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76A&38A CElEDa ]B_" APPLICATION FOR SUILDUNG PERMIT_
COUNTY OF LOS ANGELFS BUILOING
DDRE88 (7
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DEPARTMENT OF COUNTY ENGILVEER:,
BUILDING AND SAFETY DIVISION ALITY I E&A ,
JOHN A. LAMBIE, COUNTY ENGINEHR EAREST
WILLIAM-& J¢NSIEN, DUP'T OF EUILDINa R085 ST. TG "T
(STRICT ( RO P TY E O ED,OY"
FOR APPLICANT TO FILL IN I) d CONST. i
BUILDING ^ ATISTICAL CLASSIFICATION SEWER
ADDRESS �[ 1 i�f r T T, DWELL UNITS B�
CLASS. NO.
LOT NO. p i[ O K WiATER
CtRTIFICATE: NOT REQUIRED i RECEIVED
'
TRACT P IOHWAY 5'
NO. OF BLDGS. ` O. ICIRC L1) ATI}MAYOR SEOOND,.Lq CAL
SI-;�E OF LOT j( NOW ON LOT l E ZONE SPECIAL
USE OF CONDITIONS
EfKIffTING BLDG. t L 1
TEL
OWNER NO. BUILDING EXIST.
r •� -ErBACK YARD HWY STREET NAME WIDTH
ADD E83 w7 � �� � � / FRONT � U
ARCHITECT OR TEL. R L
ENGINEER NO. SIDE
ADDRESS
TEL. 8CONTRACTOR NO. ,,''Jvx 'w�
ADDRESS
O� J�/ /
� C.Y
DESCRIPTION OF WOR$ 0
0
NEW ADD ALTER REPAIR DEMOLISH
SQ. FT. NO. OF NO. OF.
SIZE STORIES FAM I-LI-ES
USE OF I
STRUCTURE ( O -
SIGNATURE OF
APP L I CAM
VALUATION $
V APPROVALS 'D TE INrr[CTOR's§IGKATuPtK
L'-iY FOUNDATION: LOCATION
FEE S FEE $ J(/ FORMS, MATERIALS
FRAME: FIRE STOPS,
I HER[DY ACKNOWLEDOE THAT 1 HAV[ REAb THIS APPLICATION B CIN LTS
SND STATE THAT THE ABOVE IS Co RFMCT AND AGREE TO COMPLY FUR ACE: LOCATION. -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GA VENT. DUCTS
]BUILD I NO CONRTRUCTION. I CERTIFY THAT IN DOING THE WORK
Aumom IZQJ HERE]BY I WILL NOT IEMPLOY ANY PERSON IN VIOLA-
TON OF TI-IE LAIR CODS OF THE RTATE OF CALIFORNIA RELAT. LATH, INT.
ING TO WORKMEN'S COMPENSATION/INSURANCE. LATH. EXT.
SIGNATURE OF LSiU J�, /J��'jNX{� HOUSE NUMBER COR-
PERMITTEE 1f A.Fr+CI // �" 777 FFF RECT AND POSTED
ADDRE85 FINAL -
JOHN F. LEWIS. P INCIPAL STR cK. URAL ENGINEER
PLAN CHECK VALIDATION CK- MA. CASH PERMIT VALIDATION M.O. CAaa-I
Ao 8, 56 9' Awl 1 D 750- 1