HomeMy Public PortalAbout5136AGNES AVE_Building (4) TEMPLE ClTj% -
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j 76A638ACE�B03263 APPLICATION FOR BUILDING PERMJT -
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
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DISTRICT NO GROUP TYPE P SSED BY
FOR APPLICANT TO FILL IN t �� CONS ,r
BUILDING STATISTICAL CLASSIFICATION SE ER MAP
ADDRESS
(CLASS NO 157� DWELL UNITS �' L1� K
LOT NO BLOCK WATER
CERTIFICATE NOT REQUIRED � RECEIVED ❑
TRACT 8 MAP HIGHWAY
' d!- i NO OF BLDGS NO / (CIRCLE) STATE MAJOR SECOND CAL
SIZE OF LOT NOW ON LOT USE ZONE SPECIAL
USE OF A
f CONDITIONS
EXISTING BLDG
TEL
OWNER ((� F. T.s�f/A NOIO7'- 4 BUILDING EXIST
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS A4gV$3 T-�/►�ff.� C. FRONT /j A
ARCHITECT OR TEL P L
ENGINEER NO SIDE I a
�y1 P L
ADDRESS /
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CONTRACTOR +f NO /y r �-Iw
EO /BSI
ADDRESS
DESCRIPTION OF WORK
NEW ALTER REPAIR DEMOLISH
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SO FT NO OF NO OF
SIZE STORIES FAMILIES
USE OF
STRUCTUREf
/ C T / ZIQkC37s/
SIGNATURE OF
APPLICANT
VALUATION S Zoe) 41 1
APPROVALS ADATE INSPECTOR S SIGNATUR
PC PMT FOUNDATION LOCATION
FEE 5 FEE $ FORMS MATERIALS
FRAME FIRE /�
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STOPS Jnr' I�rj
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS , 9 '
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 ,e'A
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR COOL OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN S COMPENSATION INSURANCE I(J
SIGNATURE %!'",A�j / LATH EXT
P RMITTEE� Q�,�Y-� ��/ Q�Qt�C/J HOUSE NUMBER COR
s� RECT AND POSTED
ADDRESS7Empt� FINAL
JOHN F LEWIS P INCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK M o CASH _ PERMIT VALIDATION CK MO CASH
7 �
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