HomeMy Public PortalAbout5004 AGNES AVE_Building_0 ~�� d
76A638A CE#803263 APPLICATION FOR BUILDING PERMIT A
C OUNTY' OF LOS ANGELES BUILDING -
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING°AND SAFETY DIVISION LOCALITY _
JOHN ik*L"AMBIE COUNTY ENGINEER NEAREST z
WILLIAM A JENSEN SUP T OF BUILDING —CROSS ST ,
DISTRIC NO GROUP TYPE ESSED BY
FOR APPLICANT TO FILL IN w CONST ter,
BUILDING STATISTICAL CLASSIFICATION F WER MAP
ADDRESS S b�7' /T ��S '=- K
� -. CLASS NO DWELL UNITS L `
LOT NO !(/K�'�" ,ZF/i6 LJ� BLOCK C WATER F7 CERTIFICATE a NOT REQUIRED RECEIVED
Lo
TRACT / annn ?j MAP HIGHWAY S NO (CIRCLE) STATE MAJOR SECOND OCA
w /o x �J NOW ON G"/ r
SIZE OF LOT LOTUSE ZONE- SPECIAL
+USE OF x "� �1 CONDITIONS
EXISTINGeBLDG r E5i �wcZ
/ d TEL a
OWNER rdAeAd NO BUILDING EXIST
��--'' SETBACK YARD HWY STREET NAME WIDTH
ADDRESS eG *Yr Z�I Lc+w 4 Pel s 44- FRONT 1
ARCHITECT OR TEL P L /
ENGINEER NO SIDE s 1 1 t l
ADDRESSfiz iIca '
TEL ,� f > a� / d Oir
CONTRACTOR NO
ADDRESS
DESCRIPTION OF WORKLu
S
IV
NEW ADD ALTER REPAIR ''' f , �^A����!£,J�"" �I J�j ( ��ZV
DEMOLISH-
so WIN
FT SIZE- !�/// NO OF r NO OF a f .sr''
USE OF �� yt1�y`�r TORIES FAMILIES ` AA
STRUCTURE '41�f '� prS�^ �W' /..� s r
oo,Al
SIGNATURE OF', -
APPLICANT + J I v
t I
VALUATION $
APPROVALS DATE INSPECTOR S SIGNATURE
PC FOUNDATION LOCATION q
FEE $ _ FEE $„" �� FORMS MATERIALS,/ /f
FRAME FIRE STOPS F c
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION r v
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 VIOLAy RLATH�-INT�v�'�-�'-'
TION OF THE LABOR CODC OF THE STATE OFICALIFORNIA RELAT /�1'//' ^�
I NG TO WORKMEN 5 COMPENSATION INSURANCE �LA%H EXT T),[ ) 6 A/p-A 3
r
*SIGNATURE �r/ HOUSE NUMBER COR,
PERMITT f - v- RECT AND POSTED
ADDRESS FINAL
x PLAN CHECK VALIDATION CK MO CASH JOHN F LEWIS PRINCIPAL STR RAL ENGINEER
PERMIT VALIDATION CK M O CASH
r � y I
1 6 2 3 JUL
1 Y
r