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78A888A CE#808 10-SB APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING F`
DEPARTMENT OF COUNTY ENGINEER ADDRESS ,
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST. '
DISTRICJ NO. GROUP TYPE "" PROCESSED BY.
FOR APPLICANT TO FILL IN I coNST._
BUILDING, '�-- _ / �/..'.' STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS '` .'� rj,'. P✓'=,{1 '.-.. BK ,-PG
� � '� _ CLASS.NO.�DWELL.UNITS /��
LOT NO.,,_„ ` /,' .yam, y0 ft MAP STATE YES NO
BLOCK NUMBER HWY.
TRACT ':' L:F�(.._ r I_ ��(,� r USE ZONE SPECIAL y�- rte/
•' _ • CONDITION .•/ �•`
NO.OF.BLDGS ,r i
SIZE OF LOT e - I NOW ON LOT ,
USE OF
EXISTING BLDG. - BUILDING YARD HWY STREET NAME EXIST.
SETBACK WIDTH
OWNER ' -? - FRONTs
MAIL P.L. - -
ADDRESS'.:. ..> ? _' ..: SIDE
TEL. P.L.
CITY NO. INSPECTION RECORD
ARCHITECT OR TEL.
ENGINEER NO.
ADDRESS
„ TEL
CONTRACTOR NO,/
ADDRESS - �
DESCRIPTION OF WORK —
NEW ADD ALTER REPAIR DEMOLISH
SQ.FT. NO.OF NO.OF r"
SIZE STORIES FAMILIES
USE OF
STRUCTURE
SIGNATURE OF
APPLICANT
APPROVALS DATE INSPECTOR'S SIGNATURE
ADDRESS - FOUNDATION: LOCATION
FORMS,MATERIALS
VALUATION$ FRAME: FIRE STOPS,
s
BRACING,BOLTS
P.C. - PMT. _j FURNACE:LOCATION,
FEE .J "' I FEE I GAS VENT,DUCTS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH.INT.
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULATINGyBUILDING CONS3"CTION. LATH,EXT.
SIGNATURE OF * "'"mow``--.. "-'-�yG.<. HOUSE NUMBER COR-
PERMITTEE� 4A -f"Ji'l fifi...��rP}Li+Y ,./' RECT AND POSTED
ADDRESS ,..r "� FINAL
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION J/CK. j M.O. CASH PERMIT VALIDATION CK. M.O. CASH
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