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APPLICATION FOR BUILDING PERMIT 1
DIVISION OF BUILDING AND SAFETY BUILDING _ p��,Z Lc I�✓ooLG
Department of County Engineer ADDRESS 7
County of Los Angeles LOCALITY T C
WM.J. FOX, COUNTY ENGINEER NEAREST
CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST.
DISTRICT NO. GR� ,rrPE i I SEWER MAP
FOR APPLICANT TO FILL IN Jr-"" BK PG
/ r ` CONST
ADDREBUILDSS 9l 1? /_ woo/. MAP ''11 P! STATE YES NO
r NUMBER i�V HWY
LOT NO. -�/�F /STT GFG BLOCK USE 'E SPECIAL �e ^� A407
CONDITIONS ,j
TRACT
NO. OF BLDGS. EXIST.
SIZE OF LOT J� I NOW ON LOT SETBACK gU1LDING YARD HWY STREET NAME WIDTH
USEOF FRONT ^'
EXISTING BLDG. P. L. DiAF
OWNER SIDE
P. L.
MAIL
ADDRESS O TRACT DWELL. I UNIT
5 INDUSTRIAL
TEL. DWELL. I UNIT
CITY NO. 6 PUBLIC BLDG.
ARCHITECT OR TEL. 2 DUPLEX I UNIT 7 ADDN., ALT.. ETC.
ENGINEER ----NO. 8 APT. UNITS L07 Z
- 8 MISCEL. _
ADDRESS 4 COMMERCIAL All (}��LE
TEL. INSPECTION RECORD
CONTRACTOR NO.
ADDRESS
DESCRIPTION OF WORT{
NEW ADD ALTER REPAIR DEMOLISH I:
SO, FT. NO. OF f NO. OF - l
SIZE ` STORIES FAMILIES / �.
/
USE OF STRUCTURE ` —
SIGNATURE OF _ -
APPLICANT .49 APPROVALS
DATE INSPECTOR'S SIGNATURE
ADDRESS
$ FOUNDATION: LOCATION
FEE $ / FORMS. MATERIALS `
,L/ FRAME: FIRE STOPS,
� N ' _ BRACING, BOLTS
VA NATIO�e�tl FEE $ FURNACE: LOCATION,7 - y
I
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS —GAS VENT, DUCTS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT f
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT.
AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION' /- LATH, EXT. Z- -
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE _RECT AND POSTED
ADDRESS_____—_
_ _ __ FINAL
WM.J. FOX, COUNTY ENGINEER VALIDATION C. N. DIRLAM, CHIEF BLDG. INSPECTOR
,o 1 3 4 7 tS DEC 30 1 6 1 4.0 0 kjo 1 5 0 Cu JAN A 1 30-00 +�
C REV.11/76)
APPLICATI N FB U ILD G PERMIT
COUNTY OF LOS ANGELES . BUILDING AND SAFETY
FOR APPLICANT TO FILL IN A�oeess Q B�
BUILDING �—
ADDRESS XJ LOCALITY
NEAREST /✓
CITY � ZIP CROSS ST. -
NO.OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK_ PAGE • PARCEL
DISTRICT I GROUP ITYPE FIRE PR ESSED BY `
TRACT BLOCK LOT NO.. O
TEL.
OWNER NO.
��f STATISTICAL CLASSIFICATION EWER MAP
ADDRESS /�/ _ CLASS NO DWELL.UNITS B
CITY 3 P
ARCHITECT OR TEL. VALUATION c,V
ENGINEER NO.'-
ADDRESS BLDG..SETBACK FROM
TEL. FRONT PROP.LINEOF (STREET)
CONTRACTOR NO. TOTAL SETBACK ROM TYPE OF EXISTING.
LIC. HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH
ADDRE55� NO. �s _
LIC. -- +
CITY CLASS
CON TRUCTIO LENDE BLDG.SETBACK FROM
NAME AND BRANCH SIDE PROP.LINE OF (STREET)
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH. ,Q
SQ.FT. NO.OF NO.OF CHECK + = V
SIZE STORIES FAMILIES ONE 0
E ZO�E MAP O'
DESCRIPTION OF WORK NEW ❑ � f
.. ECIilT d
ADD DITIO�N7S y�
• ��L �6LTiJ REPAIR ❑ALTER DATEL� ` ��O Q BY �"� Z
USE OF C�
EXISTING BLDG. DEMOL ❑ C
APPLICANT TEL
(PRINT) • NO.yyy�C;� �3 C
BY(SIGNATURE '
I H Y ACKN LEDGE THA HAVE READ THIS APPLICATION AND STATE
THAT T E ABOV CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES f�
AND LA R TING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE i=J -
WORK A (ZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM• _ Z _
PENSATION INSURANCE.' g cs-77 9.u P
IL
SIGNATURE OF `# 0 0,0 0 0 1
PERMITTEE _
ADDRESSC� Z 2 1 X7i•C l;
TEL. O 7 0 0 1 / i,0 Cit
clrr NO' 1 5-•7 S
/�Q)
P.C.Fee$ Permit F1ee `� >
Issuance Fee �f�/ Y W
Total Fee