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76A638A CE#8035.61APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ABU DD ESS C I—
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
0I5T CT N GROUP T PR CE S Y
FOR APPLICANT TO FILL IN -� G' CONST.
BUILDING %��') ,/ / /�� STATISTICAL CLASSIFICATION SEWER MAPA
ADDRESS /�`7 /� 4/ K P
_ CLASS. NO. DWELL. UNITS
LOT N90, BLOCK WATER NOT REQUIRED RECEIVED
TRAIT .ERTIFICATE: �����z
T
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NO.O�LDGS. NOP �%C.� HIGHWAY
STATE MAJOR SECOND, OCAL
SIZE OF LOT �7J J' �J'(/ (NW ON LOT USE ZONE SPECIAL
,
USE OF CONDITIONS
EXISTINGJ�BLDG �%f/�''//�l
OWNER/J��o-I�L'*� ..�LGi���ZxI/ NO.
BUILDING EXIST.
J �f �j YARD HWY STREET NAME
ADDRESS`J�,Jr��`7✓`j� /yd'"rl' SETBACK WIDTH
' FRONT I --� /
ARCHITECT OR TEL. P. L. >'
ENGINEER NO. SIDE I
Q
P.L.
ADDRESS EL Q n INSPECTION RECORD m
CONTRACTOR ,�,Q� NOR v Q
ADDRESSr W
DESCRIPTION OF WORK H
Z
NEW AADQ ALTER REPAIR DEMOLISH -
SQ. FT ,.�(r �` NO.OF NO.OF
IZE L /I�1I STORIES FAMILIES
USE OF 1117
STRUCTURE
SIGNATURE OF
APPLICANT
VALUATION$ e .
APPROVALS .DATE INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION: LOCATION
FEE $ FEE $• < FORMS, MATERIALS
FRAME: FIRE STOPS.
IHEREBY 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- LATH, INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WOR NQS COMPENSATIOrA INSURANCE.
LATH,EXT.
SIGNATURE . •( HOUSE NUMBER COR-
PERMITTEE �`"" RECT AND POSTED '
ADDRESS FINAL r~. -"•' -t
i
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. . M.O. c"m PERMIT VALIDATION M.O. CASH
0 5 7 8 AFF, 52 3 0 pi 5.0 '0 F'
1 D 3 6A' 0 in