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76A688A}CE1038 APPLICATION FOR BUILDING PERMIT 1
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALI
JOHN A LAMBIE COUNTY ENGINEER NEAREST z t
C CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST
DISTRICT NO ;EP T.pE P CESSED BY
FOR APPLICANT TO FILL IN 9 `�j' CONST I
BUILDINGp
ADDRESS �d 6 J �S STATISTICASSIFICATION ,I SEWER A BK PG
LOT NO 7 �S BLOCK, CLASS NO DWELL UNITS
TRACT" (p`S � � NUMBER ' Qd SWYTATE
HYES
USE ZONE SPECIAL
p NO OF BLDGS �tl CONDITIONS
SIZE OF LOT � Q � l0 0 NOW ON LOT i +
USE OF
EXISTING BLD � S N/L /✓ °
BUILDING EXIST
SETBACK YARD HWY STREET NAME WIDTH
OWNER / S (v/£' 4' d FRONT
MAIL P L
ADDRESS SIDE ,
TEL 1 -P L
CITY NO " INSPECTION RECORD
ARCHITECT OR TEL ��s
ENGINEER NO
ADDRESS p
CONTRACTOR ea-vl /r C /%
ADDRESS �a,t '�J TC
0. /�T �'/s� r�S /►/ SD / �LGG�
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DESCRIPTION OF WORK ` PIS77
NEW ADD A E REPAIR DEMOLISH
SO FT e - NO OF NO OF
SIZE STORIES FAMILIES tn A/ n
USE OF STRUCTURE �r� LT Z/rJ Q Q rJ T
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Cl o-0
SIGNATUREOF �' i APPROVALS
APPLICANT a .Q
DATE INSPECTOR S SIGNATURE
ADDRESS FOUNDATION LOCATION
FORMS MATERIALS
$r P C S FRAME FIRE STOPS
FEE BRACING BOLTS
VALUATION � f) d S �� FURNACE
CE LOCATION N
FEE
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP LATH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WIT L COO,,Il NTY ORDINANCES AND
STATE LAWS R GU WING COQI TRUCTION LATH EXT -
SIGNATURE OF HOUSE NUMBER COR
PERMITTE RECT AND POSTED
ADDRESS FINAL �1U W& Nd9
CLYDE N DIRLAM PRINCIPAL TRU6TURAL ENGINEER
PLAN CHECK VALIDATION CK mo CASH VALIDATIONCK M O CASH
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