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79A688A CE#809. 1-61 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ADDRESS -� • /Zic%,
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY e
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST I /
WILLIAM A. JENSEN SUF'T OF BUILDING CROSS ST. /
DISTRICT,NO. /GROAJP'
r, TYPE -�� P ES/�`r-ED�I7B
FOR APPLICANT TO FILL IN ,-5 o o-- / CONST. 4� (C7 6
BUILDING STATISTICAL CLASSIFICATION I S WER MAP
ADDRESS' dG� Imo- K G -1
CLASS._NO.10-DWELL.UNITS /� G
LOT NO BLOCK WATER-CERTIFICATE:
ATERCERTIFICATE: NOT REQUIRED ❑ RECEIVED
MAP
TRACT yy NO.OF BLDGS. NO. 0Hc�iRc EI STATE MAJOR SECON LOCAL
SIZE OF LOT.) / J� �j 13 I NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG.
OWNER Ci W�DC�b` TEL.
eV& � NO, BUILDING EXIST.
YARD HWY STREET NAME
/� 9 SETBACK WIDTH-
ADDRESS,5"{ zi__-T-e_' $j> '- I SSP � FRONT
ARCHITECT OR 7grEL. P. L. `-
ENGINEER NO. SIDE
P.L.
ADDRESS
�pTEL.
INSPPEEJCTION RECORD O
CONTRACTOR .�//1 ./ISA D NO.
ADDRESS
DESCRIPTION OF WORK w
0.
NEW ADD ALTER REPAIR DEMOLISH I Z
SQ.FT. - NO.OF �r
IZE STORIES FAMILIES
USE OF
STRUCTURE
SIGNATURE OF
APPLICANT - l��
VALUATION ��} l' �3J u
APPROVALS DATE INSPECTOR'S°SIGNATURE
F E $ FEE $ rl f1 FOUNDATION:FORMSMATERIIALSON
FRAME: FIRE STOPS.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS / ¢'
AND STATE THAT THE ABOVE 15 CORRECTAND AGREE TO COMPLY FURNACE: LOCATION. / I
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 I v1oLA- LATH,INT.
TION OF THE LABOR CODE OF THE STATE OF CAL OR A RELAT-
ING TO WORKMEN'S COMP NSAT N IN CE LATH,EXT.
SIGNATURE OF ' HOUSE NUMBERCOR-
PERMITTEE / RECT AND POSTED ► It
ADDRESS J FINAL
CLYDE N. DIRT AM, RINCIPAL S� -K_
R RAL ENGINEER
PLAN CHECK VALIDATION cK, M.o. cwsH PERMIT VALIDATION 7
M.D. CASH
LA o4 0 0 4 JAN 3 1 D 4.00- �'