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76A698A CE#8091157 APPLICATION FOR BUILDING PERIT 1�
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUMDING AND SAFETY DMSION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST
DISTRICT NO G40UP TYPE SEWER MAP
FOR APPLICANT TO FILL IN [ter/�� f� BK PG
&o CONST
ADDRESS
BUILDING U G Y STATISTICAL CLASSIFICATION
S
LOT NO / CLASS NO __
DWELL UNITS _C�
BLOCK
9,�/ MAP STATE YES NO
/ NUMBER HWY
TRACT USE ZONE S CIAL
NO OF BLDGS CONDITIONS
SIZE OF LOT J` NOX ON LOT
USE OF
EXISTING BLDGP- BUILDING EXIST
SETBACK YARD HWY TREET ME WIDTH
OWNER FRONT
MAIL P L01"at
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ADDRESS O SIDE
TEL P L
CITY NO INSPECTION RECO
ARCHITECT OR _
—ENGINEER W '�' -=---�'.O
ADDRESS /D L ru[ivC.
TEL
CONTRACTOR IL NO
ADDRESS /6
DESCRIPTION OF WORK
E ADD ALTER REPAIR DEMOLISH
FT NO OF
SIZE STORIES FAMILIES
USE OF STRUCTURE0��
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SIGNATURE OF APPROVALS
APPLICANT
ATE �NSPEC 0'F RAS-SFGN"ATORE
ADDRESS FOUNDATION LOCATION r a'
$ P C SFORMS MATERIALS
S Q FRAME FIRE STOPS
�^ FEE J (� BRACING BOLTS — -��,
VALUATION FURNACE LOCATION
pion FEE /� GAS VENT DUCTS `E
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LATH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS R BUILDING CONSTRUCTION LATH EXT
SIGNATURE OF 1 -� HOUSE NUMBER COR
PERMITTE 1' RECT AND POSTED
ADDRES l FINAL 3
CLYDE N DIRLAM PRINCI AL STRUCTURAL NGINEER
PLAN CHECK VALIDATION CK mo CASH PERMIT VALIDATION cK mo CASH
LAf43012STJM1'823A 338 r1o, ®,
E '3 0 1 3 S JUL 18 1 13.5 0 M