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16A638A CE#803162 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS 3,S f _- i y�)
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN,SUPT OF BUILDING CROSS ST.
DISTRICT NO, . G 1315 TYPE PR C ED BY
FOR APPLICANT TO FILL IN ,tom" CONST. -
BUILDING 1 STATISTICAL CLASSIFICATION S L ER MAP
ADDRESS . (�,[_ S ��61te!.
BK
CLASS. NO. DWELL.UNITS
LOT NO. / BLOCK WATER
CERTIFICATE: NOT REQUIRED---RECEIVEDEl
TRACT D MAP 1 HIGHWAY ��J�
NO.OF BLDGS. % NO. (CIRCLE) STATE MAJOR SECON CILOCAL n
SIZE OF LOT �--� /J W
L. NOON LOT USE 701 E SPECIAL -
USE OF I CONDITIONS i
EXISTING BLDG. ` t-�--/ Jf � �_ Y
"
TEL L' f�f �. '� C'_ -rVG'".r
OWNER ONO. BUILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS J.,.." �.L ��( �, FRONT
ARCHITECT OR TEL. P. L.
ENGINEER NO. SIDE
F. L.
ADDRESS a
O
TEL. V
CONTRACTOR C_ N
ADDRESS/6"3/ 6-'ot"ec A z
DESCRIPTION OF WORK W
CL
H
(NEW ADD ALTER REPAIR DEMOLISH Z
SQ.FT. NO. OF NO. OF /
SIZE C' - STORIES FAMILIES
USE OF
STRUCTURE
SIGNATURE OF ��_�` .�
APPLICANT
VALUATION $ --��
APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION
P.C. '- __ PMT. FORMS, MATERIALS
FEE FEE $
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS
BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY ],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 INSANCE. LATH, EXT.
SIGNATURE HOUSE NUMBER COR- _ -
PERM ITTEE /�a ! CAND POSTED
ADDRESS I , -• - FINAL - . _
_ 3 JOHN F. LEWIS, PRINCIPAL ST R URAL ENGINEER
PLAN CHECK VALIDATIONO.. M.O. CASH _ PERMIT;VALIDATION CK. M.O. CASH