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COUNTY` OF LOS ANGELES BUILDING'
DEPARTMENT OF COUNTY ENGINEER . ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY00,
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D. GRIFFIN, SUPT OF BUILDING' - CROSS ST.
. - DISTRICT-NO. GROUP• TYPE, P,R -SED BY,
FOR,APPLICANT TO FILL IN _:' '.CONST.
BUhLDINGSTATISTICAL CLASSIFICATION I SE R MAP
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ADDRESS � �" - � � BK P -
�.7 CLASS.NO.' - DWELL.-UNITS;
LOT NO. a� BLOCK NUMBER FjAyE YES
" USE ZONESPECIAL
TRACT - CONDITION
�A,C/� W L, •NOW ON LOTS../ -
- SIZE.OF LOT ` � �(((
USE OF: _ Y
- - -
EXISTING BLDG: • BUILDING YARD' HWY STREET-NAME
EXIST. •. ..
SETBACK WIDTH'
OWNER S D IC1T� T FRONT
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ITY N�r' i-
ITY ECT OR TEL. INSPECTION,RECORD
ENGINEER NO.
ADDRESS - OU.S<
6�4
CONTRACTOR / d ASV�W NTEL. :&
ffLO - -.
ADDRESS Al/3Sfa'/✓ OR.- )614eA't H/,' - -
DESCRIPTION OF WORE
NEW ADD- ALTER- 'REPAIR DEMOLISH
SQ.-FT. NO.OF NO..OF -
SIZE 8� - STORIES - MILIES-USE OF /�J1
STRUCTURE i PC U"Ttf L
'SIGNATURE OF �'
APPLICANT
APPROVALS '. DATE INSPEC OR'S SIGNATURE
ADDRES FOUNDATION:LOCATION �' d
dc
I Q _ FORMS,MATERIALS `
00,
VALUATION d-6 FRAME:FIRESTOPS.
a BRACING,,BOLTS
000 FURNACE:LOCATION. M:
P.C. ,t�L PMT. !: `.! •s.>v_-�":'
FEE $�j` I FEE.' $diY,� I .GAS
VENT:.DUCTS
HESREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP-
LATH.�INT.
PLICATION AND STATE THAT THE ABOVE IS'CORRECT AND
AGREE.TO COMPLY WI LL COUNTY ORDINANCES AND "�' yam-7- - -
STATE LAWS REG G BUILDINQCONS UCTION. 'LATH,EXT.
- `sem OUSE
NUMBEWCOR-
SIGNATURE O .�
PERMITTEE- ECT AND POSTED
ADDRESS FWAL // I 0
CLYDE'N.,,DIRLAM, PRINCIPAL ST RAL ENGINEER
CK: M O. -- CASH
CK. M 0..... CASH _ :< tl A�ATIOitl I` ` .. .. .
PLAN CHECg VALIDATION � PERMIT ` •
b:p r''s 4 2 3 r� - 5 .0 .
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