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7SA63MACKSBOO -4I APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING 3
DEPARTMENT OF COUNTY ENGDIEER ADDRESS 11eP1 :7
BUILDING AND SAFETY DMSION r LOCALITY
0
JOHN A LAMBIE COUNTY ENGINEER NEAREST 8
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
FOR APPLICANT TO FILL IN D�I1s�ICT NO GR P TYPE O Y
(V�1 CONST
BUILDING / STATISTICAL CLAS FICATION SEWER MAP
ADDRESS PG i
^ /1 + CLASS NO DWELL UNITS
LOT NO e! QItljper BLOCK WATER NOT REQUIRED�RECEIVED
[` } CERTIFICATE /L��
TRACT /yG#Q S/► G/d ED
iA�/ / tMAP HIGHWAY STATE MAJOR SECOND LOCAL
I I NO OF BLDGS NO 'A01 (CIRCLE)
SIZE OF LOT 'i. I NOW ON LOT O USE ZONE SPECIAL
USE OF It I CONDITIONS
EXISTING BLDG p� t
117
OWNER /v S d IV NO '
BUILDING EXIST
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS
FRONT + 1
ARCHITECT OR TEL P L
ENGINEER NO 1 SIDE
ADDRESS o -7
P L
rR EL II�iSPECTION RECORD i 1 a
CONTRACTOR ` c� 1iNOut + / g
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DESCRIPTION OF WORK /FN/M/} A /STA��wf I Urii/b47"'`�' ' o
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NEW &ADD ALTER REPAIR DEMOLISH 1 a eA
SO FT NO OF NO
ZE / d STORIES FAMILIES
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SIGNATURE OF a z ' j:7.01 sA�e � a lrol<-04-
APPLICANT r
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VALUATION$
APPROVALS DATE INSPECTOR S SIGNATURE +
�}/ �f} FOUNDATION LOCATION
FEE $ K V, ry ' OT� FEE $ FORMS MATERIALS
FRAME FIRE STOPS
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 �✓ ! �r
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA +LATH INT ��� / ►1"��'' /
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN S COMP NSATION INSURANCE LATH EXT
SIGNATURE O HOUSE NUMBER COR
PERMITTEE
c RECT AND POSTED
how � �1
ADDRESS] , •' FINAL +
PLAN CHE= VALIDATION0,,
o „ CLYDE NP DEBIVIIT VALIDATIONM PRINCIPAL T( c L/"RAL ENGINEER
Ur".2061 Adb30 3a
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