LINE HIGHWAY WIDTH
DESCRIPTION OF WORK �J° NEW ❑ +
19` ADD CORNER CUTOFF YES ❑ NO
��`� � El ALTER ❑ ❑
REPAIR❑ IN OPEN SPACE YES ❑ NO ❑
USE OF IN COASTAL PERMIT Z E YES NO ❑
EXISTING BLDG. j (� .( DEMOL ❑
APPLICANT TEL
(PRINT) ro Lv
BY (SIGNATURE) /✓ ��:� v`
1 HEREBY ACKNOWLEDGE AT I HAVE READ THIS APPLICATION '
AND STATE THAT THE ABO IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE •'�
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO \+ •, A3
WORKMEN'S COMPENSATION INSURANCjE.
SIGNATURE OFA 6 FINAL // 7� BY
PERMITTEE G• DATE
ADDRESS j tM
IL
CITY
coNO.
�� � y✓ P.C.Fee$ Permit Fee
Issuance Fee
VALUATION$ IV
tal Fe
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDTvONCK. M.O. CASH
7 .6 4ccZJON 2 1 ® 1 ?..0 0 ®b8
76AG38A C6#8038 22/73