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/..638.C.�03 ,-a, APPLICATION FOR BUILDING 1?7ERMIT
COUNTY OF LOS ANGELES BUILDING n
DEPARTMENT OF COUNTY ENGINEER ADDRESS l/ �3 Z�4' L� 423
BUILDING AND SAFETY DMSION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST O
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST 'l✓
DIST�R CT NO G P n pE PR S BY
FOR APPLICANT TO FILL IN , coNST
BUILDING ��J E S s STATISTICAL CLAS FICATION S R MAP
ADDRESS 7 BK
i CLASS NO DWELL UNITS
LOT NO I Z [U BLOCK WATER
CERTIFICATE NOT REQUIRED RECEIVED
TRACT 4 MAP HIGHWAY
NO OF LDGS NO j (cIRCLE> STATE MAJOR SECOND LOCAL
SIZE OF LOT I NOW OBN LOT .7 USE ZONE SPECIAL
USE OFCONDITIONS
EXISTING BLDG rrt1. LZ.4C'r
TEL I
OWNER A! NO A L 13 MING EXIST
SETBACK
YARD HWY STREET NAME
WIDTH
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ADDRESS I. L_c k1�V O
FRONT _� n � �� ��
ARCHITECT OR TEL P L � 15
ENGINEER NO SIDE
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ADDRESS TEL , 1 INSPECTION�RECCPRD ` p
CONTRACTOR�iACr't*l S�-�w l�A?f4/ G�� r Ile)c. `w
ADDRESS ` & - � q O
DESCRIPTION OF WORK I /` -� ✓ ` /' ' P6 OR
��G P�i ShcY�J tl� i O_
NEW ADD ALTER REPAIR DEMOLISH
SQ FT NO OFNO OF
IZE O STORIES FAMILIES
USE OF //����� "
STRUCTURE (/{ Al2C)jZ nfKF—_
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SIGNATURE OF
APPLICANT + +�
VALUATION$
a/� APPROVALS J DATE INSPECTOR S S�GNATURE
PC PMT
r VCS FOUNDATION
MATERIALS
LOCATION
FEE $ FEE $
FRAME FIRE STOPS
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION t BRACING BOLTS /
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 ICERTIFY THAT IN DOING THE WORK
AUTHOR MIA / J-✓ �d/'
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT /
ING TO WORKMEN S COMPENSATI N INSURANCE LATH EXT
SIGNATURETTHOUSE NUMBER CQR
PERMIEE RECT AND POSTED a l e/
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ADDRESS--If FINAL I/ /
CLYDE N DIRLAM PJ` �,rRINCIPAL STRUCTURAL E
PLAN CHECK VALIDATION CK. M o CASH PERM VALIDATION CK M o G7
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