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MANNA CE#9G9-.1-61 APPLICATION FOR BUILDING PE MIT
-COUNTY OF LOS ANGELES BUILDING L
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST.
DISTRICT NO. %1P TYPE SSED BY
FOR APPLICANT TO FILL IN ;' J4 �r CONST. 2 r
BUILDING 4 ��fI� STATISTICAL CLASS !CATION SEWER MAP
ADDRESS V BK PG
--CLAS.NO. DWELL.UNITS "� / `L
LOT NO. BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE:
TRACT r MAP HIGHWAY STATE MAJOR(SEI LOCAL
NO.OF BLDGS. NO. (CIRCLE)
SIZE OF LOT. I NOW ON LOT USE ZONE SPECIAL
USE OF /I y CONDITIONS
_EXISTING BLDG. / L
OWNER/I fj� SlI0_FNO.
4A CV, SETBACK WIDTH
ADDRESS '!, YARD HWY ST E T NAM
FRONT
ARCHITECT OR TEL. P.L. J
ENGINEER NO.. SIDE
ADDRESS INSPECTION RECORD °'O
TEL.
CONTRACTOR NO. V
ADDRESS O
DESCRIPTION OF WORK 0
W
' a
NEW ADD ALTER REPAIR DEMOLISH h
SQ.FT. NO.OF NO.OF ?
SIZE STORIES FAMILIES
USE OF
ST CTURE
i
GNATUR OF
APPLICANT
VALUATION�� I
APPROVALS DATE INSPECTOR'S SIGNATURE
P,C. PMT. ,q� FOUNDATION:LOCATION
FEE $ FEE v I/ FORMS,MATERIALS
FRAME:FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT 1 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. 1 CERTIFY THAT IN DOING THE WORK ,
AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LAThI,-INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S CObJEENSATION IN RANCE. LATH,EXT. - /
SIGNATURE OF HOUSE NUMBER COR' 1 /' / j�
PERMITTE RECT AND.POSTED (l /n sT�jf�
ADDRESS FINAL
CLYDE N. DIRLAM. ERINCIPAL'STRU URAL ENGINEER
PLAN CHECK VALIDATION cK. m.o. cAsil PERM VALIDATION 'A.".
M.O. CASH
L,n.! 0 4 9 5 0 APR 4 1 *1� 3.0 0
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