HomeMy Public PortalAbout5210AGNES AVE_Building (3) � Y
>�Q
e►aae.CIE 4eoa 1-61 APPTEMPLE �ITV
LICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ADDRESS BUILDING
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
DIS3ICT O Grp TYPE RO S
FOR APPLICANT TO FILL IN �> r ( CONST �{
BUILDING,,5' STATISTICAL CLA FICATION S,E�gWt A
MP
ADDRESS U V /� PG
CLASS NO DNITS WELL UG- \
LOT NO BLOCK WATER NOT OT REQUIRED rRECEIVED
TRACT MAP D HIGHWAY
O OF BLDGS NO (CIRCLE) STATE MAJOR SEC
LOCAL
SIZE OF LOT D ;K b•� OW ON LOT USL ZO E SPECIAL
USE OF A CONDITIONS
EXISTING BLEIGVE / C
TEL el
OWNER NO BUILDING EXIST
�- SETBACK YARD HWY STREET NAME WIDTH
ADDRESS U FRONT b
ARCHITECT OR TEL P L
ENGINEER NO SIDE
P L �
O_
ADDRESS TEL INSPEC'�ION' RECORD / /� „ __0
CONTRACTOR� On1 v- NO GI Z � �� //_// � �O
/7L� GC
ADDRESS
deA.4 le-
DESCRIPTION OF WORK �� v�G 'P� �_�� 9 ri
NEW ADD ALTER REPAIR DEMOLISH ✓ Z
SQ FT NO OF NO OF N A��rVf/. / s n?AfI
IZE STORIES FAMILIES // ! ✓ � �� �,,IafA � �
USE OF ( ,�
STRUCTURE 0 hl
sj H � l/2r
SIGNATURE OF
APPLICANT '
VALUATION$
APPROVALS PATE INSPECTOR S SIGNATURE
FPC PMT EE FEE $ FOUNDATION LOCATION
FORMS MATERIALS /fl�fY
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 ( , yam 1
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION 1 CERTIFY THAT IN DOING THE WORK xrl
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OFTHE LABOR CODE OF THE ST ttT'ORNIA RELAT
ING TO WORKMEN S P NS I RANCE LATH EXTf�
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE RECT AND POSTED /
ADDRESS FINAL 1/0//b F_ I_
CLYDE N DIRLAM PRINCIPAL STR RAL ENGINEER
PLAN CHECK VALIDATION CK. M O CASH PERMIT VALIDATION cK MO
CASH
LAC01, 3 6 7Q� J-10 1 D 1 5.00N V
I ,