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7ue3eACc#e03 1-61 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
B=ING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUPT OF BUILDING CROSS ST
DIS�ICTN GR TYPE RO S Y
FOR APPLICANT TO FILL IN 677_ CONST
BUILDING STATISTICAL CLAS IFICATION SE ER MAP
ADDRESS BK PG
CLASS NO DWELL UNITS �
LOT NO BLOCK WATER
CERTIFICATE NOT REQUIRED RECEIVED
TRACT MAP /J HIGHWAY
NO OF BLDGS NO v (CIRCLE) STATE MAJOR SECON OCA
SIZE OF LOT to NOW ON LOT USE ZONE SPECIAL
USE OF /� / CONDITIONS 7
EXISTING BLDG //'�'/ ,
OWNER 7' NEL r i1
7 BUILDING EXIST
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS/40 FRONT �,e, /L
ARCHITECT OR TEL P L �{(l lJ
ENGINEER NO - SIDE ilkj
P L
ADDRESS
TEL jNSPEr_TTOjq RECORD O CONTRACTOR NO V_
ADDRESS m J" 8'�L63 �K d Q
DESCRIPTION OF WORK 7 9 _c-t 19 _ W
IL
EW ADD ALTER REPAIR DEMOLISH -Z f �` , Z
SO FT_ NO OF NO OF 4
IZE STORIES FAMILIES
USE OF J
STRUCTURE
nw
UIGNATUREUOF
APPLICANT LA
VALUATION$ 3 a
AP ROVALS JDATIf INSPECTORS SIGNA3U E
PMT ,fin FOUNDATION LOCATION FEE i " ✓ FEE $ ��. �v FORMS,MATERIALS _
FRAME FIRE STOPS. o'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS i MiiYPS.
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 1 CERTIFY THAT IN DOING THE WORK (^] A
R
AUTHORIZED HEREBY I WILL NOT LOY ANY PER ON IN VIOLA- LATH, INT f!�/ I4/0
TION OF THE LABOR CODE OF TH ATE OF AL NA RELAT- ` -
ING TO WORKMEN S COMPENSAT INSURA E E _
LATH,EXT fff
SIGNATURE OF HOUSE NUMBER COR-
PERM IT[L RECT AND POSTED /A
ADDRESS 144.40eFINAL
PLAN CHECK V ATION o cASH CLYDE PERMIT VALIDATIONTRuCM, PRINCIPAL K. MA0.
EN N R
Lik,o3411p APR 16 ? 3 D 75.00' v
l 'I�« 6019 J '�; � � ) 1 5 � i,, 0
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