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7818881/C9#8089-60 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST �^
WILLIAM A. JENSEN SUPT OF BUILDING CROSS'ST.
DISTRICT NO. I GROUTYPE PROCESS BY
FOR APPLICANT TO FILL IN ' CONST., I'
BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS Q �a J� �`�I' •.� , `� CLASS. NO-5—DWELL.UNITS I B / V ,"
LOT NO. ® CD - - BLOCK MAP
/ STATE
NUMBE
YES O
o
YdTRACT USE.ZONE SPECIAL"
NO.OF SLOGS. CONDITIONS
' SIZE OF LOT ��!'jj I NOW ON LOT 2 �� �7 - \
EX STUSEO NG BLDG. A/6 /v C-S .BUILDING EXIST.
_ YARD STREET NAME
" �'7 j / � SETBACK WIDTH I
OWNER 9. (�(j , I///L``L.•Cq �y rr NO. FRONT �� / \Q�
ADDRESS
Ur,�. y I�/moi (J'b�'. �._-_•»,. .SIDE ' ' �� \
ARCHITECT OR TEL. P.L.
ENGINEER. NO. INSPECTION RECORD
�oADDRESS of Y // 'p�e t� G-
CONTRA T`OR / •I/`yr .,'�/'=C JCSIE�NO ,,, L�7� - OV
e ADDRESS 119--J-3 L• C
DESCRIPTION.OF WORK a
NEW DD ALTER REPAIR DEMOLISH
Sq. FT. ,$ 9 NO.OF NO.OF
SIZE STORIES �. FAMILIESUSE
_
STRUOCTURE �� �O 1L T '
SIGNATURE OF
APPLICANT
VALUATION
_ APPROVALS DATE INSF CTOR'S SIGNA URE
P.C. PMT. 7 FOUNDATION: LOCATION
FEE. �--f.h o I FEE �I FORMS. MATERIALS
FRAME: FIRE STOPS,
BRACING, BOLTS f1 �Y. �
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION �"�ah, 6� I�(,�'�
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING„CONSTRUCTION, I CERTIFY THAT IN. THE PERFORMANCE -
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I SHALL NOT LATH, INT.
EMPLOY ANY PERSON I ANY.MANNER SO AS TO.BECOME SUBUECT
TO THE WORKMEN'S OM PENSATION LAWS OF CALIFORNIA. `
LATH, EXT.
SIGNATURE HOUSE NUMBER COR
-
.PERMITTE A RECT AND POSTED
ADDRESS ,6">:4 6 _ 'r FINAL
CLYDE N. DDIIRg7VLAyM�, PRINCIPAL STRUCTURAL E �
PLAN CHECK VALIDATION CK. M.O, CASH PERMIT VALIDATION . CK, M.O. CASH
2 r O r� n /�,
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