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7GM444 0897SIf-55 MISCELLANEOUS APPLICATION 4 .
DMSION OF BUILDING AND SAFETY OCCUPANCY-SAFETY-TRAILERS
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
CASSATT D GRIFFIN,SUPT OF BUILDING LOCALITY
OR PP AN FI NEAREST
OWNER CROSS STMAIL a
ADDRESS DISTRICT N GROUP TYPE CONST.
/ _ �: �
CITY �f ! �f NO G����� MAP / STATE
TEL NUMBER v �+� Hwy
CONTRACTOR NO USEZONE SPECIAL
CONDITIONS
ADDRESS ���
LEGAL
DESCRIPTION I LOT NO r —� BLOCK BUILDING YARD HWY I I EXIST.
SETBACK STREET NAME WIDTH
TRACT �4l -T I NOW ON LOTNO OF S FRONT
USEOF P L
I SIDE EXISTING BLDG
SIZE OF LOT P L
APPLICATION FOR ! INSPECTION RECORD
OCCUPANCY
INSPECTION SAFETY PERM IT
TRAILER USE I LIMITED TIME USE
DATE DATE
,FROM TO
USE OF STRUCTURES OR DEVICES
I �
INSPECTION FOR I - - I _
OCCUPANCY AS -- -
APPROVALS
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS DATE INSPECTOR S SIGNATURE
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITHALS..COUNTY ORDINANCES OCCUPANCY APPROVAL
AND STATE LAWS REGULATING BUILDING) CONSTRUC- GROUP occ LOAD
TION
SIGNATURE OF t f ! �L TRAILER USE
PERMITTEE
-/-4r-'
-' f SAFETY PERMIT
ADDRESS
TEMPORARY
STRUCTURE APPROVED
TEMPORARY
STRUCTURE REMOVED
FEE$ (�U
~ "" FINAL APPROVAL
1 - 1
JOHN 4 LAMBIE. COUNTY ENGINEER VALIDATION CLYDE N DIRLAM. CHIEF BLDG INSPECTOR
y CK jM0 'CASH10
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