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76A638A CE#BD3 6 62 APPLICATION FOR BUILDING PERMIT IJ
COUNTY OF LOS ANGELES ADORE S. ��1�+21
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING { CROSS ST
DI T CAryp _ GROUP TYPE O ESSED BY
FOR APPLICANT TO FILL IN P v- CONST
BUILDINGSTATISTICAL CLASSIFICATION VEWER MAJP
ADDRESS Q t3 /7'K G
le CLASS NO DWELL UNITS
LOT NO d-3 I BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE
TRACTMAP HIGHWAY STATE JOR COND LOCAL
NO OF BLDGS N (CIRCLE)
SIZE OF LOT 3 NOW ON L/OT-O X
ONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG
O TEL
OWNER L� ` yvI b NO 3�7� BUIL ING EXIST
1 SETBACK YARD HWY STREET NAME WIDTH
ADDRESSSO ZZ ItIlSA 111WI L A/-e+ FRROL T
ARCHITECT OR
ENGINEER NO SIDE
P }
ADDRESS
TEL �v ' � O
CONTRACTOR NO
C � H
ADDRESS w
DESCRIPTION OF WORK S Y O
NEW ADD ALTER REPAIR DEMOLISH N
TNO OF NO OF _ D . ti F G� n C3 n f' Z
SIZE / A STORIES FAMILIES _
USE OF A.Jj 1'�-r �, A
STRUCTURE ,$'J Q, A-,-
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SIGNATURE O
APPLICANT
VALUATIO e fi A v/#
APPIR;VALSfo�P, D�A/TE c�
PFEINSPECTO SIGNA URE
CE $ I{{ !J� PMT
FEE $
FOFORMSI MATERIALS 7/! / /
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FRAME FIRE STOPS �
1 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
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BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK `
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLAy LATH INT
TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT / A
ING TO WORKMEN 5 PENSATION INSURANCE LATH EXT
SIGNATURE OF OUSE NUMBER COR
PERMITTEE RECT AND POSTED
ADORES
PLAN CHECK VALIDATION cK Mo cnsH _ JOHN F LEWIS PRINCIPAL STF�17E;fURAL ENGINEER
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PERMIT VALIDATION M.
CASH
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LJ��o 0 9 5 FEB142 0 3 U 5
LnLo 14 1 1- F-EB 2 6 1 D 6 050-