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76A638A CE48038-63APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION OCALITY f
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST /-
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST.
DISTR.I�NO. GROUP TYPE P O E ED Y
PE
PPLICANT TO FILL IN S coNs .
STATISTICAL CLASSIFICATION SEWER MAP
rJ CLA 55. NO. DWELL. UNITS KBLOCK WATER NOT REQUIREDRECEIVED
CERTIFICATE:No. �D D �MAP ' EI STATE MAJOR SECOND. CAL
NO.OF BLGHWAY
DGS. /NOW ON LOT USE ZONE SPECIAL
USE OF ��q� CONDITIONS
EXISTING BLDG.
/ TEL. !+�G
OWNER Q O. J�-7"O✓6 BUILDING ,.p,RO HWY STREET NAME EXIST.
SETBACK WIDTH
ADDRESS FRONT
ARCHITECT OR TEL. P. L.
ENGINEER NO. SIDE
P. L.
ADDRESS }
TEL.
IIA a
CONTRACTOR i[/ (
NO. '/ Oj
ADDRESS a'
DESCRIPTION OF WORK F} P
n
NEW ADD ALTER REPAIR MOLISH Af"/- ') Z
50. FT. ..{ NO. OF /' /f
SIZE ��1(! STORIES / FAMILIES
USE OF G
STRUCTURE e
SIGNATURE OF
APPLICANT ) ro
VALUATION $ j�--tl
APPROVALS DATE INSPECTOR'$SIGNATURE
P.C. / PMT. FOUNDATION. LOCATION
FEE $ v FEE FORMS, MATERIALS
FRAME: FIRE STOPS.
HEREBY
ACKNOWLEDGE THAT HAVE READ GRE APPLICATION BRACING. BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL COU
ORDINANCES ANO STATE LAWS REGULATING GAB VENT. DUCTS
AUTHORIZED
CONSTRUCTION. CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY WILL NOT EMPLOY ANY PERSON IN VIOLA LATH. INT.
TION OF THE LABOR COpE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S C SATION INSURANCE_ LATH, EXT,
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED .�,J /
ADDRESS FINAL �/�
JOHN F. LEWIS. RINCIPAL ST C URAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. M.D. CASH
117 :8�� JUL 10 1A 4.0.0- a