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76AGSOA C-9 8'03 &.62 APPLICATION FOR BUILDING PERMIT
i
COUNTY OF LOS ANGELES I BUILDING ,
DEPARTMENT OF COUNTY ENGIADDRESS
NEER
BUILDING AND SAFE'L'Y DIVISION LOCALITY
JOHN A. LAMBIE. CouNTY ENGINEER NEAREST
WILLIAM A-JENS EN, QUP'T OF BUILDING CROSS ST.
DISTRj;;�O. GR�idP TYPE D
FOR APPLICANT TO FILL zC�/1 CONST.
BUILDINGI STATISTICAL C FICATION
ADDRESS n 'rWER MAP
CLASH. O. DWELL. UNITS O
LOT NO.j42 BLOCK WATER NOT REQUIRED_EjRECEIVED
CERTIFICATE:
TRACT MAP HIGHWAY
NO. OF BLDGS. NO. IcIRCL[) STATE MAJOR SECOND LOCAL
SIZE OF LOTNOW ON LOT USE ZONE 6NECIAL
USE OF 7 CODITIONS
EXISTING B DG.
OWNER
BUtLDING
YARD HWY STREET NAME WI,DST.
ST.
ADDRESS FRONT
ARCHITECT OR TEL P. L•
ENGINEER NO. SIDE
P. L
ADDRESS O
U
CONTRACTO
U)
ADDRESS bL
O
DESCRIPTION OF WORK
CL
NEW ADD R REPAIR DEMOLISH to
Z
SQ. FT. NO. OF NO. OF —
SIZE ST IES FAMILIES
USE OF
STRUCTUREv', •'�
SIGNATURE O
AT
PPLICAN
VALUATION $ * 0.0
APPROVALS DATE IN 'I•IONATURE
P.a PM FOUNDATION, LOCATION _ ?
FEE f FEE $ r FORMS, MATERIALS J
FRAMEc FIRE STOPS,
I HE ENY ACKNOWLEDON THAT I HAV[ RXAD THIe APr LIGATION BRACING, BOLTS
AND STATE THAT THK ADOVK Ie C041RKCT AND AGRKK TO COMPLY FURNACE, LOCATION.
WITH ALL COUNTY 15y
AND STAT[ LAW REGULATING GAB VENT, DUCTS
eU1LDi No CONSTRUCTION. I CIPMFY THAT IN DOING K WORK
AUTHO"I7� HXRKBY I WILL NOT XMPLOY ANY PERLO VIOLA- LATH, INT.
TION OF TH[ LASOR COD[ OF ATE OF CALIF A
No rD WORKwva e c •�RAt+a LATH,DCT.
SIGNATURE OF HOUSE PLUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL g '
JOHN F. LEWIS. PRINCIPAL STRUCTURAL EN()IiZMR
PLAN CHECK VALIDATION CK. M.O. GASH _ PERMIT VALIDATION CK. MA. CAIN
,telo D 9 5 iM 13 1 A 4.0 0
h
037 4�
.•7GA630A C=9003114; APPLICATION FOR BUILDING PERMIT
COUNTY OF LOSANGELES �IDRDIN j
DEPARTMENT OF COUNTY ENGINEER
BURDING AND sAFETY-DIVISION LOCALITY'
JOHN A.I-AMBLE,CouNTy ENaINBR NEAREST
mpmm�CASSATT GRIFFIN SUPT OF RUI INa OS -
DISTRICT NO. GR UP $ SEWER. MAP
FOR APPLICANT TO FILL.IN K
_ co
BUILDING r
ADDRESS STATISTICAL CLASSIFICATION
y
CLASS.N0 Elf.,
NI .
LOT NO: DLOCK MAP STATE
NUMBER HWY. YES _
TRACT U8 ZONE SPECIAL
NO.OF BLDGB. CONDITIONS
SIZE OF LOT NOW ON LOT
UBE OR I
1$TIA:&,-
A BUILDING YARD HWY 4YRELrT NYIEC EX1ST.
SETBACK WIDTH
OWNER FRONT I.
MAIL
P.L
ADDRESS 81DS
TEL.. R L
A RCH ITECT OR TEL
INSP=ON_ RECORD
ENGINEER i NOADDRIESS
.
TEL
CONTRACTOR NO. `�-
. Z1.�
ADDRESS
DESCHUMON OF WORK
NEW DALTE3T REPAIR DEMOLISH
8Q.FT. NO.OF NO.OF
81ZH - STORIES FAMILIdCB oz
UBH OF
SIGNATURE OF APPROVALA
APPLICANT'
r DATE INSPECTOR'!!SIGNATURE
ADDRESS - FOUNDATIONS LOCATION
FORMS.MATERIALS
P.C. >< _ — FRAMEi FIRE STOPS.
a FEE BRACING.BOLTS
VALUATIONFURNACE. LOCATION,
FEE GAB VENT DUCTS
1 HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH IM.,
PLICATION,,++,,NND STATE THAT THE ABOV I8 CORRECT AND
AGREE TO COMELY WITH ALL COUNTY ORDIILANqES AND
STATH LAWS REGU TINGB 1LD1NG CO UCTION. LATH,EXT.
SIGNATURE OF HOUSE NUMBER COR-
PKR)d=lr RECT AND POSTED
ADD FINAL
CLYDE N.DIRLAM PRINCIPAL UCTURAL ENGINEER
PLLN CHLCT VALMJMOX oc. M.O. OAf i PFBWr VALEDAMN CK- M-O.
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