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•it76AGNIACE#8032-63 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF-COUNTY ENGINEER ADDRESS 57
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST I": ,/
WILLIAM A.JENSEN. SUPT OF BUILDING CROSS ST. �' + SL J�
DISTRICT NO. GROUP TYPE P OCE SED BY
FOR APPLICANT TO FILL IN l 40 CONST,
BUILDINGr [7T • STATISTICAL CL SIFICATION 6VEA MAP
ADDRESS �J / J', BK PG
��// CLASS. NO. DWELL.UNITS
LOT NO. Q repHLOCK WATER
_ D p/1�� CERTIFICATE: NOT REQUIRED RECEIVED
TRACT / ! ,O V NOP
NO,OF LD
O MAe
(HIGHWAY,
STATE MAJOR SECON LOC
BGS.
SIZE OF LOT �Q NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS IPPW
EXISTING LDG. e
� + TEL.
OWNER /�� �.0�Am,
.I� UI I G YARD HWY STREET NAME EXIST.
ADDRESS ��� �S1e L' 'oj j FRONT ET K WIDTH
ARCHITECTO TEL P. L. 6LI 0
ENGINEER a �' NyyO�� SIDE >
ADDRESS J '4'0&je� iJ' &L
P. L. , 1 0
q V
CONTRACTOR Qi O. / � � a
0
ADDRESS � + �� ( ,1��� f'�.0 �� W
DESCRIPTION OF WORKf�lD.
EW ADD ALTER REPAIR DEMOLISH Z
SO.FT. NO.OF NO. OF Of
SIZE �q STORIESyj �J FAMILIES
USE OF
STRUCTURE
SIGNATURE OF �v G
APPLICANT
VALUATION $* fQ
APPROVALS ZhTEr PE O SIG URE
FOUNDATION: LOCA N
FEES s FEE $ FORMS. MATERI S 6 IV
FRAME: FIRE ST S.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRAC,
NG. BO TS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATIO
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 CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE. LATH. EXT.
n SIGNATURE OF HOUSE NUMBER COR-
�PERIyPITTEE RECT AND POS E
ADDRESS FINAL
JOHN F. E S. PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION cK. M.O. CASH _ PERMIT UALIDATION CK. M.O. CASH
LjLo 0 1 3 6Z03 SEP'13 2 3 D 2 1;50,