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78AG381 CE#803 6157 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER A°DRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST
walm DISTRICT NO GROUPSEWER MAP
FOR APPLICANT TO FILL IN r._ TYPE B
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BUILDING CLASSIFICATION
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ADORE (� STATISTICAL f
CLASS NO /- DWELL UNITS
LOT NO BLOCK '
7MAP C STATE YES Nd
TRACT p� NUMBER J HWY
USE ZONE SPECIAL
NO OF SLOGS r ` / / CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLDG BUILDING EXIST
SETBACK YARD HWY STREET NAME WIDTH
OWNER FRONT
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ARCHITECT OR TEL INSPECTION RECORD
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DESCRIPTION OF WOAK
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NEW ADD ALTER REPAIR DEMOLISH q w`
SQ FT q NO OF NO OF Cl `�p �A A I AI ^ Y
SIZE =2 ,k
2 STORIES FAMILIES
USE OF STRUCTURE �ex:I
SIGNATU APPROVALS
APPLIC
ADDRESS FOUNDATION�LION DATE �i INSPECTOR-S SSII�GNASIGNATUREORMSMATERIALS
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$ J P C 3 FRAME FIRE STOPS
FEE BOLTS
VALUATION / ( 7D O sv V F BRACING
LOCATION
FEE 1 GAS VENT DUCTS ��y�,r✓�
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP TH INT I „17! ®�l:.P/"
PLICATION AND STATE THAT THE ABOVECORRECT AN
AGREE TO COMPLY ALL COU O INANCES AN �v v /
STATE LAWS RE TI BUI N CONSTRUCTION LATH EXT L
SIGNATURE OF HOUSE NUMBER COR
PERMIT'" RECTAND POSTED
ADDRESS FINAL
JOHN A LAMBIE COUNTY ENGINEER CLYDE N DIRLAM RI CIPAL --rRUqXURALENGINEER
PLAN CHECK VALIDATION cK m o CASH PERMIT VALIDATION 6.1-1mo CASH
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LAC,o 4 7 3 9°° SEF 12 2 3 A 1675
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