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76A638ACE=8032-63 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS �- ,
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. [,
DIST CT O. GROUP TYPE CESSED BY
FOR APPLICANT TO FILL IN a CONST. e>L��
BUILDING /'^" STATISTICAL CLASSIFICATION EWER MAP "``
ADDRESS J BK PG
CLASS. NO. DWELL.UNITS
-,d
LOT NO. BLOCK WATER NOT REQUIRED a RECEIVED E]
CERTIFICATE:
TRACTMAP q HIGHwnY STATE MAJOR SECOND, OCAL
NO.OF BLDGS. NO. -�/ ICIRCLE)
SIZE OF LOTJ7Z NOW ON LOT USE ZONE SPECIAL '
USE OF ^ CONDITIONS
ETE
XISTING BLDG. C/►t`J
/
OWNERlwla�_ N BUILDING EXIST.
SETBACK YARD HWY ST ET NAME WIDTH
ADDRES FRONT
ARCHITECT OR TEL. P. L.
ENGINEER NO. SIDE
P. L.
ADDRESS C'
TEL.
CONTRACTO NO.
ADDRESS Q
DESCRIPTION OF WORK '// u
w
EW ADD ALTER REPAIR DEMOLISH
. FT. NO.OF NO. OF ✓ '� t"f "'� r
SIZE �dSTORIES FAMILIES -�
USE OF ` '
STRUCTURE (^/
SIGNATURE OF
APPLICANT Ole of
VALUAT104rS 5r�I
APPROVALS AT INSPECT 'S SIG E
P.C. Cti PMT. FOUNDATION: LOCATION
FEE S ��"' FEE S FORMS, MATERIALS G
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. 1 CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR CODE OF E STATE OF CALIFORNIA RELAT•
ING TO WORKMEN'S COMPE I INSURANCE.
LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL • 'R" ': -..y,-
JOHN F. LEWIS. PRINCIPAL STRU URAL ENGIN R
PLAN CHECK VALIDATION cK. M.O. CASH _ PERMIT VALIDATION M.O. CASH
L/«0 7 7 6 11 AiR 16 ti 3 D n15 .0 I
8 1 5 7 r",VR ?'7 I D 6 4.0 ON