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....... APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILpwG [-�' J
DEPARTMENT OF COUNTY ENGINEER ADDRESSs LLe.
BUILDING AND SAFETY DIVISION LOCALITY, ati � d
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUP•Ton BUILDING CROSS ST.
FOR APPLICANT TO FILL,INDISTft ICT n)O. GROUP TYPE POtEED BY
CONST.
BUILDING _ �'7 1 STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS Tv CLASS,NO. DWELL. UNITS BFcp _ PG(J
LOT NO. la BLOCK - WATER NOT REQUIRED RECEIVED
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TRACT O 0 CERTIFICATE: - .,
/ MAP pI HIGH-NAY
SIZE OF LOT. / �� NO.OF BLDGS. NO. STATE MAJOR SECOND,(LOCAV
NOW ON LOT - USE ONE SPECIAL • , q .�•`�'
USE OF s..e wLO. CON IT
EXISTING BLDG.
OWNER „'!//Y OLS v . TO.L. -rf-)% BUILDING EXIST.
5�/T J SETBACK YARD HWY `JSTREET NAME WIDTH
ADORES T .0 FRONT )/ J
ARCHITECT OR TEL. P. L. -- ),
t/
ENGINEER NO. SIDE
P. L. Y
appREss
TEL. INSPECTION RECORDn s. 0
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CONTRACTOR NO. �� {'' Ii v
ADDRESS NK / .- I.r' 1.P'I Y..`/' NGf-n/1�.-!.^n
DESCRIPTION OF WOMB /�� �� �� Al! ��.2. �» G
NEW ADD ALTER- RE ghfR DEMOLISH (
5FTI� � NO. BOL4,ui 0
IZE STORIES FAMILIE
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• // st� �J/ y A�/(`, pf
USE OFlfnll V F�n .�fftW"• >�
STRUCTURE /
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SIGNATURE OF nn�,
APPLICANT I�
VALUATION$
r� APPROVALS ,DATE INSPECTOR'S SIG ATVRE
FEE $26 /� PMT' S^ FOUNDATION: LOCATION b/z�/G� _
FEE $ FORMS, MATERIALS O /
FRAME: FIRE STOPS, / •� y
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS
AND STATE THAT THE AROV E IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCT .,h
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
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AUTHORIZD HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOL _ LATH, INT.
TION OF THE LABOR CODE OF THE STATE OF LIFORNIA RE
ING TO WORKMEN'S/fOMPENSATION IN SU NCS 'LATH, EXT.
SIGNATURE OF �/ c
PERMITTEE H OUSE NUM BER R.
ECT AND POSTED
ADDRESS NAL
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EER
PLAN CHECK VALIDATION CK. M.o. cABx PERMIT VALIDATION DK, M.G.
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