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76AL70A CIE#803 1-61 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING L�
DEPARTMENT OF COUNTY ENGINEER ADDRESS J
BUILDING AND SAFETY DMSION LOCALITY �t�
JOHN A LAMBIE COUNTY ENGINEER NEAREST - 14,/
WILLIAM WILLIAM A JENSEN SUP T OF BUILDING CROSS ST pg�
FOR APPLICANT TO FILL IN DISC} GROUP TYPE�r IFCONST /I )ESSED
BY
BUILDING STATISTICAL CLASSIFICATION S '"ER MAP
ADDRESS qq ++�� .BK
CLASS NO.�tDWELL UNITS L;
LOT NO BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE
TRACT n MAP HIGHWAY STATE MAJOR SECOND
NO OF BLDGS NO CIRCLE) LOCAL
SIZE OF LOT %��,XI NOW ON LOT US- ZONE SPECIAL
USE OF n CONDITIONS
EXISTING BLDG
,M1,� E L
OWNER T� O BUILDING EXIST
YARD HWY STREET NAME
y►/ �/ r SETBACK WIDTH
ADDRESS 4 2% 14G�lJF,-S' / �+ FRONT
ARCHITECT OR ' TEL P L
ENGINEER NO SIDE
P L
ADDRESS-C-2-2 ,INSPECTION RECORD a
CONTRACTO � 6 nil tKL � - � ` O
ADDRESS � , V O .
DESCRIPTION OF WORKCIL
NEW ADD ALTER REPAIR DEMOLISH ,: f y �
SQ FT NO OF NO OF /� /� ,F 9� -
IZE STORIES- FAMILIES t9 � /
USE OF
STRUCTURE �/7,h111_ -z-, �/r
SIGNATURE /�lo, i ggi,, t// , yfj� 777 ,""'aa 1
APPLICAN
VALUATIONS Ooo I gpPROVALS DATE INSPECTOR S SIGNATURE
`+JI- FOUNDATION LOCATION �/
P C PMT /hl
FEE $ FEE $ FORMS MATERIALS
FRAME FIRE STOPS r{Jp++-/ �✓'-��
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS
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 r
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT /
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT 1 `\
ING TO WORKMEN S COMPENSATION INSURANCE LATH EXT l /�
SIGNATURE OF�� CHOUSE NUMBER COR
PERMITTEE RECT AND POSTED 1 r
ADDRESS � - FINAL
CLYDE N DIRLAM PRINCIPAL STRUCTURAL EN R
PLAN CHECK VALIDATION cK. mo cABH PFJI IIT VALIDATION cK. mo
cASH
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