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76AEI8A CC....... APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES 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
FOR APPLICANT TO FILL IN
DISTRICT NO GR CONST ESSED BY
BUILDING STATISTICAL CLASSIFICATION StWER MAP
ADDRESS S GLBK P
CLASS NO DWELL UNITS
LOT NO BLOCK WATER NOT REOUIRED ivi RECEIVED
CERTIFICATE
TRACT K-/
NIDNwAv STATE MAJOR SECOND O AL
NO OF BLDGS ICIRCLEISIZE OF LOTNOW ON LOT PECIAL
USEOFNDITIONS
USEDEXISTING B DGTELOWN L NO E%1ST
`` �/ D HWY STREET NAME WIDTH
ADORESS,/�// I/*�ARCHITECT OR TEL
ENGINEER NO SIDE d
P L
ADDRESS O
TEL
CONTRACTO NO I y.
jr 0
ADDRESS �v
DESCRIPTION WORE
N
NEW ADD ALTER REPAIR EMOLIS
SO FT NO OF
SIZE ST ES FAMILIES
USE OF
STRUCTURE
SIGNATURE OF
APPLICANT
VALUATIONS
APPROVALS DATE INv[voR BsIGHAruRE
PC PMT J FOUNDATION LOCATION
FEE $ FEE $ �--� FORMS MATERIALS
FRAME FIRE STOPS
1
HEREBY
ACKNOWLEDGE
L[DGC 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 HERESY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR COD[ OF THE STATE OF CALIF OflNI [LAT
INO TO WORKMEN S COM TION INS4AANCC LATH EXT
SIGNA REO HOUSE NUMBER COR
FERMIRECT AND POSTED
ADDRES FINAL
JOHN F LEWIS PRINCIPAL ST RAL ENGINEER
PLAN CHECK VALIDA ON CK M D CASH _ PERMT VALIDATION CK M G CASH
LILD 5 9 8 0 FEB 2 7 1 D 4.0 0" a