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79AG38A«aeo� 9 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
DIS ICT O TYPE PR ESSED BY
FOR APPLICANT TO FILL IN , coNsr
STATISTICAL CLASSIFICATION SEWER MAP
BUILDINGa I BK PG
ADDRESS (�
CLASS NO/��DWELL UNITS
LOT NO BLOCK MAPNUMBER 0 1 HWYE YES N
TRACT USEZONE SPECIAL
NO OF BLDGS CONDITIONS
SIZE OF LOT �zrI NOW ON LOT
USE OF
EXISTING BLDG BUILDING YARD -1WY STREET NAME EXIST
�` TEL L �J TBACK WIDTH
41
OWNER y=, Ill LY� /Y. NO RROL T
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ADDRESS SIDE
ARCHITECT OR TEL P L
ENGINEER NO INSPECTION RECORD
ADDRESS a
TEL /� 0
CO NO
ADDRESS
DESCRIPTION 65F WORK
° '' a
N
NEW ADD ALTER REPAIR DEMOLISH yi'`� °� Z
SO FT NO OF NO OF
SIZE STORIES FAMILIES Lo+r
USE OFa
STRUCTURE
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SIGNATURE OF
APPLICANT
VALUATION$
APPROVALS DATE INSPECTOR S SIGNATURE
PC PMT •• / FOUNDATION LOCATION
FEE $ FEES e5, FORMS MATERIALS
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS /yy
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 1 CERTIFY THAT IN THE PERFORMANCE } t
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I SHALL NOT LATH INT
EMPLOYANY PERSON IN ANY MANNER SO AS TO BECOME SUBUECT
TO THE WORKMEN 5 COMPENSATION LAWS OF CALIFORNIA
TH EXT
SIGNATURE OF USE NUMBER COR
PERM �r
ITTE CT AND POSTCD
ADDRESS FINAL 3
AL
PLAN CHECK VALIDATION/ CK CK M O CASE{ CLYDE NPS ISP T T VALIDATIONcK REN
M o ENGINEER
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