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76A638A CE9803 8 63APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES Aon elsS U of
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY f
JOHN A LAMBIE COUNTY ENGINEER NEAREST -
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
DISTRI T NO GROUP TYPE SSED BY
FOR APPLICANT TO FILL IN CONST
BUILDING / STATISTICAL CLASSIFICATION S ER MAP
ADDRES aQ CLASS NO DWELL UNITS BK /SPG
LOT NO BLOCK _ WATER
CERTIFICATE NOT REQUIRED RECEIVED
TRACT MAP /9A
NO OF BLDGS NO (CIRCLE) STATE AJ R ECOND LOCAL
SIZE OF LOT i NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG
TEL 6T t
OWNE r NO L BUILDING EXIST
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS t)� FRONT / ,J
ARCHITECT EL P L L �6
ENGINEER O SIDE
ADDRES TEL � r `� r
CONTRACTOR NO V
ADDRESS ` O
DESCRIPTION OF WORK
IR A W
NEW ADD ALTER REPAIR DEMOLISH ,}�' t �N
SQ FT NO OF NO OF . w
SIZE STORIES FAMILIES
USE
STRUCTURE
I
SIGNATURE OF
APPLICANT
VALUATION
APPROVALS DATE INSPECTOR S SIGNATURE
P C PMT p v FOUNDATION LOCATION /\ /
FEE $�- FEE $ FORMS MATERIALS
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
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 VIOLA LATH INT
TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN S COMPENSATION INSURANCE LATH EXT " r
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE . ECT AND POSTED
ADDRESq/-(:zgvc, LN F LEWIS PRINCIPAL
PLAN CHECK VALIDATION CK M O CASH JOH PERMIT VALIDATION rRCK TURM O ENc NEER
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