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79AS30A CC#00316, APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDINGA/ A-apes
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITYe Ci
JOHN A LAMBIE COUNTY ENGINEER " NEAREST «
WILLIAM A JENBEN SUP T OF BUILDING CROSS ST
DISTRICT NO GROUP -TYPE P SED BY
FOR APPLICANT TO FILL IN CONST L
BUILDING
� d�/0 of STATISTICAL CLASSIFICATION SE ER MAP
ADDRESS 7 � K PG
CLASS NO DWELL UNITS
LOT NO BLOCK WATER
CERTIFICATE NOT REQUIRED M RECEIVED
Ux
TRACT rZ .IZ MAP HIGHWAY STATE MAJOR SECOND OCAL
NO OF BLDGS NO (CIRCLE)
SIZE OF LOT NOW ON LOT USF ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG ! C
TEL
OWNER i NO ��� BUILDING EXIST
''`` SETBACK YARD HWY STREET NAME WIDTH
6
ADDRESS _2 aa4 es 1 FRONT
ARCHITECT OR TEL P L
ENGINEER NO I SIDE
P L
ADDRESS ! TEL Cl 37Z INSPECTION RECORD a
CONTRACTOR M �TU��-r NO g
ADDRESS wo h
DESCRIPTION OF WORK 0
W
CL
NEW ADD ALTERPI REPAIR DEMOLISH U)
SQ FT NO OF f NO OF ?
IZE STORIES ! FAMILIES
USE �
STRUCTURE
W 6 a-6 r ,p/� �.r ��st d 6" w�,e
SIGNATURE OF
APPLICANT
VALUATION$ 2 V U
APPROVALS DATE INSPECTOR S SIGNATURE
P C ���. PMT �}- FOUNDATION LOCATION , J
FEE $ FEE FORMS MATERIALS
FRAME FIRE STOPS
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION -�
s-WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR CODE OF THE STATE F CALIFORNIA RELAT
ING TO WORKMEN S COM S COM
PENS
LATH EXT
SIGNATURE OF / HOUSE NUMBER COR
PERMITTEE RECT AND POSTED
Z si
ADDRESS �� FINAL -Ai/ �/
PLAN CHECK VALIDATION CK. M O CASH CLYDE p °ERMIT VALIDATION M 'PRINCIPAL TR CK. RMAo ENGINEER
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