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70A538A CB.sos APPLICATION FOR BUING PERMI
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF .COUNTY ENGINEER
ADDRESS O
BUILDING AND SAFETY DIVISION LOCAL&Y
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WIT AM A.JENSEN, •UP'T OF BU ILDINQ CROSS ST.
DISTRI N GRO E P OCE 4Y
FOR APPLICANT TO FILL IN ON
BUILDINGSTATISTICAL C SSIFICATION SEWER MAP
ADDRESS 01-57
CLASS. NO. DWELL. UN IT� BK P�
WATER
LOT N f ( OCK CERTIFICATE: NOT REQUIRED RECEIVED
TRACT D MAP HIGHWAY
NO.OF BLDGS. NO. Q ICIRCLZ) STATE MAJOR SECOND OCAL
SIZE OF LOT NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG.
TEL
OWNER NO. "qbO dUIL6TNG EXIST.
/ SETBACK YARD HWY Or REET NAME WIDTH
ADDRESS 411 l FRONT
ARCHITECT OR TEL P. L-
ENGINEER NO. SIDE
P. L.
ADDRESS
TEL O
CONTRACTOR + O.�Z. 1 U
ADDRESS c
DESCRIPTION cfFwoaK
NEW ADD ALTER REPAIR CE-OLIS H
Z
SQ. FT. NO. OF
SIZE STOFjIES FAMILIES
USE
STRUCTURE
SIGN RE OF
AP IUCA NT
VALUATION$ V4 O
APPROVALS DAT INSP[CTOR'S SIGNATURE
P.C. PMT. FOUNDATION: LOCATION
FEE $ FEE $ 'el FORMS, MATERIALS
FRAME: FIRE STOPS,
I HC1EEY ACKNOWLEDGE THAT I HAV[ READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ADOR
OVE If CRKC-r AND AGREE TO COMPLY FURNACE: LOCATION.
WITHALL COUNTY ORDINANCEA AND UTATE LAW REGULATING GAS VENT. DUCTS
EUILDI Na CONDTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHOArZES
D HERESY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT.
TION OF THE LAEOR COD[ OF THE ATE qo 'l
F CALIF R RELAT-
ING TO WORKMEN'•COM 6ATION •U
LATH. EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL
JOHN F. LEWIS. PRINCIPAL STRUCTURAL EN/�T}.�'y-� �J
PLAN CHECK VALIDATION CK. M.G. CASH PERMIT VALIDATION CK. M.O. (CJ�SH /
5 0 72-0 OCT2 0 1 D 4,0 .0- q
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