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16A6311A CE tt..r 61 APPLICATION FOR BUILDING PERMIT
I COUNTY OF LOS ANGELES BUILDING
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DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION LOCALITY 42 2 e off -
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. IQ • L
DISTRICT NO. I GROUP TYPE PROCESSE15 BY
FOR APPLICANT TO FILL IN o CONST.
BUILDING
STATISTICAL CLASSIFICATION ER MAP
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ADDRESS BK PG
/D S�N�/ /--/�@ Y S' T CLASS.NO.-�r—DWELL.UNITS -`
LOT NO, 3 BLOCK WATER NOT REQUIRED RECEIVED
p CERTIFICATE: LLLJJJ
TRACT / �,'I7 MAP HIGHWAY
J NO OF BLDGS. NO. V (CIRCLE) STATE MAJOR SECOND L CAL
SIZE OF LOT /, -�' �/� I NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS •
EXISTING BLDG. /
STEL. 1
OWNER e GL.-y/es.J: SCLC' Gj 1 NO•�/. BUILDING YARD HWY STREET NAMEEXIST.
�jL��7 /`G+.-YG+I- 0� SETBACK WIDTH
ADDRESS
AVP—� FRONT 1
ARCHITECT OR TEL. - P. L. /4-rQ
ENGINEER NO. SIDE O.
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ADDRESS TEL. INSPECTION RECORD u
CONTRACTOR NO.
F
ADDRESS U
W
DESCRIPTION OF WORK ' N
Z_
N AL ER REP DEMOLISH
S F NO.OF NO.OF
I E a x S, STORIES FAMILIES
USE OF AA -� 1 '
STRUCTURE ji" A � A 1 TSI^ 7, L'
Albw N -nucI A t,.„ I--w,
SIGNATURE OF e -
APPLICANT
VALUATION$ O /
��p/ APPROVALS DATE INSPECTOR'S SIGNATURE
FEE $ FEE $I FO FORMS.MA�TERIIALSON
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 ORDINANC ESAND STATE LAWS REGULATI G GAS VENT,DUCTS
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
A UTHORIZED.HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA-
TI
IOLA- LATH, INT. '!
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE. +±
LATH,EXT.
SIGNATURE O�% - vHOUSE NUMBER COR-
PERMITTEE� RECT AND POSTED ,I
ADDRESS 0 FINAL
tiM1,
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EZ-7 R
PLAN CHECK VALIDATION CK M.O. CASH PERMIT VALIDATION cK M.O.