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B08960 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS'ANGEL S BUILDING +�f
DEPARTMENT OF COUNTY ENGINEER ADDRESS - �
BUILDING AND SAFETY DMSION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
DISTRICT NO GROU TYPE PR SSED BY
FOR APPLICANT TO FILL IN CONST '
g `` ,I STATISTICAL CLASSIFICATION SE ER MAP
ADDRESS 61Z /y dyON• �/YM l�#4691/EL' BK F-/—
LOT
CLASS NO DWELL UNITS
LOT NO& J'o BLOCK MAP NUMBER HAT YES
TRACT !<a 03 USE ZONE SPECIAL '+
!� NO OF BLDGS 14 CONDITIONS
SIZE OF LOT.�O O X & I/ I NOW ON LOT ���///
USE OF
EXISTING BLDG L BUILDINGYARD HWY STREET NAME EXIST
TEL SETBACK WIDTH
OWNER NO FRONT
P L
DDR ESS R1 SIDE
ARCHITECT OR TEL P L
ENGINEER NO INSPECTIPN RECORD
ADDRESS
� ��.,��q f
TRACTOR ��1' D I TELNO d '� c3'�'.a A �"�'�, " A I 0
ADDRES
A
DESCRIPTION OF WORE O
NEW / ADD ALTERj REPAIR DEMOLISH 1"'f�`Af f •.l" �p ,/ y ,�,,�� 'Wil
SQ EFT W"•!o 22 STORIES NO O IES / vI A lv' 4_ "N
of
STRUCTURE
SIGNATURE OF
APPLICANT
VALUATION
APPROVALS DATE INSPECTOR S SIGNATURE
PCPIVIT FOUNDATION LOCATION _` )' `r
FEE $ FEE $ FORMS MATERIALS f', 2 TJ/
_� FRAME FIRE STOPS
IHEREBY 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 ic.
BUILDING CONSTRUCTION I CERTIFY THAT IN THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED I SHALL NOT LATH INT
EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBUECT
TO THE WORKMEN 5 COMPENSATION LAWS OF CALIFORNIA /
LATH EXT
SIGNATUREIla HOUSE NUMBER COR
LMITTE t RECT AND POSTED /
ZRESS v '��� #SMA FINAL
CLYDE N DIRLAM PRINCIPAL ST6(:: RAL ENGINEER
PLAN"CHECK VALIDATION CK Mo CASH PERMIT VALIDATION CK M o CASH
LA,,'n'B 3 7 6 "o' ,'A 9 3 A 150 (3�v;
N
J I ACc 9 0 2 5 JJ4 2 2 1 A 3 C).() C)