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' APPLICATION FOR RELOCATION BUILDING PERmJT 1
' COUNTY OF LOS ANGELES BUD EISS
NT ` /
£DEPARTMEOF COUNTY ENGINEER ,
BUILDING AND SAFETY DIVISION LOCALITY ' G"L, '
JOHN A LAMBIE, COUNTY ENGINEER NEAREST A 1
WILLIAM A JENSEN, SUP T OF BUILDING CROSS ST
} DIST NO GROUP TYPE S WER AP PROC SED BY
-FOR APPLICANT TO 'FILL IN � r-- coNsr BK PG
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PROPOSED - t
BUILDING �0 L/e�O/ Al -MAP cq STATE (�g
ADDRES yy/ 4 'n NUMBER �liC� �p HWY YES NO '
LOCALITY USE ZONE SPECIAL
PRESENT, q / CONDITIONS
BUILDING
ADDRESS
LOCALITY /-//" l�l7 BUILDING YARD HWY STREET NAME EXIST
f SETBACK WIDTH
OWNER �/ G P [� ,� - FPROL T f
MAIL /S � �/v L.p/f A SIDE
ADDRESS T .yw�.
CITY
"� IJ TEL
T -3 P L `
//�� y /� SURETY DATE REC D
MOVINGCONTRACTOR lr1 • Po/pR e�14NO 4 /?_j�o� BOND FILED BY
t
y. g CASH ' DATE REC D
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ADDRESS-. / n le A DEPOSIT $ FILED BY
BUILDING T TEL / APPROVALS DATE INSPECTOR S SIGNATURE
CONTRACTOR NO, FOUNDATION LOCATION p
FORMS MATERIALS OADDRESS "
PRESENT FRAME FIRE STOPS,
ENT
USE E BRACING BOLTS 1
BUILDING E' S/'^ e Yl e'�._, _ �m PC y FURNACELOCATIO E-
PROPOSED p ` GAS VENTS DUCTS 0
USE OF
BOLDIN „e p ' IZ, W
t LATH, INT s a
�uj
SQ FT NO OF,, LATH EXT a
SIZE ROOMS - STORIES
WALL !� �/ HOUSE NUMBER COR
WALL
//QJ�La COVERING r /7�� RECT AND POSTED
LEGALFINAL
DESCRIPTION LOT`NO BLOCK"
TRACT �l DISTRICT ENGINEER
r WORK COMPLETED
ra NO OF BLDGS SURETY BOND
SIZE OF-LOT O1 F NOW ON LOT RELEASED
USE OF � , NO,OF� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
EXISTING BLDG z FAMILIES APPLICATION AND STATE THAT THE ABOVE IS CORRECT
1 HEREBY STATE THAT THE INFORMATION GIVEN AND AGREE TO COMPLY WITH,ALL COUNTY ORDINANCES
CORRECT ! AND STATE LAWS REGULATING BUILDING CONSTRUC-
SIGNATURE OF yy TION
APPLICANT �- I CERTIFY THAT IN DOING THE WORK AUTHORIZED 1
ADDRESS WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
WORKMEN S COMPENSATION LAWS OF CALIFORNIA
VALUATION $ P C $ SIGNATURE OF
w FEE PERMITTEE
' FEE $ ADDRESS
VALIDATION ' °"O CASH CLYDE N DIRLAM,PRINCIPAL STRUCTURAL ENGINEER
- PERMIT VALIDATION CK m6 CASH OF
C� ? ,1 7- w, ,2 2,a'2 5, D 2 5.0 0
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