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70AUIIA CE#003 F✓QO APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING )—/
DEPARTMENT OF COUNTY ENGINEER ADDRESS l 1
BUILDING AND SAFETY DIVISION LOCALITY rZ ,I JfA
JOHN A LAMBIE COUNTY ENGINEER NEAREST A
T F WILLIAM A JENSEN SUP T of BUILDING CROSS ST
D1STRl T NO GROUP PRO SED BY
FOR'APPLICANT TO FILL IN
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BUILDING STATISTICAL CLASSIFICATION SEVAR MAP
ADDRESS At PG
11 CLASS NO DWELL-UNITS—
LOT
NITSLOT NO P BLOCK MAP NUMBER HWYE YES r
TRACT USEZONE SPECIAL
NO OF BLDGS /h CONDITIONS
SIZE OF LOT NOW ON LOT CNV//
USE OF L
EXISTING BLDG BUILDING - EXIST
TEL SETBACK YARD HWY ST EET NAME WIDTH
OWNER L442Y4NO FRONT
P L
ADDRESS SIDE
ARCHITECT OR TEL P L
ENGINEER NO INSPECTION RECORD
ADDRESS _ n
CONTRACTOR TEL
ADDRESS E U
DESCRIPTION OF WORK
H
NEW ADD ALTER REPAIR DEMOLISH
SO FT NO OF NO OF Q1
SIZE STO S FAMILIES
USE OF t
STRUCTURE LfC7
t.I Q L coJ 41:
SIGNATURE OF
APPLICANT
VALUATION$ 3,oc)o
APPROVALS DATE INSPECTOR S SIGNATURE
PC PMT 0 FOUNDATION LOCATION40
FEE S `! FEE FORMS MATERIALS
FRAME FIRE STOPS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP BRACING BOLTS
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
WORKMEN S COMPENSATIONJ`a4.WS OF CALI RNIA LATH EXT oe
SIGNATURE OF �... r J HOUSE NUMBER COR a
PERMITTE RECT AND POSTED ,(
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ADDRESS
ukA a FINAL
CLYDE N DIRLAM PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION m o CASH PERM VALIDATION Clc m o CASH_
LAuj 1 7 3 7 E A42 7 -' 3 D 300
LtCO2 7 3 s1-4 � r ?7 1 0 1 2 00