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76A638A CE 4 803 6 62APPLICATION FOR BUILDING PERM T
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY C
d JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST rl
DISTRICT NO G P TYPE OCESSED BY
FOR APPLICANT TO FILL IN �-� CONST
L
BUILDING STATISTICAL CLAS IF CATION EWER MAP
ADDRESS BK/
CLASS N WELL UNITS
LOT NO Q� BLOCK WATERElCERTIFICATE NOT REQUIRED RECEIVED
TRACT MAP HIGHWAY, STATE MAJOR SECOND OC L
NO OF BLDGS / NO (CIRCLE)
SIZE OF LOT NOW ON LOT USE ZONE SPECIAL
USE OF I CONDITIONS
EXISTING BLDG
TEL V
OWNER 1 NO 1-Q+ O" BUILDING EXIST
yyJJ r �. SETBACK YARD HWY STREET NAME WIDTH
ADORES W �/'` FRONT
ARCHITECT OR TEL P L r
ENGINEER NO SIDE
P L a
ADDRESS O
TEL
CONTRACTOR NO h
ADDRESS O
DESCRIPTION OF WORK ~
-! a
NEW ADD SLYER REPAIR DEMOLI N
Z
SQ FT NO OF OF —
SIZE STORIES FAMILIES
USE
STRUCTURE
ol
SIGNATURE OF
APPLICAN
VALUATION $ l
�APPROVALS DATE INSPECTOR S SIGNATURE
P C PMT .t FOUNDATION LOCATION
FEE $ FEE FORMS MATERIALS I
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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 1
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT I \
ING TO WORKMEN S COMPENSATION INSURANCE
�/ LATH EXT
SIGNATURE O/l HOUSE NUMBER COR �—
PERMITTEE ��Cl�/.(^Q RECT AND POSTED
ADDRESS,,_{ !�stif^t-Mtn Q,,. W 97#{ FINAL
JOHN
PLAN CHECK VALIDATION CK M O CASH _ I PERMIT VALIDATION TRCK RM O ENGCASH
ER
0 7 4 8 6- NOV 27 1 D 4 00- c
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