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76AB38A CE0803 8 63APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING �/� Z�
DEPARTMENT OF COUNTY ENGINEER ADDRESS !J
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST ,�V(✓
DISTRICT NO d_ TYPE isE Y
FARCHITECT
OR APPLICANT TO FILL IN ,, Q
CONST
NG � SpTATISTICALCLASSI (CATION SEWER MAP
SS ` BKCLASS NO DWELL UNITS BLOCK WATERNOT REQUIRED RECEIVED
CERTIFICATEV00MAP HIGHWAYSTATE MAJOR SECOND LOCAL
NO OF BLDGS NO U (CIRCLE)LOT ' K ( NOW ON LOT U ZO E PECIAL
' CONDITIONS
NG BLDG
TEL( 11/ NO BUILDING EXIST
I'Q�y�p SETBACK YARD HWYSTREET NAME WIDTH
SS140 /7 � AUP O R i FRONT
ECT OR TEL P L
ER NO SIDE
P L
ADDRESS d
TEL O
CONTRACTOR NO
09
ADDRESS G
DESCRIPTION OF WORK 15
CL
L"
NEW ADD ALTER REPAIR DEMOLISH Z
SQ FT NO OF NO OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE
t
SIGNATURE OF
APPLICANT
VALUATION $ ®� f
APPROVALS ATE/ INSPECTOR S SIGNAT E
PMT
FOUNDATION LOCATION
FEE $ FEE ,� FORMS MATERIALS H'
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION �s P
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS �+�'�•�
BUILD INGCONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH-INT _--
TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN S COMPENSATION INSURANCE
/► LATH EXT J((�/ PV 0"✓ C�J"�y�l/r
SIGNATURE Opf HOUSE NUMBER COR /
PERMITTE fll/ ) RECT AND POSTED
ADDRESS a /" FINAL
JOHN F LEWIS PRINCIPAL STRUCTURAL ENG R
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK MO CASH
0,1, 7 6Z ,Md 16 1 D 1150-
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