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DIVISION OF BUILDING AND SAFETY OCCUPANCY-SAFETY-TRAILERS
Department of County Engineer
County of Los Angeles BUILDING . 11
JOHN A LAMBIE. COUNTY ENGINEER ADDRESS Q G�,R �`� Aj e
CASSATT D GRIFFIN,SUP T OF BUILDING `7 t
LOCALITY i
FOR APP ICANT TO F LL IN NEAREST d W
OWNER CROSS ST Z-'J..S CA-
OWNER
ADDRESS (�S` �� tu
MAIL- DISTRICT NO GROUP I TYPE CON T
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CITYC"j,(,,, ti�„ NO 1 on`�S MAPSTATE
TEL NUMBER o.2—t5 HWY YES NO
CONTRACTOR NO USE ZONE SPECIAL
CONDITIONS
ADDRESSLEGAL
DESCRIPTION I LOT NO' BLOCK BUILDING
BACK YARDI HWY I STREET NAME I WID H
NO OF BLDGS
TRACT NOW ON LOT FPROINT I I I
I EX STUSEO NG BLDG SiIDE I I
SIZE OF LOT P L
APPLICATION FOR INSPECTION RECORD
OCCUPANCY
INSPECTION I SAFETY PERMIT
TRAILER USE I LIMITED TIME USE
F �°�� ✓
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DATE DATE
FROM TO
USE OF STRUCTURES OR DEVICES
r,-, v -
INSPECTION FOR
OCCUPANCY AS - -- -
APPROVALS
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS DATE INSPECTOR SIGNATURE
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES OCCUPANCY APPROVAL
AND STATE LAWS REGULATING BUILDING_CONSTRUC- GROUP OCC LOAD 1
TION
SIGNATURE OF TRAILER USE -�
PQRMITTEE 'f•
_A SAFETY PERMIT Ov I
ADDRESS� TEMPORARY
{
GG STRUCTURE APPROVED
TEMPOBARY � I Y
STRUCTURE REMOVED
FEE$
Q FINAL APPROVAL
JOHN A LAMBIE COUNTY ENGINEER VALIDATION CLYDE N DIRLAM, CHIEF BLDG INSPECTOR
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