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78A"A CE 809-7-'.58 A B Y ��V A II I O � FOR B`V I L®I 0 FI G II E 9 \Y 9 9 I E -
BUILDING AND SAFETY DIVISION BUILDING e
Department of County Engineer
ADDRESS ^ /— !�//✓�
• County of Los Angeles LOCALITY �+ /
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
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CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST L �/�
DISTRICT NO. GROUP .TYPE SEWER MAP -
FOR APPLICANT TO FILL IN
CONST
BUILDING
STATISTICAL CLASSIFICATION
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LOT NO. �� /d,.L/ ' Z� BLOCK CLASS. NO DWELL. UNITS
MAP STATE N
NUMBER 0� � HWY
TRACT - USE ZONE SPECIAL
NO OF BLDGS. -/ CONDITIONS
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EX STOING BLDG G'�'s.�- ��-.�1�--. B ILDING f^ ^/ �7 EXIST
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STREET NAME
OWNER �JL,��(/fes SETBACK i� WIDTH
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CITY I-el.La�/_%,0 NO. INSPECTION RECORD
ARCHITECT OR TEL
ENGINEER NO.
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ADDRESS Lzi/ _///�/ y� OJ/ � 1 •J ,G h �M�
DESCRIPTION OF WORK
NEW L ADD ALTER REPAIR DEMOLISH
SQ FT. /' NO. OF NO OF � _/ / CI GG v IV �G,
SIZE �"'T STORIES / FAMILIES f
USE OF STRUCTURE �IL/� ✓ �,'�T✓�
APPROVALS Y
SIGNATURE OF
APPLICANT•-� `�_ DATE' INSPECTOR'S SIGNATURE
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FOUNDATION* LOCATION
ADDRESS
FORMS, MATERIALS
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P. C. S { f�„�i FRAME FIRE STOPS. i�
FEE //t' BRACING. BOLTS oq
FURNACE LOCATION, C
VALUAT N GAS VENT, DUCTS 4-
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I HEREBY ACKNOWLEDGE THAT 1 HAVE EREAD THIS AP- LATH, INT. 4-!`
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH, c
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STATE LAWS REGULATING -UIL NG CONST r- [ON. _ ,
SIGNATURE OF - HOUSE NUMBER COR- y� �9
PERMITTEE RECT AND POSTED �// /
ADDRESS G-L ' FINAL c:r/ ., .sc••�
JOHN A. LAMBIE. COUNTY ENGIN R, CLYDE N. DIRLAM. PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION c M O CASH PERMIT VALIDATION CK M O CASH
Ar 6 7 -4 7 APR 3 1 22-00
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