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79AS38A CE#1103.1-61 APPLICATION FOR BUILDING PER
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY �L
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST e
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
DISTRICT NO_/ ROUP YpE P ED BY
FOR APPLICANT TO FILL IN BOJ coNsr. r�
BUILDING STA ISTICALCLASSIFICATION S ER MAP
ADDRESS �'� �/-ee� K PG
CLASS.NO./41-DWELL.UNITS!—
LOT NO. BLOCK WATER NOT REQUIREDVil RECEIVED
CERTIFICATE:
TRACT MAP /� HIGHWAY ST TE MAJOR SECON LOCAL
NO.OFBLDGS. N.. /-- (CIRCLE)
SIZE OF LOT I NOW ON LOT US- ZO E SPECIAL
USE OF CONDITIONS
EXISTING BLDG.
TEL. //
OWNER // NO. .- Z. B ILDING YARD HWY T NAME EXIST.
ADDRESS /��"� /'l�/N17IIIQ` SFRONTK1/ WIDTH
ARCHITECT OR TEL. P. L.
ENGINEER NO. SIDE
P.L.
ADDRESS TEL INSPECTION RECORD O
CONTRACTOR NO. V
ADDRESS
O
DESCRIPTION OF WORK u
W
a
NEW ADD ALTER REPAIR DEMOLISH N
SQ.FT. NO.OF z
IZE STO S FAMILIES
USE OF
STRUCTURE
SIGNATURE OF
APPLICANT
VALUATION$
APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. - FOUNDATION: LOCATION
FEE $ FEE $ FORMS,MATERIALS
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING, BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT.
TION OF THE LABOR CODE OF THE STATE OF C LIFO IA RELAT-
ING TO WORKMEN'S COMPE
i
TION ATE 0 N
LATH,EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS RIM, FINAL J"
CLYDE N. DIRLAM, PRINCIPAL STIR U AL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION (!� .o. CASH
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