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DEPARTMENT OF COUNTY ENGINEER ADDRESS (�► G f
BUILDING AND SAFETY DIVISION < LOCALITY r 6, (.
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST � /
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST.
• DISTRICT NO. GROUP I TYPE PROCESSED BY
FOR APPLICANT TO FILL IN S 0$ CONST.V
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FRAME: FIRE STOPS, /,., •t
I HEREBY 'AC K NOWLEDGE THAT I HAVE READ THIS APPLICATION I BRACT NG,.BOLTS
AND STATE THATTHE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION.
WITH ALL COUNTY ORDINANCES AND STATE LAWS T REGULATINW-. GAS VENT, DUCTS
BUILDING CONSTRUCTION. I CERTIFY THAIN DOING THE WORK�• / -
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE,LABOR CODE OF THE STATE:OF CALIFORNIA RELAT-
ING.TO WORKMEN'S COMPEENS TION INSURANCE. LATH, EXT. /
SIGNATURE OF �� HOUSE NUMBER COR-
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ADDRESS ,�'C FINAL SA/0.1
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JOHN F. LEWIS, PRINCIPXL'STRUCTURAL ENG R
PLAN CHECK VALIDATION CK: M.O. CASH 1 PERMIT VALIDATION CK. M.G. CASH
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COUNTY OF LOS ANGELES 'BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDREss,
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST } /
WILLIAM A. JENSEN SUP'T OF BUILDING CROSS ST.
DISTRICT NO. OUP TYPE P C SSED BY
FOR APPLICANT TO FILL IN CONST. SS
BUILDING // STATISTICAL CLASSIFICATION . SE ER MAP
ADDRESS(„ ;/Z� -�O , ZZ4 eZ � CLASS. NO. DWELL.UNITS Z7 C
-LOT-NO. .J '` BLOCK .WATER NOT REQUIRED RECEIVED
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pN L� .� (CIRCLE) STATE MAJOR SECOND, OCAL
SIZE•OF LOT.(fQ X i D 3. I NO.OF BLDGS.
NOW ON LOT USE ZONE SPECIAL _
USEOF- CONDITIONS
EXISTING'BLDG. TEL
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OWNER fr�7 A11NO./!/ ? � I. .
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SIGNATUREOF
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VALUATION$
APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION: LOCATION
FEE I .FEE $ 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.:[ 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 CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE.
'. LATH,EXT: ,
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SIGNATURE ' - HOUSE NUMBER COR
PERMITTEE_ CC.���IJJll �-�' RECT AND POSTED
ADDRESS 6-Z.�-o " FINAL
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENG
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION - CK. M.O. CASH
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