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'1 7GA638ACEg803263 APPLICATION FOR BUILDING PERMIT t
` COUNTY OF LOS ANGELES BUILDING OF
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DEPARTMENT OF COUNTY ENGINEER ADDRESS �/ s Axe.
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST- A/4 boll
y DISTRICT NO 1 GROUP TYPE 1. PROCESSED BY
FOR APPLICANT TO FILL IN .04? } 'T CONST
BUILDING STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS S /'`� / CLASS NO BK SPG
I A� _ DWELL UNITS ^^ rJS
LOT NO BLOCK WATER 44f-
d CERTIFICATE NOT REQUIRED ® RECEIVED ❑
TRACT e �ys NAOP - HIGHWAY STATE MAJOR SECOND LOCAL^
NO OF BLDGS (CIRCLE)
SIZE OF LOT NOW ON LOT USE ZONE SPECIAL
USE OF a CONDITIONS Z Z
EXISTING BLDG r - /
LT D/
OWNER NO IVQO BUILDING YARD HWY t STREET NAME EXIST
R SETBACK WIDTH
ADDRESS �• �,i �i • (• • FRONT
ARCHITECT OR f TEL
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ENGINEER NO SIDE 1
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ADDRESS { 0
to '
TEL V
CONTRACTOR `ZC+�.� NO y t
ADDRESS r v r I FO
DESCRIPTION OF WORK y uVi
EW ADD ^ALTER REPAIR DEMOLISH a Z
S FT NO OF NO OF ■
SIZE g A STORIES FAMILIES a t
USE OF STRUCTURE 'Q% -&Ab rG O r
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SIGNATURE OF
APPLICANT-' o&- f ra }
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VALUATION $^ / TS r 1
APPROVALS DATE INSPECTOR S SIGNATURE
P Cy PMT FOUNDATION LOCATION ! T
FEE $ �r FEE $+ - FORMS MATERIALS
FRAME FIRE STOPS h
1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION 'BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION 3 r
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS l +
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT s
TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT
INC TO WORKMEN SZCO7ENSON INSURANCE LATH EXSIGNATOR OF// tga�e� HOUSE NUMBER CORPERMITTE �� RECT AND POSTED a'r / 4 e r
ADDRESS .0Q» J FINAL 1'///oel. +� }
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r < / - (JOHN F LEWIS PRINCIPALffSTRUCTURAL EIVGI' #.� t
PLAN CHECK VALIDATION cK M O CASH _ PERMIT VALIDATION CK M O CASH
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'ULO O 5 5 3 JUN 2i6 1 D�j } ' 4.00,-
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