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76A638A CE�#803 263 APPLICATION FOR BUILDING PERMIT
COUNTY OF ,LOS ANGELES ,BUILDING
uDEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISIONLOCALITY
JOHN A L^AMBIE COUNTY ENGINEER NEAREST I /
WILLIAM A JENSEN SUP T'OF BUILDING 'CROSS ST /
4a DISTRI T NO GROUP TYPE RCESSED BY
FOR APPLICANT TO FILL IN � \ CONS`
BUILDING STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS !e`�.� BK P
I CLASS NODWELL UNITS
LOT NO *^ - BLOCK WATER `
CERTIFICATE NOT REQUIRED RECEIVED '
V1 12
TRACT MAP .� J HIGHWAY STATE'MAJOR SECOND GIA# NO OF BLDGS - NO , (CIRCLE)
SIZE OF LOTNOW ON LOT USE ZONE SPECIAL, r'
USE OF J 3 CONDITIOS
EXISTING BLDG
T,EL
OWNER Q NO BUILDING YARD HWY S REET AM 7 EXIST
L SETBACK - r , / WIDTH
ADDRESS" /`
'
ARCHITECT OR TEL- 'STP LFRONT
r ENGINEER NO, - 1 SIDE }
ADDRESS , 4 t 0
TEL
CONTRACTOR l � - NO
ADDRESS
V
DESCRIPTION OF WORK r " _ a
4 (�
Z
NEW, ADD ALTER REPAIR DEMOLISH I z
SQ FT NO OF NO OF
SIZE STORIES FAMILIES -
USE OF
STRUCTURE J, '
9-66
SIG ATURE OF
APPLICANT ` r
VALUATION
I I APPROVALS DATE-, INSPECTOR Sr IGNATURE
P C� . PMT FOUNDATION LOCATION
FEE $ FEE $ - FORMS MATERIALS
FRAME FIRE STOPS 'r /
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY- 'FURNACE LOCATION
WITHALL 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 CODC O: THE STATE`OF CALIFORNIA RELAT - / r
ING TO WORKMEN S COMPENSATION INSURANCE LATH EXT
' SIGNAT OF HOUSE NUMBER COR
PERMITT _ RECT AND POSTED
A ��j
DDRESF FINAL
f _p JOHN F LEWIS PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK'VALIDATION CK M O CASH PERMIT VALIDATION-- CK M O CASH
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