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76A639A CE 4803 2-63 APPLICATION FOR BUILDING PERMIT'
COUNTY OF LOS ANGELES BUILDING -
DEPARTMENT OF COUNTY ENGINEER ADDRESS L.- 7
BUILDING AND SAFETY DIVISION LOCALITY �7Z1
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST /
WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. `C
FOR APPLICANT TO FILL IN DISTRICT NO. G ouP TYPE P ESSED BY e
CONST."
BUILDING ✓ 'f STATISTICAL CLASSIFICATION S WER MAP
ADDRESS �•� �Q y / BK PG
CLASS. NO. DWELL. UNITS
LOT NO. BLOCK WATER CERTIFICATE: NOT REQUIRED ❑ RECEIVED
TRACT (/y� MAP HIGHWAY STATE MAJOR SECOND, OCAL
NO.OF BLDGS. NO. Q (CIRCLE)
SIZE OF LOT NOW ON LOT C USE ZONE SPECIAL
USE ^ CONDITIONS
EXISTING BLDG.
TEL.
OWNER If
// r . NO. //Z BUILDING YARD HWY TREETNAME EXIST.
ADDRESS
�(p em /C �/� 6�b4f-
SETBACK
WIDTH
ARCHITECT OR TElf. P• L
ENGINEER NO. SIDE
P. L. CL
ADDRESS +j
TEL. O
CONTRACTOR NO.
! f O
ADDRESS
1'
DESCRIPTION OF WORK a
N
NEW ADD ALTER REPAIR DEMOLISH Z
SQ. FT. NO.OF NO. OF
SIZE17q STORIES FAMILIES
USE OF Lf
STRUCTURE hIE
J
SIGNATURE OF
APPLICANT A A G ZFx
D
VALUATION S 7 0�-(l'
APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION
PC
FEE S O'-+ FORMS. MATERIALS �� �,G ✓/
FRAME: FIRE STOPS. 1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. '
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS
BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK r
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH. INT. y
TION OF THE LABOR CODE OF THE STATE OF ALIF NIA �iELAT —
ING TO WORKMEN'S COM SAT N INSURANC
LATH. EXT.
SIGNATURE OF r HOUSE NUMBER COR- .--
PERMITTEE RECT AND POSTED
ADDRESS >PI79 FINAL
JOHN F. I EWIS FORINCIPAI STIR RAL ENGINEER
PLAN CHECK VALIDATION cK. M.D. CASH _ PERMIT VALIDATION CK. M.G. CASH
....!'1J0 8 5 4 tuJ�i 1 i- ` 5 2 J Int .5 3.7 5
8 9 0 .51 Fc325 1 A 7 1 .0 0"