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76A639A CE#0039.119 APPLICATION FOR BUILDING PERMIT 1
COUNTY OF LOS ANGELES BUILDING [)
DEPARTMENT OF COUNTY ENGINEER ADDRESS
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BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D. GRIFFIN SUPT OF BUILDING CROSS ST.
DISTRICT NO. GROUP TYPE, PRgc ESSED BY
FOR APPLICANT TO FILL IN �";Q coNST.
BUILDING,{ q 7' STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS dJ I� Q , CLASS.NO. DWELL.UNITS /! K P! a
LOT NO. /!l"/1� ` BLOCK MAP STATE
NUMBER HWY. YES NO
TRACT9 9 USE ZONE SPECIAL
SIZE OF LOT X NO.OF BLDGS. I CONDITIONS
J NOW ON LOT rJ
USE OF
EXISTING BLDG. BUILDING EXIST.
* SETBACK YARD HWY STREET NAME WIDTH
OWNER d 12
MAIL /f.!'QSb FRONT
ADDRESS a h !^ /1 0 C !C I� ��t� ✓ SIDE
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1 �1
TEL G P.L.
CITY ilk ( C-c L) rl t NO.�s�c INSPECTION RECORD
ARCHITECT OR TEL. .
ENGINEER NO. ,
ADDRESS
� TEL iZ
CONTRACTOR 0'/ NO.
Lv �_
ADDRESS / �.Y L iSt!/Y +� _
DESCRIPTION OF WORE 5'3 L
NEW ADD ALTER REPAIR DEMOLISH
SQ. FT. NO. OF NO. OF
SIZE STORIES FAMILIES /
USE OF / ` ^ / 'P/ a/N' 0 .r.•"�(,,,....__..
STRUCTURE
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SIGNATURE OF f/1
APPLICAN Vf
` _,. APPROVALS OAXE INSPE TOR'S SIGNATURE
ADDRESS 2 Z /��" k641— FOUNDATION: LOCATION
FORMS, MATERIALS i
VALUATION $ ( FRAME: FIRE STOPS,
BRACING, BOLTS
M FURNACE: LOCATION,
FEE V� I FEE $ . I GAS VENT,DUCTS u '�
I HEREBY ACKNOWLEDGL THAT I HAVE READ THIS AP- LATH, INT.
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWSRE ULATIN BpllILDING CONSTRUCTION. LATH,EXT.
SIGNATURE O G /( !� �� HOUSE NUMBER COR-
PERMITTE , RECT AND POSTED
ADDRESS' 7�'? �'1 _ FINAL F -r G p
CLYDE N. DIRLAM, P INCIPAL ST CT RAL ENGINEER
PLAN CHECK VALIDATIONCC
K. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
4
L AIPo 2 1 6 1 a JU-1 13 2 3 0 22.5 0
o2 S 4 9 JiiJ 2>7 1 G 4 Jc.IV J
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