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1Y1381 CA#.032/90 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMSIE, CouNTY ENGINEER NEAREST -
WILLIAM A. JENSEN Bug T of BUILDING CROSS ST.'
FOR APPLICANT TO FILL IN msrr N .GROUP TYPE' 7w&, _4
R
�. CONST. _4&
BUILDING ((— // J, - /./t STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS J iI6 N ige7 / +e�IJ �d� CLASS.NO.�DWE, UNITS / B
LOT NO. BLOCK MAP i1 STATE YES NO
'1 NUMBER oL
Y.
TRACT Z�G IX d USEZONE SPECIAL �•
��11 NO.OF SLOGS. - /I % CONDITIONS
SIZE OF LOT /�O X „Z d IN ON LOT
USE OF
EXISTING BLDG. _ S - - BUILDING - EXIST.
YARD HWY -STREET NAME
SETBACK WIDTH
OWNER .Q oC 1-e ei^NO. -��� FRONT I J
/ P.L.
ADDRESS _f Q eW SIDE .
ARCHITECT OR TEL. P,L.
ENGINEER NO. INSPECTION RECORD
ADDRESS ..,'11♦ '
CONTRALTO/RQw1�11�-r NO,. �� � �V' , 9 )u�" t a
ADDRESS J/ N• .P _� ''/l� '9 .R� enw�Y9s AnJ f"'1 lC!. V
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH -
FT. NO.OF / NO,OF
SIZE SLU STORIES FAMILIES
USE OF J
STRUCTURE YL 4
SIGNATUFaOF
APPLICANT Avo
VALUATION S r
rAPPROVALS DATE INSP CTOR'S SIGNATURE
P.C.
n a o PMT, j� FOUNDATION: LOCATION A
FEE $ FEE r7 a� FORMS MATERIALS d/fin rYA
( HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE
- BRACIN
STOPS,G, BOLTS
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION,
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS U
STATE LAWS REGULATING BUILDING CONSTRUCTION.
1 CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH, INT.
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
WORKMEN'S COMP NSATION LAWS OF CALIFORNIA. LATH, EXT. �, 9
SIGNATURE OF HOUSE NUMBER COR-
PERM=EE RECT AND POSTED
ADDRESSZ=2 6 / FINAL Y
T CLYDE N. DIRLAM. PRINCIPAL STRpeTUfAL ENGINEER
PLAN CHECK VALIDATION <K. M.O. <A9H PERMIT VALIDATION(<K, , M.o. <Asx
292 -1JIJ ?L�5 2 3 U r2 2.5 0 '. r
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LAC�3 C)-0..L9 .qua;
30 1. D 45.00 �/