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7awaaeACIS A03a58 ; APPLICATION FOR BUILDING PERMIT
ULDN COUNTY OF LOS ANGELES gDDRESS,
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION LOCALITY x
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST
DISTRICT ISLO I GROUP TYPE P E ED
FOR APPLICANT TO FILL IN I CONST I
BUILDING r' SEW MAP
STATISTICAL LASSIFICATION
ADDRESS C, BK PG
CLASS NO DWELL UNITS L 41
LOT NO BLOCK MAP STATE
NUMBER HWY YES O
TRACT r USEZONE SPECIAL
NO OF BLDGS J CON
�'] DITIO
SIZE OF LOT /3 Y,7-3 NOW ON LOT I�
USE OFXISTJMG
86DG BUILDING YARD HWY STREET NAME EXIST
SETBACK WIDTH
OWNER 1t FRONT Q
MAIL 3 O P L
ADDRESS SIDE
+� TELP L 1.
Iry NO SPECTION RECORD w
ARCH TECT O TEL
ENGINEER NO �a y
DDRES � � T l
TEL a .�
CONTRACTOR S NO
/ r I
DD S
DESCRIPTION OF WORK 5� r'f za
W ADD ALTER REPAIR DEMOLISHNscr- r '
FT ''ff^^ NO OF NO OF
SIZE ��y(S¢() STORIES FAMILIES
USE OF SN C URE Y
1
SIGNATUREOF APPROVALS
APPLICANT
DATE, INSPECTOR S SIGNATURE
ADDRESS FOUNDATION LOCATION I
FORMS MATERIALS J
/y P C S FRAME FIRE STOPS
� V O FEE BRACING BOLTS
VALUATION § FURNACE LOCATION
FEE 1--yGAS VENT DUCTS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LATH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND O
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND ZN
LATH EXT
STATE LAvis REGULATI BUILDING C STRUCTION HOUSE NUMBER COR 7
SIGNATURE `
PERMITTE RECTAND POSTED
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ADDRESS y
M�IFINAL c'
CLYDE N DIRLAM PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION C M O CASH PERMIT VALIDATION CK M O CASH
LAC, 1�,8;5 4 9r JAN-15 2 3 A _ 1 .9 501
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LAJ;o2 1 7{26r FEB 4 1 A 3 9 0 0 , SO