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7fA659A CE#8J3 61 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING '_r
DEPARTMENT OF COUNTY ENGINEER ADDRESS-:J ;
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. 72�C-
DISTRICT NO. GROUP TYPE CESSED BY
FOR APPLICANT TO FILL IN CONST
BUILDING �j' STATISTICAL CLASSIFICATION EWER MAP
ADDRESS =) . � I BK 7
CLASS.NODWELL. UNITS /
LOT NO. C� BLOCK WATER NOT REQUIRED RECEIVED ❑
CERTIFICATE:
TRACT 1V MAP HIGHWAY STATE MAJOR SECOND, OCAL
NO.OF BLDGS. NO.. _.(r ICIRCLE)
�f'
SIZE OF LOT�,'O 1' I NOW ON LOT USE ZONE SPECIAL
USE OF �}� CONDITIONS _
EXISTING LDG. Z �'I.A C1'- iJ -2
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OWNER NO.k ti "3' _ BUILDING EXIST.
R
_ ro, YARD HWY STEET NAME
SETBACK WIDTH
ADDRESS d FRONT /'�+;
ARCHITECT OR TEL. P. L. _ -i c
ENGINEER NO SIDE y
P. L. G
ADDRESS TEL. INSPECTION RECORD c
CONTRACTOR NO. -
ADDRESS CF
DESCRIPTION OF WORK LL
a
v
NEW AD ALTER REPAIR DEMOLISH
SQ. FT. �j NO.OF NO.OF
LALUATION
d TORIES FAMILIES ,/
_.�-{�` -Z.�L.--iJ'S �.tu., C �:,
.q."''..;
F y�
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PPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. C' FOUNDATION: LOCATION
FEE I FEE 5 FORMS,MATERIALS
FRAME: FIRE STOPS, -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS ,r
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. - f`
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS /
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 CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE.
LATH,EXT.
SIGNATURE OF ,���- HOUSE NUMBER COR-
PERMITTEE a' RECT AND POSTED
ADDRESS -Sl F1NAL
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M. . CAS
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