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MGM Ce#0032/60 APPLICATION FOR,BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALI
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
mom 0-179a DISTRICT NO GROUP I TYPE PR C ABY
FOR APPLICANT TO FILL IN j _� CONST
BUILDING / j� 1' STATISTICAL C SIFICATION SEWER MAP
ADDRESS / T �P ( 1 �/�E S T•C + Y
,/2- /y CLASS NO DWELL UNITS
F 4
LOT NO �0 D s O - BLOCK NUMBER HAP YESWY
O �
TRACT 61 W/ USE ZONE SPECIAL
T_FNO OF BLDGS CONDITIONS
SIZE OF LOT X q n I NOW ON LOT Z
USE OF
EXISTING BLDG ES �+' 1z/}G� BUILDING EXIST
YARD $1jppG STREET NAME
TEL SETBACK WIDTH
OWNER G E/� -rNO 'OO FRONT oJD!
ADDRESS J<7 V ' ;4 Ag'Af.5 - I s 6 t-1'4 SIDE ,�C (f�C/
ARCHITECT OR TEL P L
ENGINEER NO INSPECTION RECORD
ADDRESS
TEL
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CONTRACTORk_s RS O AJ NO A-l#
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ADDRESS 5.�,�' L TR �S - A Bei ? 7.x� (i➢i1/711 A!� Gfr'7'�K U
DESCRIPTION OF WORK O
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NEW 6CD3> ALTER REPAIR DEMOLISH �{
SQ FT NO OF NO OF p�
SIZE STORIES FAMILIES
USE — �S �� �
STRUCTURE
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SIGNATURE OF ��
APPLICANT '
VALUATION$
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APPROVALS DATE INSPECTOR S SIGNATURE
PC PMT
FOUNDATION
MATERIALS
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FEE $ FEE $
FIRE
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP FRAMEBRACINGBOLTTSS
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE LOCATION
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS
STATE LAWS REGULATING BUILDING CONSTRUCTION ^� /
I CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH INT
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH EXT
WORKMEN S COMPENSATION LAWS OF CALIFORNIA
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE_p-1 RECT AND POSTED
ADDRESS o J FINAL
CLYDE N DIRLAM PRINCIPAL ST RAL ENGINEER
PLAN CHECK VALIDATION CK M o CASH PERVALIDATION cK M o CASH `
LAC 3 7 5 1 t ir�R p 9 0 0 ®�