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76A638A CE#803 8"63 APPLICATION FOR BUILDING PERMIT ,
COUNTY OF LOS ANGELES BUILDING E =:; ry � � J
DEPARTMENT OF'COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY ig
JOHN A LAMBIE. COUNTY,ENGINEER NEAREST ^
WILLIAM A JENSEN, SUP T,OF BUILDING CROSS ST
DISTRICT NO I GROUPTYPE PROCESSED BY
FOR APPLICANT TO FILL IN _- O coNsr —� ,
BUILDING L y� STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS ds D/a.iJ' -s CLASS NO DWELL UNITS IVK PG/
46
LOT NO A[-I::-BLOCK WATER NOT REQUIRED RECEIVED ❑
CERTIFIMAPCATE
TRACT CDC C/ NO '12 OCA HIGH
{ IGRCLE)
SIZE OF LOT ,26 NNO OF OW ON LOTS STATE MAJOR SECON LOCAL
USE ZONE SPECIAL
USEOF - �J6A4�s / P {� CONDITIONS 0 r
EXISTING BLDG'^� ,7 �-•` `'�//1 G�GpC /,��/
OWNER y�i'.�L ��%/vRO ry70��17 BUILDING EXIST
/y fir-+ �` SETBACK YARD HWY STREET NAME WIDTH
ADDRESS 0-5 3_z Fj 11Y.F ' �� FRONT �O
ARCHITECT OR TEL P L
ENGINEER NO SIDE
P L
ADDRESS
7
�`LL
CONTRACTOR R I& QQ Lp V
0
DESCRIPTION OF WORK v
W
d
NEW ADD ALTER REPAIR DEMOLISH i 1A
SQ FT NO OF NO OF /Q_ �� \ z
SIZE STORIES FAMILIEESS^
ke-
STRUUSE OCTURE D �Z, �'1�f- /( !I - b y�9
SIGNATURE O
APPLI ANT
VALUATION
�-• APPROVALS DATE INSPECTOR S SI GNA SURE
PC• 7j PMT 9 FOUNDATION LOCATION
FEE $ / FEE $ / — FORMS MATERIALS
FRAME FIRE STOPS n (�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE.IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION v
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH INT
TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN SOPENSA ION SU RA NCE `
Z1G/-� LATH EXT
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE �+ RECT AND POSTED
��'/�.� le -Al
ADDRESS �p-
PLAN CHECK VALIDATION CK M o CASH JOHN F LEWIS PRINCIPAL ST XJ"C qL ENGINEER
CHECK, VALIDATIONO --
PERMIT VALIDATION CK M o CASH
Lr4�of3i 2 4 2 AUG 28 2 3 0 1 9.7 5 A
Lt1T 3773 SEP15 1 d 3 9.50