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76A538A Cr.#80311-57 APPLICATION FOR BUILDING PERMIT 1
COUNTY OF LOS ANGELES BUILDING -1
DEPARTMENT OF COUNTY ENGINEER ADDRESS
I Id BUILDING AND SAFETY DIVISION LOCALITY i
JOHN A.LAMBIE,COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST.
DISTRICT NO. I OROUP TYPE j�SEWER MAP
FOR APPLICANT TO FILL IN j IcoNsr /./ BK,��
BUILDING �`/ STATISTICAL CLASSIFICATION I
ADDRESS
CLASS.NO. DWELL.UNITS
LOT NO. Legal Attnchpci BLOCK MAP STATE
NUMBER y Y YE5 NO
TRACT USE ZONE SPECIAL '®
L NO.OF BLDGS. /' CONDITIONIf Qg!t
741
SIZE OF LOT 78 X 65 NOW ON LOT
Nc3n.p3
USE OF
EXISTING BLDG. BUILDING EXIST.
t �@. - V SETBACK YARD HWY STREET NAME WIDTH
OWNER r" Q Q FRONT
MAIL S IQZ d $%�LISOQ' .D P.L.
ADDRESS• SIDE -
TEL. P.L.
CITY Pasadena No.cty3z;)7A
ARCHITECTOR TELS /�i2� tiL INSPECTION RECORD
ENGINEER NO.
ADDRESS l L •0 - �Jj' ✓ lP
TEL. f P
CONTRACTOR NO. v `'r
ADDRESS 2'3r 4 S.' Ro g emA a d R l V d
DESCRIPTION OF WORK
NEWX ADD ALTER REPAIR DEMOLISH
SQ.FT NO.OF NO.OF
SIZE STORIES FAMILIES
USE OF STRUCTURE
Dwelling &
SIGNATURE OF APPROVALS
APPLICANT !
ATE INSPECTOR'S SIGNATURE
ADDRESS 2C S. R s I em a FOUNDATION: LOCATION P�
/ l FORMS.MATERIALS /' /rJolw f' �
FEE. $ 7 Q FRAME:
ACINGRBOLTTS S e_11
S
VALUATION —FURNACE: LOCATION. r
FEE 'GAS VENT.DUCTS/�
1 HEREBY ACKNOWLEDGE THAT I HAVE READ T;;85 AP- LATH,INT. i
PLICATION AND STAT_E T THE ABOVE IS CORRECT AND ,^ �)
AGREE TO COMPLY ALL COUNTY ORDLN/�NCES ANDA
STATE LAWS I G BUILDING NSTRUCTION. LATH,EXT.
STATE LAWS
SIGNATURE HOUSE NUMBER COR-
PERMIT' RECT AND POSTED
ADDRESS FINAL
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION M.O. CASH PERMIT VALIDATION CK. M.O. CASH
OF
C` 7 4 3 9 DECA 39.00
1.