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76AS30A CC 44103 1�1 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS �G y
BUILDING AND SAFETY DMSION LOCALITY l
JOHN A LAMBIE, COUNTY ENGINEER NEAREST /
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
DISTRICT NO OUP TYPE —
CESSED BY
FOR APPLICANT TO FILL IN -p � � CONS
BUILDINGSTATISTICAL CLASSIFICATION WER MAP
ADDRE over BK PG
�� CLASS NO DWELL UNITS
LOT NO O/' LOCK WATER
CERTIFICATE NOT REQUIRED Q RECEIVED
TRACT �D .5 MAP HIGHWAY STATE MAJOR SECOND O AL
NO OF BLDGS NO '" (CIRCLE)
SIZE OF LOT0`5 X /�S S.�y NOW ON LOT Z USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG
TEL
OWNER {' / NO BUILDING YARD HWYSTREET NAM EXIST
ADDRESS to D Z GGOV ( G' SETBACK ) WIDTH
FRONT
ARCHITECT OR TEL P L
ENGINEER NO SIDE
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ADDRESS d
Q SPEC,TION RECgRD 0
'CONTRACTO ;OV-e / ;-e 47TEL
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ADDRESS!/ �Xi ; „7 CGI I'�` Q
DESCRIPTION OF WORK
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//'D ALTER REPAIR DEMOLISH Z
S ZET '9LVO STORIES FAMIILIES I
USE OF
STRUCTURE
SIGNATURE O
APPLICANT
VALUATIO $
APPROVALS 14ATE INSPECCTTdRR,S/SIGNATURE
PC PMT FOUNDATION LOCATION
FEE $ ` FEE S-, ) FORMS MATERIALS
FRAME FIRESTOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION 4' I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK t NOT EMPLOY ANY PERSON IN VIOLA
AUTHORIZED HEREBY I WILL LATH INT
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN S COMPENSATION INSURANCE
A,�/J LATH EXT
SIGNATURE O �l //� v�i'<cam(/ / HOUSE NUMBER COR-
PERMITTE RECT AND POSTED I✓[ IIS J�..
ADDRESS F -/I!/INAL - ,/���
CLYDE N DIRLAM, PRINCIPAL STR�c�1RAL ENGINEER
PLAN CHECK VALIDATION c M o CASH PERM[T VALIDATION ( c� m o C"H
}_Auo 3 5 2 2 Vn' 1 8 2 3 Q, 1 8 C o A �= �