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76A639A CE#8031-61 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ADDRESS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY 4 e
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST �
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. _'-e
iZ SA AL7
DISTRICT NO. I GROUP I TYPE PROCESSED BY
FOR APPLICANT TO FILL IN S o t j CONST. 6 o a
BUILDING [/(� / ^ ,�. STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS 7/. /�(. ��/�(�J�'E`L �' c' CLASS. NO.-'i-' DWELL. BK PG
.J DWELL. UNITS L. .4
LOT NO. �� BLOCK WATER NOT REQUIRED ❑ RECEIVED
i i ��-.. CERTIFICATE:
TRACT 16 /o S NO. (CIRCLE)
MAP 7 J HIGHWAY STATE MAJOR SECOND LOCA
SIZE OF LOT /-7 0 )( IL �� I NOW ON LOTp�
USE ZONE SPECIAL
USE OF /' �A G CONDITIONS
EXISTING BLDG. C V A -1 1
_ TE
OWNER NO / BUILDING EXIST.
�/p�t �/ / �' SETBACK YARD HWY STREET NAME WIDTH
ADDRESS j 7.2 fr/Yi J J,A��UL�a".0.L [ ' FRONT
ARCHITECT OR TEL. P. L •z L1. �"%`{:L-[-O W E
ENGINEER NO. SIDE
P.L.
ADDRESS
TEL. INSPECTION RECORD O
CONTRACTOR t)al "y&A NO.
ADDRESS O
DESCRIPTION OF WORK w
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NEW ALTER REPAIR DEMOLISH to
SQ. FT. ` NO.OF NO /r
.OF t ✓�
IZE J STORIES FAMILIES -
USE OFd y(/
STRUCTURE Ki
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SIGNATURE OF �r
APPLICANT y
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VALUATION$ ,� S GC D
APPROVALS DATE INSPECTOR'S SIGNATURE-
P.C.
IGNATUREP.C. I PMT, i^ L FOUNDATION: LOCATION
FEE $ FEE $r^ LZ FORMS, MATERIALS
FRAME: FIRE STOPS,
I 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 WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- I n
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S MP NSATION I URA E.
LATH,EXT.
SIGNATURE OF �_ HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL
CLYDE N. DIRLAM• PRINCIPAL STRYC URAL ENGINEER
PLAN CHECK VALIDATION cK. M.o. cAsH PERMIT VALIDATION cK" M.O. CASH