HomeMy Public PortalAbout5004 AGNES AVE_Building__ ~�� 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
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LOT NO !(/K�'�" ,ZF/i6 LJ� BLOCK C WATER F7 CERTIFICATE a NOT REQUIRED RECEIVED
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CONTRACTOR NO
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DESCRIPTION OF WORKLu
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NEW ADD ALTER REPAIR ''' f , �^A����!£,J�"" �I J�j ( ��ZV
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SIGNATURE OF', -
APPLICANT + J I v
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VALUATION $
APPROVALS DATE INSPECTOR S SIGNATURE
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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
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*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
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1 6 2 3 JUL
1 Y
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