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76A688A cE#BDB 8_68 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS AI1jGFi"FC BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A JENSEN,SUP T OF BUILDING CROSS ST
DISTRIC=N TYPE BY
FOR APPLICANT TO FILL IN 0 coNST
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BUILDINGY STATISTICAL CLAVIFICION SEWER M
AP
ADDRESS we r_' vrA CLASS l-_ zx_ WATELL BK PG
LOT
NO OCK WATER
CERTIFICATE NOT REQUIRED RECEIVED
TRACT MAP HIGHWAY
NO OF BLDGS NO (CIRCLE) STATE MAJO SECON LOCAL
SIZE OF LOT NOW ON LOT USE ZONE f SPECIAL
USE OF /Q� N ///77711, CONDITIONS
EXISTING BLDG QV) / e
OWNER �L�/� G/�ci NO ri �Q�1 BUILDING YARD HWYSTREET NAME EXIST
SETBACK WIDTH
ADDRESS lolf bkXAO JA FRONT
ARCHITECT OR TEL P L
ENGINEER NO SIDE
P L
ADDRESS
TEL 0
CONTRACTOR NO 1 V
ADDRESS ' Im
0
DESCRIPTION OF WORK ri
W
d
NEW ADD ALTER REPAIR EMOLISH N
SO FT NO OF Z
SIZE STORIES FAMILIES
[FEE
SE OF
TRUCTURE
SIGNATURE OF
APPLICANT
ALUATION $ m47
APPROVALS DATE INSPECTOR S SIGNATURE
C PMT /-� FOUNDATION LOCATION
$ FEE $ -f" FORMS MATERIALS
FRAME FIRE STOPS
1 HEREBY ACKNOWLEDGE THAT 1 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 PERSONIN VIOLA LATH INT
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN 8 PENSATION INSURANCE
LATH EXT
SIGNATURE HOUSE NUMBER COR
PERMITTLIU RECT AND POSTED
ADDRE 00 FINAL
JOHN F LEWIS PRINCIPAL STRU U AL EN`QjbW4R
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK MO CASH
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