HomeMy Public PortalAbout5420 ACACIA ST_Building_1/12/1962_foundation 70AG39-CE 879-2-80 - r
APPLICATION FOR REL'OCAT�ION B ILDING PERMIT
COUNTY OF LOS ANGELES ADDRESS T ,,L I
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION Loco l r
JOHN A,LAMBIE, COUNTY ENGINEER t NEAREST
WILLIAM A JENSEN, Sup'T OF BUILDING ,CROSS ST
-- FOR-APPLICANT TO FILL IN DIST NO GROUP TYPE SEWER,MAP P O 4 BY
—� CONS BK"'•, PG
J R
PROPOSED � tl a � _
BUILDING MAP `
ADDRESS �` O NUMBER / HWYEYES O -
LOCALITY ` a USE,ZONE SPECIAL°
PRESENT CONDITION ' Q
P.
BUILDING L tJr
ADDRESS12-0
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pal Z
LOCALITY Q B ILDINGYARD HWY' STREET NAMEe EX ST
SETBACK WIDTH
OWNER FRONT !° ti
MAILP L ( u C CJ
ADDRESS /2 r SIDE
P L
1 NO -
CITY
SURETY DATE REC'
MOVING TEL BOND ILE.17:2 eY'
CONTRACTOR " NO'I, a b
CASH DATE +fi a REC D
ADDRESS, DFVOSIT $ - FILED BY
BUILDING TEL APPROVALS = /ppDA}�TTEl'' INSPECTOR S SIGNATURE �
CONTRACTOR NO FOFOORMS, MATERIALS ION /� j4 � � O
ADDRESS FiAAME FIRE STOPS, ` U
PRESENT 4
USE OF -BRACING;BOLTS
BUILDING FURNACE LOCATION 0
PROPOSED GAS VENTS, DUCTS E_
USE OF
BUILDIN
' LATH, INT
SQ FT` 3 ROOMS STORIES`r ;.I LATH, EXT
SIZE R
WALL ,Q ROOF HOUSE NUMBER COR- I
COVERING Iiti 'fMD'ti"LF�'I COVERING COR-
RECT AND'POSTED
fLEGAL
DESCRIPTION LOT N BLOCK FINAL
DIST INEER `
TRACT WORK COMPLETED
NO OF BLDGS' SURETY BOND
SIZE OF LOT I NOW ON LOT ' RELEASED /
USE OF 'No ofI HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
EXISTING BLDG' FAMILIES APPLICATION AND STATE THAT`THE ABOVE IS CORRECT
1 HEREBY STATE-THAT THE INF RMATION,GIVEN IS' AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
CORRECT , AND STATE LAWS REGULATING BUILDING CONSTRUC-
SIGNATURE TION
APPLICANT 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED I
ADDRESS�Z y/� r WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
ago WORKMENS COMPENSATI LAWS OF CAA ORNIA
VALUATION $ P C $ rte [SIGNATURE O�
yFEE ITTE
FEE $ HDD.1 ESS /4-'1-
VALIDATION C5,5) -0 CASH CLYDE N DIRLAM, PRINC PAL TURAL ENGINEER
PFJMT VALIDATIO M D CASH ' ®F
U,j s'{4 3 7 OEC 2),7 2`'5 D 1'5_0 r�
r 6 -D 1g 5.0, 0-