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7GA639A CE#8038-39 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST f^
CASSATT D. GRIFFIN, SUPT OF BUILDING I CROSS ST.
DISTRICT NO. GROUP I TYPE -_ I PROCESSED BY
FOR APPLICANT TO FILL IN CONST., .'.
BUILDING / ,.•� STATISTICAL CLASSIFICATION I SEWER MAP
ADDRESS �L,,,.� �� ,,� /� BK PG
/c.�/f b^-"-=-.ra l 44- ``fes'-'rte'- CLASS. NO. DWELL. UNITS
LOT N6 f�(}� ,.L ! BLOCK MAP - STATE YES NO
NUMBER HWY.
TRACT jr'� / USE ZONE SPECIAL
NO. OF BLDGS. CONDITIONS
SIZE OF LOT r I NOW ON LOT
USE OF : r BUILDING
EXISTING BLDG. EXIST.
YARD HWY STREET NAME
_ ! SETBACK WIDTH
OWNER !7-•/'_ / f {fa FRONT
MAIL P.L.
ADDRES �l� /< `1..CL.t°{ i`I„_ SIDE
TEL..- P. L.
CITY %`f-<--� rt NO. ' INSPECTION RECORD
ARCHITECT OR TEL.
ENGINEER NO.
ADDRESS
TEL.
CONTRACTOR NO.
ADDRESS
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLIS
SQ. FT. NO. OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE
SIGNATURE OF
APPLICANT APPROVALS DATE INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION: LOCATION
FORMS, MATERIALS
VALUATION $ --- I FRAME: FIRE STOPS,
BRACING, BOLTS
'`~ I FURNACE: LOCATION,
FEE $ FEE $ 'r
P.C. PMT. CJ GAS VENT, DUCTS
I "
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH,INT.
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS RSG LATl. @U.LLDII�IG CO/p, TRUCTION. LATH,EXT.
SIGNATURE OF`�, f / f .iJ HOUSE NUMBER COR-
PERMITTE Af f �.`Gµ RECT AND POSTED
ADDRESS--i�'1 �,�/ .G:- ,(., :o isdf '4'r. FINAL
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. + CASH
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