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i9A898A CC hC9•f-el APPLICATION FOR eUILDING PERMIT .
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS;
°DBEs; f
r
'BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST.-
FOR APPLICANT TO FILL IN DIST !CT NO. GR IOU CON C SED BY
CONST.
BUILDING • STATISTICAL CLASSIFICATION SEWER MAP
ADDRES p� � K
CLASS.NO.4_2DWELL.UNITS--
LOT N
NITS -LOTN BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE: Uaw
TRA MAP� O'Z/qo��o HIGHWAY
(CIRCLE) STATE MAJOR SECOND, OCAL
NO.OF BLDGS.
NO. -�
SIZE OF LOT. I NOW ON LOT USE ZONE SPECIAL
USE / CONDITIONS
EXISTING BLDG. Af
(/ •
TEL.
OWNER NO. BUILDING YARD HWY STREE NAME
SETBACK. WIDTH'EXIST.
ADDRESS FRONT
ARCHITECT OR TEL P.L.
ENGINEER NO. SIDE
ADDRESS
D.
TEL. INSPECTION RECORD 0
CONTRACTOR NO.
ADDRESS O
DESCRIPTION OF WORK G
1 h
EW ADD ALTER REPAIR DEMOLISH I. Z
SQ.FT. NO.OF NO.OF
SIZE STORIES FAMILIES
USE OF �r
STRUCTURE
SIG ATURE OF
APPLICANT '}
VALUATION$ V I
APPROVALS DAT INSPECTOR'S SI ATURE
FEE $ FEE PMT.
$ FOUNDATION:LOCATION
�� FORMS,MATERIALS 1
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, f f
WITH ALL COUNTY ORDINANCES ANI) STATE LAWS REGULATING GAS VENT DUCTS I I
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY'1 WALL NOT EMPLOY ANY PERSON IN VIOLA- LATH,INT.
TION OF THE LABOR CODE OF THE STATE.OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE.
//� _ LATH,EXT.
SIGNATURE OFI� (/J HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED O ..
ADDRESS ` f f
FINAL
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL Ej8nqSqR
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cr. . m.o.
L,ti,o 3 7 0 2 APR 23 1 D 49 O N