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76A668A CE#8032/60 APPLICATION FOR BUILDING PERMIT Z
COUNTY OF LOS ANGELES BUILD,NG
DEPARTMENT OF COUNTY ENGINEER A°DRES
BUILDING AND SAFETY DIVISION LOCALITY '7
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
DISTRICT NO. GROUP TYPE PROCESSED BY
FOR APPLICANT TO FILL IN � coNsr. I
BUILDING /�
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS��j.,,����j,�- /U �7 ^�� �s/�� _
f–f �7 � � BK PG
� —�^I '9 � CLASS.NO. � DWELL.UNITS
LOT NO. e� - ' / ` rN BLOCK MAP STATE YES NOr
_ > /
_ NUMBER HWY. -
TRACT I _„y ��_ � -.h / \_r:. 1„d USE ZONE SPECIAL
�- 'i "` 1 NO.OF SLOGS.
SIZE OF LOT _ f..._ CONDITIONS
1 NOW ON LOT
USE OF Y '
EXISTING BLDG. / �_'% it (:7.�t °.Y• r %-= BUILDING EXIST.
SETBACK FRONTYARD HWY STREET NAME
T O ly6 -; SK WIDTH
OWNER �
r
ADDRESS ,ice/ `�. / - SIDE
•- a_� -r�- --'-__
ARCH ITECT OR TEL. P. L.
ENGINEER NO. INSPECTION RECORD
ADDRESS
TEL. Qi
CONTRACTOR Ci -'''�" /LY; NO. O
ADDRESS U
DESCRIPTION OF WORK a
O
NEW ADD REPAIR DEMOLISH w
III SQ.FT. NO.OF NO.OF (y�
SIZE STORIES FAMILIES
USE OF 7 /. __ , "&
STRUCTURE �//�� p�"�'"t4
s • I
SIGNATURE OF ( ' � dh a /
APPLICANT-
VALUATION
PPLICANT VALUATION$
APPROVALS DATE INSPECTOR'S SIGNATURE
IPMT. FOUNDATION: LOCATION
FEE $ i FEE $ � FO RMS, MATERIALS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS,
BRACING,
_ BOLTS
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION,
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT,DUCTS
STATE LAWS REGULATING BUILDING CONSTRUCTION.
I CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH, INT.
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
WORKMEN'S COMPENSATION^ S QF CALIFORNIA. LATH,EXT.
SIGNATURE O - HOUSE NUMBER COR-
PERMITTEF� RECT AND POSTED
ADDRESS FINAL
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGJDLEZR
PLAN CHECK VALIDATION CIC. M.O. CASH PERMIT VALIDATION CK. M.O. /CASH ;
5 28
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