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aueaeACr,#eoaseo APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ADD EISS 3 /4 Nes Z
DEPARTMENT OF COUNTY ENGINEER
B=ING AND SAFETY DIVISION LOCALITY le-
JOHN
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JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST Ir
DISTRICTNO GROUP TypE ,P SSED BY
FOR APPLICANT TO FILL IN CONST
.� STATISTICAL CLASSIFICATION SE ER MAP
ADD EISS ll / 3 AI "y e s v�, P
CLASS NO DWELL UNITS s
LOT NO Q 45 V BLOCK MAP STATE
NUMBER o HWY YES O
�y USE ZONE(� /J
TRACT J-0?(/ CONDITIONS ONS /'dl/, l
NO OF BLOA J
SIZE OF LOT l�' � IN ON LOT
USE OF
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SETBACK YARD HWY STREET NAME WIDTH
OWNER /1 G� R/��1 L L- NO FRONT 4
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ADDRESS 3 ,►N A S S asps SIDE
ARCHITECT OR TEL P L
ENGINEER NO INSPECTION_RECORD
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CONTRACTOR 11 'Nr NO `�"�LyT7'a O
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ADDRESS Q
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISHSQ J N
S ZET :2 STORIES FAM1NO OF NO0 IES / I
USE OF /W 4(01<0
STRUCTURE AUL-//1/Nr�
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SIGNATURE OF
APPLICANT
VALUATION
APPROVALS DATE INSPECTOR S SIGNATURE
PMT FOUNDATION LOCATION
FEE $ /
FEE $ o FORMS MATERIALS �
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS � J
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION Yn �
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS d
BUILDING CONSTRUCTION I CERTIFY THAT IN THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED I SHALL NOT LATH INT
EMPLOY ANY PERSON IN ANY MANNER S TO BECOME SUBUECT ,¢
TO THE WORKMEN S C O PENSATIAW FORNIA I ATH EXT �P- p
SIGNATURE OF HOUSE NUMBER COR
PERMITTE RECT AND POSTED d �v
ADDRESS FINAL D� l
PLAN CHECK VALIDATION CK M O CASH CLYDE PERMIT VALIDATIONLAM PRINCIPAL TR cK RAL ENGINEER
j��I�,5 7 4 2 :-".1 a 2 0 >= 3 D 2 1 0 0 +