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76A638A CE#803 5-61APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ABUILDING
DDRESS /O ' E e e rSr.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION LOCALITYTi ern C
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OP BUILDING CROSS ST. Q
DISTRICT NO. GROUP TYp PROCESSED BY
FOR APPLICANT TO FILL IN ,S— -F I CONST. 3r V11u K
BUILDING p / STATISTICAL CLASSIFICATION ER MA
` ADDRESS /D 7 G/ :2�l.t'Y' Fr CLASS.NO.—Z—DWELL.UNITS B� _3
LOT NO, BLOCK WATER NOT REQUIRED ❑
lkjRECEIVED
p CERTIFICATE:
TRACT JL 7 MAP / HIGHWAY LOCAL
O.OF BLDGS. T NO. 1 (CIRCLE) STATE MAJOR SECOND,
SIZE OF LOT NOW ON LOT ( USE ZONE SPECIAL ��
USE OF CONDITIONS
EXISTING BLDG. + l L/� G _
TE
OWNER [Y ,�, � NQ 'w f �� BUILDING YARD HWY STREET NAME EXIST.
�.�, ,,,cc. SETBACK C WIDTH
ADDRESS .P6.1 f T�zSRY C.G / re �{� /6)"
� FRONT
ARCHITECTOR TEL. P. L. �U ).
j ENGINEER NO. SIDE d.
P.L. O
ADDRESS TINSPECTION RECORD
CO RACT NE O. .l
O
ADDRESS S .2 -su..J 47 u
DESCRIPTION OF WORK 2.'
y � Z
5
NEW I^ ADD ALTER REPAIR DEMOLISH 7 "
SQ.FT. NO.OF NO.OF
IZE STORIES FAMILIES
USE OF
STRUCTURE
0
SIGNATURE OF
APPLICANT
VALUATION$ /
fh�WROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT NDATION: LOCATION _
FEE $ F _�" FORMS,MATERIALS
n RAM E:FIRE STOPS,
I HER EDGE TH T sa♦ o ICA N RACING, BOLTS
AND STA E THAT THE ABOVE 1 CT O CO LY FURNACE: LOCATION,
WITH ALL COUNTY ORDINANC A D S W IN GAS VENT DUCTS -
BUILDING CONSTRUCTION TIFY T I
AUTH OR I ZED.H E REBY I WI ` OT EM Y AN L -
TION OF THE LABOR CODE OF TH TATE _ F,QR A EL y LATH, INT.
ING TO WORKMEN'S COMPENS A 1 U E. C(nJ(
LATH,EXT,
SIGNATURE OF ' /' HOUSE NUMBER COR-
PERMITTEE T RECT AND POSTED
ADDRESS -'C FINAL '9 _
CLYDE N. DIRLAM, PRINCIPAL STRU RAL ENGINEER
PLAN CHECK VALIDATION cK M.O. CASH PERM VALIDATION cK M.O. CASH
76A638A CE#B03 5-61APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING .�
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY c
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
DISTRICT NO. G U TYPE SSED BY
FOR APPLICANT TO FILL IN CONST.
BUILDING STATISTICALCLASSIFICATION SE ER MAP
ADDRESS _K
CLASS. NO. DWELL.UNITS �—
El
LOT NO. BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE:
TRACT � MAP HIGHWAY STATE MAJOR SECOND, (0–CA
� O.OF BLDGS. NO. i (CIRCLE)
SIZE OF LOT OW ON LOT US-7 ZONE SPECIAL
USE OF C CONDITIONS
EXISTING BLDG.
TEL.
OWNER - - NO. BUILD NG EXIST.
SETBACK YARD HWY TREET NAME WIDTH
ADDRESS 62 FRONT
ARCHITECT OR r TEL. P. L. ' ti f >-
ENGINEER NO. SIDE d
P.L. O
ADDRESS INSPECTION RECORD
TEL
CONTRACTO
ADDRESS i (J
DESCRIPTION OF WORK H
Z
N ADD'W ALTER REPAIR DEMOLISH �'>
SQ.FT. _ NO.OF NO.OF yr
IZE - - STORIES FAMILIES
USE OF e c
STRUCTURE
SIGNATURE OF
APPLI 'I
CANT
VALUATION S t�
APPROVALS DATE INSPECTOR'S SIGNATURE
FEE FEE $ FOUNDATION: LOCATION
FORMS,MATERIALS
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS }
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 DOING THE WORK
AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA• LATH, INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT.
ING TO WORKMEN'S COMPENSAr N INSURANCE.
LATH, EXT, -
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE - RECT AND POSTED
` j,
ADDRESS - � / FINAL �1= 1."' - �_ `��.:-_--. � r
CLYDE N. DIRLAM, PRINCIPAL STR AL EP46INEER
PLAN CHECK VALIDATION CM M.O. CASH PERM VALIDATION M.O. CASH