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76A638A CE#803 8-63 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING n
DEPARTMENT OF COUNTY ENGINEER ADDRESS C
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST.
DISTRICT NO G P TYPE CE D B.
FARCHITECT
OR APPLICANT TO FILL IN `- coNsr. �. l
NG STATISTICAL CL FICATION SEWER MAP
SS a K� P 3
- CLASS. NO. DWELL. UNITS
. �'V` t BLOCK WATER NOT REQUIRED ❑ RECEIVED
CERTIFICATE:
MAP r) HIGHWAY STATE MAJOR SECOND. LOCAL
NO.OF BLDGS. NO. (✓ / CIRCLE)
LOT NOW ON LOT USE ZONE SPECIAL
CONDITIONS
NG BLDG. Q /
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(` NO. BUILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
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ECT OR TEL. P. L.ER NO. SIDE
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ADD / ALTER REPAIR DEMOLISH r ,+ V1
NO. OF NO. OF Z
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APPROVALS /DATF, INSPECTOR'S SIGNATy1 E
FOUNDATION: LOCATION '
P.C. PMT. FORMS. MATERIALS
FEE � FEE � .�
FRAME: FIRE STOPS. -I
I HEREBY 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
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN' OMPENSATION IN RAN C
LATH. EXT. t�
SIGNATURE HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENSiLN ER
PLAN CHECK VALIDATION CK. M. CASH PERMIT VALIDATION CK. M.D. CASH
O 1 7 JUN 16 1 D 11.50-
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