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APPLICATION FOR RELOCATION BUIL®IMG PE .MIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS l i-��jjl ✓(�L
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST 1
WILLIAM A. JENSEN,SUPT OF BUILDING CROSS ST
FOR APPLIC T O FILL IN DIST`.,NO GROUP CON SEWER MAPF P - ESSED BY
[ADDR
ROPOSED - v �1 t2
UILDING I S MAP / STATE
ESS f+ // W NUMBER ` HWY YES
OCALITY 4 C USE ZONE SPECIAL
RESENT ` CONDITIONS
UILDINGS I- / /DDRESS' /OCALITY 6 S BUILDING YARD HWY STREET NAME EXIST.
_ SETBACK WIDTH
OWNER VA Al r1,6 V Cf FRONT
MAILP L
ADDRESS 4 SIDE
TEL P L
CITY SURETY DATE RECD
CONTRACTOR
MOVING TELNO. .. BOND $ FILED By
^
W.
/+ CASH DATE RECD
ADDRESS Z Z \ DEPOSIT $ FILED BY
BUILDING ��`` TEL APPROVALS DATE INSPECTORS SIGNATURE >"
CONTRACTOFCl/I �� N P S FOUNDATION LOCATION - O
�y cJ FORMS, MATERIALS t o
ADDRESS O ArApL •-vq/Y Rl�� FRAME- FIRE STOPS,
PRESENT (� N is g� 'L_7--f BRACING, BOLTS a
USE OF O
BUILDING S FURNACE LOCATION ! 0
PROPOSED _USE OFc,,Q _ / 'tx GAS VENTS, DUCTS
BU LDIN v ' ��1` LATH, INT %' w
SQ FI'. NO OF LATH, EXT %
SIZE ROOMS -7 STORIES
WALL ♦ p f ROOF HOUSE NUMBER OR-
COVERIN A F1 h'4 IL COVERING /� RECT AND POST D
LEGALOY I FINAL
DESCRIPTION LOT NO. BLOCK
DISTRICT ENGINEER
TRACT WORK C " L ED
r NO OF BLDGS / SURETY O D
SIZE OF LOT NOW ON LOT RELEAS
USE OF NO OF 1 H y
LEDGE THAT I HAVE READ THIS
EXISTING BLDG � FAMILIES APPLIC ITATE THAT THE ABOVE IS CORRECT
1 HEREBY STATE T T THE 1 FORMATIO GIVEN IS ANDfA EPLY WITH ALL COUNTY ORDINANCES
CORRECT ANDTREGULATING BUILDING CONSTRUC-
SIGNATURE OF TION
p'PPLICP' 1 C YN DOING THE WORK AUTHORIZED 1
ADDRESS �7 D WILL NOT ANY PERSON IN VIOLATION OF THE
WORKMEN S COMPENSATION LAWS OF CALIFORNIA.
VALUATION $ P C $ SIGNATURE OF
FEE PERMITTEE
FEE $ ADDRESS
VALIDATION CK M.O. CASH CLYDE DIRLAM, PRINCIPAL STRUCTURAL ENGINEER
PERMIT VALIDATION M O. CASH OF