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78A838A CE#803 B_83 APPLICATION FORUILDING ERMIT -
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS 0
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST `
DISTRICT N GROUP TYPE P SSED BY ..
FOR APPLICANT TO FILL IN 5, C1 CONST
BUILDING / STATISTICAL CLASSIFICATION S WER MAP
ADDRESSj^J BK P
I � CLASS NO DWELL UNITS
LOT NO ' BLOCK WATER
CERTIFICATE NOT REQUIRED RECEIVED
TRACT MAP HIGHWAY STATE MAJOR SECOND OCAL
'S NO OF BLDGS y{ NO L (CIRCLE)
SIZE OF LOT U IS NOW ON LOT .
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' ZONE SPECIAL 1�Cl
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USE OF Jf CONDITIONS
EXISTING BLDG
TEL
OWNER UILDING EXIST
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS j ,NV✓��� FRONT
ARCHITECT OR , TEL P L
ENGINEER NO $IDE
ADDRESS nn T 'y. X O A'.�- 1"'1 'N'Ll o Af J!sC1'.:� l , {�A to
CONTRALTO vh N / O 0 "' �J / `,f'p�sa lit u
ADDRESS / /_,A- I%— 4 ! 3 1 C `" ti =— .. O
DESCRIPTION OF WORK
Lu'
NE ADD ALTER REPAIR DEMOLISH z
QNO OF NO
E T / STORIES FAMOF / '
USE OF E6
S
STRUCTURE
I
Q,a:"' o'*o.
SIGNATURE OF
APPLICANT
VALUATION $ , s-.� APPROVALS DATE INSPECTOR S SIGNAT RE
</ FOUNDATION LOCATION
FEE s PMFEE T FORMS MATERIALS
F $ $
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS I1 fr A
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS V ( $ <F
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LAB CODC OF THE STATE OF CALIFORNIA RELAT (w
ING TO WORKMEN PENSATIO NSU RA NCE ' G r
LATH EXT
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE RECT AND POSTED
�r
ADDRESS FINAL .,
0- LAN CHECK-VALIDATION cK' M o CASH JOHN F LEWIS PRINCIPALS URAL ENGINEER
PERMIT VALIDATION CK M o CASH
z �
2 5 9 " _ AtlG 1 3 2 3D
30.254 d
3098% AUG 25 1 D 60S0N d