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76AGSBA CE 403 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS z
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST '
DISTRI U21
TYPE P S BY
FOR APPLMffmmm3mICANT TO FILL IN CONST
BUILDING r q STATISTICAL C SSIFIC TION SEWER MAP
ADDRESS a -�Z l f� C_�SF1�/��O I B �C,Cy�/
LOT NO CLASS NO� DWELL UNITS
f BLOCK MAP STATE YES NO
TRACT / NUMBER p�O HWY
USE ZONE SPECIAL
NO OF BLDGS CONDITIONS
SIZE OF LOT N W ON LOT
USE OF
EXISTIN BLDG "" BUILDING EXIST
YARD HWY STREET NAME
7�� SETBACK WIDTH
4./
OWNER _ f-t p L lLs FRONT ��I �O !
MAIL P L �(J _
ADDRESS SIDE
TEL P L
CITY NO E INSPECTION, RECORD, r
ARCHITECT OR TEL
ENGINEER 4 / L4—FO4L,4.IA,--'-; NO
ADDRESS
TEL
CONTRACTOR L lc-mo
_jjD RESS
DESCRIPTION OF WORK
NEW'*< ADD ALTER REPAIR DEMOLISH a
SQ FT NO OF NO OF
SIZE STORIES FAMILIES
USE OF STR gC RE G ( _ 'S—, g
SIGNATURE OF APPROVALS i
APPLICANT
DATE INSPECTOR S SIGNATURE
ADDRESS LFOFORMSTMATERIAION C LOCATION
$ P C S. FRAME FIRE STOPS
G� FEE BRACING BOLTS
VALUATION .ADD $ FURNACE LOCATION
L
FEE GAS VENT DUCTS
f
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LATH INT 1
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITHAL OUNTY RDIN_ANCES AND LATH EXT ,
STATE LAWS REGULATI RUCTION
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE RECTANDPOSTED
ADDRESS FINAL
CLYDE N DIRLAM PRINCIPAL STRU RAL ENGINEER
' PLAN CHECK VALIDATION 01 mo CASH PERMIT VALIDATION cK mo CASH,
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L4to5826-u ItPR28 2 3 A 300At ®'
M5827cu) APR28 1 A 1200 � k