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>•A•••A EE A.,.I-�I APPLICATION FOR BUILDING PER IT !J
COUNTY OF LOS ANGELES BUILDING tf
DEPARTMENT OF COUNTY ENGINEER ADDRESS ✓ �j
BUILDING AND SAFETY DMSION LOCALITY ,
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
DIS RICT NO. GROUP TYPE PRO ESSED BY
FOR APPLICANT TO FILL IN �f , CONS=
BUILDING / STATISTICAL CL)A.SSSIFICATION SEWER MAP
ADDRESS S O �• �• CLASS. NO.__L_CILIW ELL. UNITS C� ^^BK PG
LOT NO. BLOCK WATER OT REQUIREDLT RECEIVED 1-1
TRACT /�w1rp cr CERTIFICB L `//A)TE: HIGHWAY
SIZE OF LOT�J O 1 /Itys��I NOW ON LOTS US PZONE SPECIAL
(CIRCLEI STATE MAJOR SECOND, LOCAL
useOF /„14 CONDITIONS
EXISTING BLDG. 1\r
. TEL.
OWNER �1� , n NO. Pl— BUILDING YARD HWY 5 REET NAME EXIST.
ADDRESS ,f4'&O / � SETBACK WIDTH
FRONT 2�
ARCHITECT OR TEL. P. L. .J'O
ENGINEER NO. SIDE
P.L.
ADDRESS TEL. INSPECTION RECORD
CONTRACTOR NO. V
ADDRESS VII O
DESCRIPTION OF WORK
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NEW ADD ALTER REPAIR DEMOLISH Z
SO.FT. NO.OF NO.OF _
IZE STORIES FAMILIES
USE OF
STRUCTURE
SIGNATURE OF
APPLICANT
VALUATION S
APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION: LOCATION
FEE S FEE S FORMS, MATERIALS
FRAME: FIRE STOPS,
1HEREBY 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 ORDINANCE. 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 CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE.
LATH.EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE _ RECT AND POSTED
AooREss FINAL
CLYDE N. DIRLAM. PRINCIPAL STRUCTURAL ENG R
PLAN CHECK VALIDATION CK. M.O. GASH PERMIT VALIDATION CK. M.D. CASH
U`„0 3 2 2 2 SEP P 8 1 D 2 .0 0
APPLICATION FOR BUILDING PE �MI-T
COUNTY OF LOS ANGELES ADDRESS ��TV Z CXCYMJ
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION LOCALIT
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSSST,
DISTRICT NO. GROUP TYPE SED BY
q.
FOR APPLICANT TO FILL IN S, 6 CONST. / PR' ES
BUILDING r'I,{/� 7' �D STATISTICAL CLASSIFICATION EWER MAP
ADDRESS ( , v T� I �K %O
CLASS.NO2+3 DWELL.UNITS-0 PG
LOT NO. `7 BLOCK WATER NOT REQUIRED 111/ RECEIVED
Li
TRACT / 9rya3��. [� / CERTInFICATEq: LED
SIZE OF LOT.. •rV lT NO. OF BLDGS. NQ c+C..a V IICGRCLEI STATE MAJOR SECOND. LOCAL
NOW ON LOT USE ZONE SPECIAL
USEOF CONDITIONS
EXISTING BLDG. /L
TEL. �J
OWNER QW. NO. BUILDINGEXIST.
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS ,.f O FRONT
ARCHITECTOR TEL. P. L.
ENGINEER NO. SIDE
P. L.
ADDRESS TEL. INSPECTION RECORD
CONTRACTOR NO. 0
ADDRESS j
DESCRIPTION OF WORK V _ �� � �� O
N ADD ALTER REPAIR DEMOLISH
SO. FT. d NO.OF NO.OF _
SIZE /� STORIES FAMILIES
USE OF
STRUCTURE
c.
SIGNATURE OF
APPLICANT
VALUATION$
I� APPROVALS ��DATE� INSPEC dR'S SIGNATURE
FEE $ FEE $e/ `r0 FO FORMS, MATERIIALSON
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- FFINAL
INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE.
EXT.
SIGNATURE OF NUMBER COR-
IS
OR-
PERMITTEE AND POSTED
AODREss
CLYDE N. DIRLAM, PRINCIPAL STRUCTi/RAL ENG
PLAN CHECK VALIDATION cK M.O. cAex PERMIT VALIDATION CK. M.O. CAeH
L 3220 a $ P ? g 1 D 5.0v n