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APPLICATION
UIL ICI IT
COUNTY OF LOS ANGELES
ASSESSOR
DEPARTMENT OF COUNTY ENGINEER
MAP BOOK PAGE
BUILDING AND SAFETY DIVISION
BUILDING Ij
ADDRESS C �6
COLEMAN W. JENKINS, SUP•T OF BUILDING
LOCALITY `
FOR APPLICANT TO FILL IN
NEAREST
Print or t e onl
CROSS ST.
BUILDING
DISTRICT NO,
�'
GROUP
"'-ice"
TYPE
CONST._
ADDRESS
/
STATISTICAL CLASSIFICATION
LOT NO. BLOCK
1
TRACT
CLASS NO. DWELL,UNITS
NO. OF BLDGS.
USE ZONE
MAP /
NO.
SIZE OF LOT
NOW ON LOT
SPECIAL
USE OF -
CONDITIONS
EXISTING DG,
OWNER
TEL,.
NO.
-
�[®tI
ADDRESS E=� ..�.n....
y—t
CITY i J"'
ARCHITECT O
`"
TEL.
ENGINEER 9
NO.
ADDRESS
TEL.
CONTRACTOR
NO,
LIC.
ADDRESS
NO.
—_
LIC.
CITY
CLASS
CONSTRUCTION LENDER
NAME AND BRANCH
ADDRESS
SQ. FT. NO. OF
NO, OF
NEW ❑
SIZE STORIES
FAMILIES
USE OF�
CTUR
STRUCTURE � ��,
� '' 5
ADD ❑
,.� --'
_._ v
�/li
AL ER ❑
£PAIR
SIGNATURE OF
APPLICANT DEMO
VALUATION $
P.C, a—e- PMT,
FEE $ FEE $
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATION INSURANCE.'
SIGNATURE OF
PERMITTEE
ADDRESS
_ e. _T
PLAN CHECK VALIDATION CK. M.O. CASH
I
PARCEL
3� 6
PRO R�y4SED B ,
/T* ,
SEWER MAP
BK PG
FRONT PROP. LINE OF (STREET)
TYPE OF EXISTING SETBACK I HIGHWAY } YARD = TOTAL
HIGHWAY WIDTH FROM C.L.
f- _
SIDE PROP. LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL
HIGHWAY WIDTH FROM C.L. CD
} = 01- '!
CD
CORNER CUTOFF YES ❑ NO ❑ 1 w ,
'=3
SEE REVERSE SIDE FOR SPECIAL APPROVALS '!
APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION
FORMS, MATERIALS
FRAME: FIRE STOPS,
BRACING, BOLTS
FURNACE: LOCATION,
GAS VENT, DUCTS
LATH, INT.
LATH, EXT,
HOUSE NUMBER COR-
RECT AND POSTED
FINAL
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER
PERMIT VALIDATION CK. M.O. CASH