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76,%638,%m2/60 APPLICATION FOR BUILDING PER IT 1
COUNTY OF LOS ANGELES BUILDING
DEPARTNIENNT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING I CROSS ST
FOR APPLICANT TO FILL IN DISTRICT NO G UP TYPE P C SED BY
Q y� CONST
BUILDING j STATISTICAL CLASSIFICATION SE ER MAP
ADDRESS / BK PG
CLASS NO DWELL UNITS
LOT NO ,J fW,42t7 b, BLOCK15%J MAP STATE YES
NUMBER HWY
TRACT USE ZONE SPECIAL
/ -0 NO OF BLDGS }n � CONDITIONS
SIZE OF LOT d/ O NOW ON LOT I� I/'Y
USE OF
EXISTING BLDG BUILDING EXIST
TEL SETBACK YARD HWY EET NAME WIDTH
OWNER NO FRONT
? P L alo
ADDRESS ! SIDE
ARCHITECT OR TEL P L
ENGINEER NO INSPECTION RECORD
ADDRESS
TEL a
CONTRACTOR i NO O
ADDRESS V
DESCRIPTION OF WORK
IS Z 72.7 CUr 4vtr
NEW ADD ALTE REPAIR DEMOLISH y
SQ FT NO OF NO OF J ( /✓� LL
SIZE STORIES FA LIEUSE OFiv
S
STRUCTURE ,
r L !J 0 �0 drI
S IGNATUA OF
APPLICANT
VALUATION$ �. 010 1
APPROVALS DATE INSPECTOR S SIGNATURE
PCPMT FOUNDATION LOCATION
FEE $ FEE $ FORMS MATERIALS ,a
FRAME FIRE STOPS /
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP BRACING BOLTS �k<°CLLF-N7 Ak
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE LOCATION
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS
STATE LAWS REGULATING BUILDING CONSTRUCTION
1 CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH INT
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
WORKMEN S COMPENSATION LAWS OF CALIFORNIA LATH EXT
SIGNATURE OF HOUSE NUMBER COR
PERMITTE RECT AND POSTED pyo
ADDRESS FINAL
CLYDE N DIRLAM PRINCIPAL STRUCTURAL ENGI
PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK MO
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