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76A638A CE#a0311-57 APPLICATION FOR BUILDING PERMIT Z
COUNTY OF LOS ANGELESgDDRESS —Df.� GliCk
DEPARTMENT OF COUNTY ENGINEER
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BUILDING AND SAFETY DIVISION LOCALITY =lo
JOHN A.LAMBIE.COUNTY ENGINEER NEAREST _
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. T.
DISTRICT NO. GROUP TYPE SEWER MAP
FOR APPLICANT TO FILL IN BK
CONST L,
BUILDING STATISTICAL CLASSIFICATION �J
ADDRESS - /
1, CLASS.NO.�DWELL.UNITS
LOT NO. ":C1 BLOCK MAP STATE YES NO
•JrA^,r^' 1c_cn LV i - NUMBER ® 0 HWY.
TRACT -- -^+r USE ZONE SPECIAL
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NO.OF BLDGS. ' CONDITIONS
_ �
SIZE OF LOT 2 I NOW ON LOT C.
USE OFJ
EXISTING BLDG.li',�'i�SSE: ^. 'C� BUILDINGXIST.
SETBACK YARD HWY STRE AME WIDTH
OWNER ,_,j;!., -;,• T-,^-ll FRONT 120
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MAIL _ P.L. a
ADDRESS - =• SIDE
TEI�, P.L.
CITY "_i NO. INSPECTION RECORD
ARCHITECT OR TEL.
ENGINEER NO. I
ADDRESS
TEL,
CONTRACTORL,:'Ci"."' , • i NO;}T
ADDRESS 7)'l lo, n+DESCRIPTION OF WORK
NEW -'� ADD ALTER REPAIR DEMOLISH
SQ.FT. NO.OF l NO.OF -
SIZE ''' mj STORIES FAMILIES-
1
USE OF STRUCTURE
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SIGNAT RE O 00, �. APPROVALS
APPLIC
DATE INSPECTOR'SSIGNATUR
ADDR S ! .,�.--: Lor-er 1 " l'- � � FOUNDATION: LOCATION 'L / ✓
FORMS,MATERIALS O 7
$ FRAME: FIRE STOPS, /
FEE BRACING,BOLTS f ��
VALUATION (, SS FURNACE: LOCATION.
FEE GAS VENT,DUCTS -
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH,INT.
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMP ITH ALL COUNTY �1��,ESSTATE LAW EGU TING BUIL 1 LATH,EXT.
SIGNATUOF - HOUSE NUMBER COR-
PERMI RECT AND POSTED
ADDRES T'^' - FINAL
CLYDE N.DIRLAM, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
_x,02929- x- 172 3 A 13.004
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