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FOP. ANY MATERIAL STO'HOc Jn SNC=RK-
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7EABlBACE#003 B-B9 '-APPLICA"T"ION FOR BUILDING PERMIT_ "
COUNTY OF-LOS`ANGELES- BUILDING ADDRES
DEPARTMENT OF COUNTY ENGINEER i
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN,SUPT OF BUILDING CROSS ST '
DIST GRC 'TYPE RO SSED BY
APPLICANT TO FILL IN �7e� CON
STATISTICAL
'
BUILDING STATISTICAL CLASSIFICATION _ - SEWER MAP
ADDRESS OS,3.Z L -O _ - •' - K PG
�( CLASS NO DWELL UNITS -, I 'T
LOT NO.: l B f'I - 6 BLOCK' MAP STATE
NUMBER �� HWY YES 'NO
TRACT p /� USE ZONE SPECI L - '- - -
N OF --� CONDITIONS '
SIZE OF LOT 3S� r �4 O• I NOW ON LOTS �q�
USE OF
�S/ " �Q �cL'•>' BUILDING - EXIST
EXISTING BLDG
SETBACK .YARD HWY STREET NAME WIDTH
OWNER O O 74� FRONT; �Q
MAIL' - �Q S.-3 Y P L
ADDRESS /.. /✓ �� - SIDE `
'
TEL/11-1-/071
EL P L '
CITY T e �� C, No /• -/07 INSPECTION RECORD
ARCHITECT OR TEL
ENGINEER NO -L _�_C • - _ -
ADDRESS - / 1
TEL ; ' J. T,(j /�,%
CONTRACTOR �L� .NO TO QP r "'��-
ADDRESS C ep' '!'1'
DESCRIPTION OF WORK
�yr
NEW ADD ALTER REPAIR DEMOLISH
SQ" p NO OF NO OF ) -
SIZE �Q STORIES - FAMILIES
USE OF- �J '
STRUCTURE /'C G �E �^ C •, - - -
5.
SIGNATURE OF ,r y-,• .�y�
APPLICANT
APPROVALS DATE INSPECTOR'S SIGNATURE
ADDRESS - FOUNDATION. LOCATION ,L� _
FORMS,MATERIALS -'Z (+ -6
0 , 2
VALUATION $ '— FRAME FIRE STOPS, ^ �• I -
BRACING, BOLTS Z /�Iaa !_ `r, _
FURNACE LOCATION, �,O
FEE S / FEE GAS VENT,DUCTS /Q `•'v - `^ -
•I HEREBY ACKNOWLEDGE THAT 1 HAVE'READ THIS AP- LATH,INT. 6`to
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND I -
AGREE TO COMPLY WITH ALL'COUNTY ORDINANCES'AND
STATE LAWS GULA G BUIL CONSTRUCTION. LATH,EXT,
.HOUSE NUMBER COR-
RECT
OR- '
SIGNATURE O � RECTANDPOSTED -
PERMITTE
ADDRESS �`�"� •' FINAL
CLYDE N DIRLAM, PRINCIPAL STTdZVRAL.ENGINiEER
PLAN]CHECK VALIDATION CK M.O. CASH PERMIT VALIDATION cK. M o. r—sH _
L&5-53`15-1%2 JAM,2 2 2 3 A_. 13.5 O A oil -
JAN
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