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76A888A CE#803.1- 1 APPLICATION FOR BUILDING PERMIT
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COUNTY OF LOS ANGELES BUILDING
UIADDL ss
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIWSION LOCALITY !
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST j
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
DISTRICT NO. GROUP Tp PE Pq7SED BY
FOR APPLICANT TO FILL IN CONST.
BUILDING cf �J� STATISTICAL CLASSIFICATION SE ER MAP PG
ADDRESS '�d� "/(g '.' i-,ti CLASS.NO. DWELL.UNITS B
LOT NO. / BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE:
TRACT MAP / HIGHWAY'
NO.OF BLDGS. NO_ /'i (CIRCLE) STATE MAJOR SECON OCAL
SIZE OF LOTX tel/ I NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG.
TEL.
OWNER - NO. rf Zlef BUILDINGEXIST.
SETBACK YARD HWY ST BEET NAME WIDTH
ADDRESS FRONT j)
ARCHITECT OR TEL. P.L. 'L
ENGINEER NO. SIDE i
ADDRESS
TELIN,S�P TION RECORD O
- .,
CONTRACTOR 4/,L.7 Ga.i �rL Ilk 4i.`NO.f 4_� J,Z U
ADDRESS ' + BL.�E /:7'y BLrA' Q
DESCRIPTION OF WORK u
W
CL
NEW ADD ALTER REPAIR DEMOLISH N
-SQ.FT. - NO.OF NO.OF
�IZE .�� 4 STORIES I FAMILIES J'
USE OF
STRUCTURE 00,
SIGNATURE OF
APPLICANT -
VALUATION$ .�1
APPROVALS DATE INSPECTOR'S,SIGNATU
FEE $� I FEE $ 06 FOUNDATION: LOCATION
FORMS,MATERIALS
FRAME: FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT I 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 WQRK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PE N IN VIOLA- LATH,INT. C '
TION OF THE LABOR CODE F THE STATE O CA ORNIA RELAT-
ING TO WORKMEN'S CO' N SU NC ".
LATH,EXT.
SIGNATURE OF HOUSE NUMBER COR- ..1, - ..
PERMITTEE I RECT AND POSTED
ADDRESS 'S ° ;
FINAL
CLYDE N. DIRLAM, PRINCIPAL ST Ctj1RAL ENGINEER
PERMIT CHECK VALIDATION cK ' M.O. CASH PERT VALIDATION �� M.O. CASH
LliW 6 0 0 41-c� rluv 72 3 G 2 8.501 � r
Lto 7 5 4 0:ai NOV 2 8 1 G