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76AG38A CE#808 I-62 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
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. GROUP ITYPE SSED BY
FOR'APPLICANT TO FILL IN CONST.
BUILDING STATISTICAL CLASSIFICATION MAP
ADDRESS fT�-
CERTIFICATE:
PCLASS.NO. DWELL.UNITS /yLOT NO. BLOCK WATER NOT REQUIRED RECEIVED
TRACT MAP HIGHWAY
NO.OF BLDGS. NO. (CIRCLE) STATE MAJOR SECOND,LOCAL
SIZE OF LOT NOW ON LOT USE ZONE SPEC IAL
USE OFCONDITIONS
EXISTING BLD L'-
TEL.)J
OWNER N .Iv BUILDING EXIST.
^`^ SETBACK YARD HWY STREET NAME WIDTH
ADDRESS +I FRONT
ARCH ITEC OR TEL. P. L.
ENGINEER NO. SIDE
ADDRESS . O
TEL c
CONTRACTOR yy,, rd O. .d
ADDRESS pC 34 /dAw C
f
DESCRIPTION OF WORK u
u
v
NEW ADDALTER REPAIR DEMOLISH 2
SQ.FT. NO.OF NO. OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE
SIGNATURE OFAs
^
APPLICANT
VALUATION$ 6s
APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION: LOCATION
FEE $ FEE $
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. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKM N'S COMPENSATION INSUR N E. LATH,EXT.
SIGNATURE OF HOUSE NUMBER COR.
PERMITTEE RECT AND POSTED
ADDRESS FINAL -Z�
JOHN F. LEWIS, PRINCIPAL STR CTURAL ENG R
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
V 1 6 9 6"' OCT 21 1 D 6.00-
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