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78A838A CE#803 8 83 APPLICATION FOR BUILDING PERM
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COUNTY OF LOS ANGELES elsN
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DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION LOCALITY C�
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
DISTC Nf}, P` TYPE P
FOR APPLICANT TO FILL IN QY CONST
BUILDING I TL_ STATISTICAL CL SSIF ATION SEWER MAP
ADDRESS {P� 411KK o PG
CLASS NO DWELL UNITS VV ..J?fV�
LOT NO LOCK WATER
CERTIFICATE NOT REQUIRED RECEIVED
TRACT MAP HIGHWAY STATE MAJO SECOND LOCAL
NO OF BLDGS NO (CIRCLE)
SIZE OF LOT NOW ON LOT USE ZONE SPECIAL
USE OF ^ CONDITIONS
EXISTING BLDG
OWNER O CCl BUILDING YARD HWY STREET NAME EXIST
SETBACK WIDTH
ADDRESS % m FRONT
ARCHITECT OR TEL P L
ENGINEER NO SIDE
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ADDRESS
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DESCRIPTION OF WORK
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USE
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SIGNATURE OF
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VALUATION $ 00
APPROVALS DATE INSPECTOR 6 SIGNATURE
PC PMT FOUNDATION LOCATION
FEE $ FEE $ , FORMS MATERIALS
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY i WILL NOT EMPLOYAN ERSON IN VIOLA LATH INT
TION OF THE LABOR CODE JF THE STATE O AL ORNI ELAT
ING TO WORKMEN S COMP ATI INSU LATH EXT
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE RECT AND POSTED
ADDRESS FINAL
F LEWIS PRINCIPAL
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PLAN CHECK VALIDATION CK M O CASH JOHNPERMIT VALIDATION TRCK URM O ENGINEER
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76A638A CE 6.3 APPLICATION FOR BUILDING PERMIT '
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
DIraZR1CT R U TYPE P Y
FADDRESS
R APPLICANT TO FILL IN a ONST
STATISTICAL CL SSIFICATIO4 SEWER MqP
CLASS NO DWELL UNITS BK-- •per- —J
BLOCK WATER
CERTIFICATE NOT REQUIRED RECEIVED F]
TRACT MAP HIGHWAY
NO OF BLDGS NO CZ 10 (CIRCLE) STATE MAJO SECOND LOCAL
SIZE OF LOT NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG on
TEL
OWNERSor-49 NO BUILDING EXIST
SETBACK YARD HWY STREET NAME D H
ADDRESS FRONT
ARCHITECT OR TEL P L
ENGINEER NO SIDE C
P L (! • ♦ O
ADDRESS
V
TEL
NO14
0
ADDRESS U
DESCRIPTION OF WORK I a
I �
Z
EW ADD ALTER REPAIR DEMOLISH
F NO OF NO OF
SIZE STORIES FAMILIES
USE OF • >�
STRUCTURE
SIGNATURE OF
APPLICANT
VALUATION $
APPROVALS DATE INSPECTOR S SIGNATURE
PC PMT .0 FOUNDATION LOCATION
FEE $ FEE VV FORMS MATERIALS
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR CODC OF THE STATE OF CALIFO IA RELAT
ING TO WORKMEN 5 CO PENSA&101RANO LATH EXT
\SIGNATURE F I HOUSE NUMBER COI#
.'PERMITTEE RECT AND POSTED
ADDRESS Ina FINAL 4
JOHN TR
PLAN CHECK VALIDATION CK M O CASH NII
t PERT VALIDATION CK ruRM o EN CASH
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