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76A898A CE#pp 80910 L8 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ADD BUILDING
ISS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY C�O►a LC t
JOHN A LAMBIE COUNTY ENGINEER y NEAREST
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST
DISTRICT NO GROUP TYPE P SSED BY
FOR APPLICANT TO FILL IN CONST
BUILDING STATISTICAL CLASSIFICATION I SE KR MAP
ADDRESS _ 1T CLASS NO WELL UNITS
LOT NO C BLOCK EMAP STATE YES O
NUMBER HWY
TRACT USE ZONE SPECIAL '
r� NO OF BLDGS / CONDITIONS
,SIZE OF LOT' e� I NOW ON LOT `
USE OF
EXISTING BLDG BUILDINGYARD HWY "a STREET NAME EXIST
.� SETBACK _ WIDTH
OWNER FRONT
MAILADDRESS 49',51 W I A) H Ll(?,-' SIDE
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CITY _ No INSPECTION RECORD y
ARCHITECT OR TEL
ENGINEER NO
ADDRESS L r a,*:r
CONTRACTOR 11-303 P,Q P NO 4021I
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ADDRESS `
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DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH c
SQ FT �-NO OF NO OF r '
SIZE (�0 1" I STORIES FAMILIES
USE OF
STRUCTURE54 C !
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15,c e—,.4
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SIGNATURE OF '-
APPLICANT APPROVALS DATE INSPECTOR S SIGNATURE
ADDRESS ' FOUNDATION LOCATION 4
FORMS MATERIALS
VALUATION$ FRAME FIRESTOPS r
l L�� q �J BRACING BOLTS
FEE $/,3 [ .I FEE $}G�/ al FURNACE
VENT DUCTS LOCATION
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LATH INT + i
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULdTINGNG CONSTRUCTION LATH EXT r V
SIGNATURE OF HOUSE NUMBER COR I V a
PERMITTE &V J RECT AND POSTED
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ADDRESS FINAL r
M o CASH CLYDE N DIRLAM PRINCIPAL STRC /MAO ENGINEER N
PLAN CHECK VALIDATION PERMIT VALIDATION (/ _
? 6 ,4 3 A ' -13.5 Q 1
._ 2 ? ? 2 SEP 172700 A 2700