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76A63BA CE#803 5 GIAPPLICATION FOR BUILDING PERMIT ,
• COUNTY OF LOS ANGELES BUILDING °f (o C d S o
DEPARTMENT OF COUNTY-ENGINEER
BUILDING AND SAFETY DMSION LOCALITY = /e GI,'7''a
JOHN A LAMBIE;COUNTY ENGINEER NEAREST
WILLIAM A JENSEN BUP'T OP BUILDING CROSS ST
DISTRICT NO GROUPTYPE .PROCESSED BY
FOR APPLICANT TO FILL IN f�,'o d� CONST
BUILDING[� d,p 1 STATISTICAL CLASSIFICATION ER MAP /
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ADDRESS 7 i� IF/li S �, CLASS NO DWELL UNITS SK
LOT NO ,[. BLOCK s WATER
CERTIFICATE -NOT REQUIRED [a- RECEIVED Li
TRACT Sa Aa -13 MAPHIGHWAY STATE MAJOR SECONDNO OF BLDGOCA
SIZE OF LOT .S`"/ �_10 NOW ON LOTS I- SE ZONE NO ;a 0 /' SPECIAL(CIRCLEI
USE OF . CONDITIONS
EXISTING BLDG, E W , A- 1
TEL -
OWNER NO BUILDING YARD' MWY STREET NAME EXIST
SETBACK WIDTH
ADDRESS'7O
IF
ARCHITECTOR TEL , FRONT
T O I — Ag a s O _40
ENGINEER NO Z SIDE
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ADDRESS i �TE SPECTION RECORD C
CONTRALTO D d O NO "� ;r w
SS ,[� `
ADDRE • T , 1 's i �! /, W
DESCRIPTION OF WORK S - 4 a
` I 3 17411 Z.,a r � +vw' �- ?
NEW ' AAr__*ALTER REPAIR DEMOLISH
SQ FT NO OF NO OF ✓,q/L••`••07 '
IZE STORIES FAMILIES r
USE OF, • _ / 7
STRUCTURE ere
� r
1
SIGNATURE OF e
APPLICANT
VALUATION
1' APPROVALS DATJJE'// JJ'INSPECTORS SIGNATURE'
F E $ ' FEE $ L PC PMTO FOFORMSION MATERIIALSON` / (l'�G
FRAME FIRESTOPS.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING,,BOLTS
BOLTS
AND STATE THAT THE ABOVE ISCORRECT 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
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT - LATH INT
ING TO WORKMEN S COMPENSATION INSURANCE i -
LATH,EXT
PERMITTEE SIGNATUREO t HVUSE NUMBER COR I G
RECT AND POSTED
ADDRESS 's FINAL
j %CLYDE N'DIRLAM, RINCIPAL STT AL ENGINEER
PLAN CHECK VALIDATION CK. M O CASH (PERMIT VALIDATION I CK. ,Y o CASH
.. j Lko8 2 7 4 - H9 27 �1 0 •9.0 0