HomeMy WebLinkAbout755576A638A CE*803 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES
BUILDING
DEPARTMENT OF COUNTY ENGINEER
ADDRESS
BUILDING AND SAFETY DIVISION
LOCALITY X
JOHN A. LAMBIE, COUNTY ENGINEER
NEAREST
COLEMAN W. JENKINS.SUP'T.OF BUILDING
CROSS ST. 11 , J, , /'.1:
DISTRICT NO
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GROUP
TYPE.
PROOE'SSED BY
F F
FOR APPLICANT TO FILL IN
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ITCON S
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BUILDING
B L D N 0
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS j. "� '. , i:. !'., . . 1. 1
A D R S Ar/
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BK PG
CLASS NO. DWELL UNITS
LOT
LOT NO.
L N
USE ZONE MAP
NO.
RD
AT T0
C
TRACT A.5
SPECIAL
NO, OF LDGS,
CONDITIONS
FS
T_
0
I E LOT
SIZE OF LOT LOT
U S E
USE OF
EXISTING BLDG.
T N L'
EXISTING
BLDG. SETBACK PROM
-z' TEL,. :
FRONT PROP. LINE OF (STREET)
OWNER N 0",
OW NER -
TYPE OF EXISTING SETBACK HIGHWAY + YARD TOTAL
•D
HIGHWAY WIDTH FROM C.L
ADDRESS
ADDRESS
I T Y
CITY&�'j�"-ji:_)_Y'0�> Pj,4ji: Lj
ARCHITECT C H I T E C T 0 R TEL
AR C , I T E CT
BLDG. SETBACK FROM
SIDE PROP. LINE OF (STREET)
ENGINEER NO .
E NG , NEER
TYPE OF EXISTING SETBACK HIGHWAY + YARD TOTAL
E S
ADDRESS
ADDRESS
D D R
HIGHWAY WIDTH FROM C.L.
TEL.
+
CONTRACTOR NO
0 N T A 0 R
CONTRACTOR
LIC
CORNER CUTOFF YES NO
D-
R S
ADDRESS
E S
ADDRESS No
A
LIC
CITY C LASS
SEE REVERSE SIDE FOR SPECIAL APPROVALS
D E
DESCRIPTION OF WORK
�E - _
N DD
NEW ADD ALTER REPAIR DEMOLISH
W A
SQ. F NO. OF NO. OF
IZE. STORIES_FAMILIES
SIZE.
USE OF
Il �-j �,,-
STRUCTURE
_4 ie
SIGNATURE OF
APPLICANT ,
T
VALUATION$
APPROVALS DATE INSPECTOR'S SIGNATURE
P. C. PMT.FORMS,
FOUNDATION, LOCATION
FEE$ FEE $ ell
MATERIALS
FIRE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
BRACING .OLT4
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 THAT. IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA-
LATH. INT.
TION OF THE LABOR CODE: OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE;
LATH. EXT.
SIGNATURE OF
HOUSE NUMBER COR-
PE,RM ITTEE
RECT AND POSTED
ADDRESS
Fl NAL
JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION,-'"cK.M.0 CASH
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