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APPLICATION FOR BUILDING PERMIT S
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE.COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST.
DISTRIGTNO. I GROUP I TYPEI PROCESSED BY
FOR APPLICANT TO FILL. IN CONST.
BUILDING v STATISTICAL CLASSIFICATION I BK PG SEWER MAP
ADDRESS / vfi ,/
CLASS.NO._DWELL.UNIT6
LOT NO. BLOCK MAP STATE YES NO
NUMBER HWY.
RACT USEZONE SPECIAL
NO.OF BLDGS. CONDITIONS
IZE OF LOT / ' 1 v' l NOW ON LOT
USE OF
EXISTING BLDG. BUILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
OWNER % / / ,_'�%a / - ✓:
FRONT
MAIL
ADDRESS / Y. vim.+,... P.L.
TELSIDE
CITY NO. rll
ARCHITECTOR TEL. INSPECTION RECORD
ENGINEER NO.
ADDRESS
TEL.
CONTRACTOR NO.
ADDRESS
DESCRIPTION OF WORK
NEW (ADO ALTER REPAIR DEMOLISH
SO.FT. NO.OF NO.OF —
SIZE STORIES FAMILIES
USE OF STRUCTURE
SIGNATURE OF 7�l,t' APPROVALS
APPLICANT
DATE INSPECTOR'S SIGNATURE
ADDRESS F FORMS.MATERIALS CATION
$ Y FORMS.MATERIALS
- P.C. S FRAME: FIRE STOPS.
FEE BRACING.BOLTS
VALUATION $ FURNACE: LOCATION.
FEE GAS VENT,DUCTS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP. LATH.INT.
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
SSTATE LAS REGULA�T3NKGj BUIJ`I RUCTION. LATH,EXT.
IGNATUREOF HOUSE NUM
BER COR-
PERMTE RECT AND POSTED
ADDRES 1. / FINAL
CLYDE N. DIRLAM. PRINCIPAL STRUCTURAL ENGINEER,
PLAN CHECK VALMATION CIL M.G. D H PEDUr VALMATION cK. M.O. C H
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JeASSSA CE APPLICATION FOR BUILDING PERMIT
BUILDING AND SAFETY DIVISION nooaess 6 2A.cv
Department of County Engineer
County of Los Angeles LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
CASSATT D. GRIFFIN. SUPT OF BUILDING CROSS ST G,
FOR APPLICANT TO FILL IN DISTR�No. GROUP TYPE SPKfM 4P
J CO ST.
ADDRESS
BUILDING `/`/.22
T STATISTICAL CLASSIFICATION
LOT No. �� %�/J/ BLOCK CLASS. NO1`+ DWELL. UNITS
�/�� MAP STATE YES NO -
TRACT ��/ -l��/ NUMBER HWV
��{{ f/ U/�fE ZONE SPECIAL
SIZE OF LOT �Uh ,7 I NOW ON LOTS 3 -•�T//� NJ� CONDITIONS
USE OF _'•'00_
EXISTING BLDG. -e BUILDING EXIST.
YARD HWY STREET NAME
�/�� SETBACK WIDTH
OWNER G(/ -( FRONT �-
.MAILP. L.
ADDRESS 5�0OGY SIDE _ '
TEL. P. L.
CMM No /v1 INSPECTION RECORD''
ARCHITECT/61? TEL.
ENGINEER NO,
ADDRESS
TEL.
CONTRACTOR NO. - - I
ADDRESS �•- �•,,./ d -^' b' C
DESCRIPTION OF WORE -
471 0�.�.�.��—�C���_ A
NEW ADO ALTER REPAIR DEMOLISH - - E I�
SO. NO. OF NO. OF
SIZEFT. STORIES FAMILIES
USE OF STRUCTURE �+ t
a YG2!/P�77�r2 r�.JJ.
� n _ APPROVALS -
SIGNATURE
I APPLICADATE INSPECTOR'S SIGNATURE
ADDRESS F FORMS•MATERIALSUNDAION: ION 7 I0I'S7
FRAME: FIRE STOPS.
'FEE _BRACING. BOLTS
- -�c- FURNACE: LOCATION.
VALUATION .J v GAS VENT, DUCTS.
FEE f
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH, INT. 'I
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND _
AGREE TO COMPLY WIT ,ALL COUNTY ORDINANCES AND
STATE LAWS R GU G BU DI UGT LATH, ENU
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
A DDRE ss 2 'L FINAL
IO IN A. LAMBIE,'COUNTY ENGINEER, CLYDE N. DI RLAM, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.o. cwSH PERMIT VALIDATION CK. M.O. CASH
s 2032^ S 5 " 1 8.50 M