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7GA658A CE'#5091-62 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING �y
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY s -'
JOHN A. LAMBIE, COUNTY ENGINEER' NEAREST
WILLIAM A.JENSEN, SUPT OF BUILDING CROSS ST.
FOR APPLICANT O FILL IN DISTR j-NO. GROU TYPE SED BY
bC% CONST. C
BUILDING I STATISTICAL CLASSIFICATION SE R MAP
ADDRESS BK P
CLASS.NO. DWELL.UNITS
LOT NO. BLOCK. WATER
CERTIFICATE: NOT REQUIRED RECEIVED
TRACT MAP HIGHWAY TATE MAJOR SECONOCAL
NO.OF BLDGS. NO. (CIRCLE) 9.
SIZE OF LOT NOW ON LOT Z USE ZONE SPECIAL
;NESE OF ,.,_ CONDITIONS
EXISTING BLDG.
TE
OWNE �s�cS / BU.ILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS�® FRONT
ARCHITECT Q TEL P• L.
ENGINEER `J NO.
ADDRESS
CONTRACTOR NO.
0
ADDRESS c f � r
DESCRIPTION OF WORK "� ' /0 L
y`I If r3 �o�-�- u
NEW ADD ALTER REPAIR DEMOLISH
SQ.FT. NO:OF NO. OF
SIZE Q STORIES FAMILIES
USE OF
STRUCTURE ,,. fw /
�k�'_�" It
SIGNATURE OF l�
APPLICANT
VALUATION S
APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION
FEE FEES -r FORMS, MATERIALS �r J / .-n-
FRAME FIRE STOPS. "•,
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE ,S 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 COD OF THE STATE OF CALIFORNIA RELAT.
ANG TO WORKMEN'S COMP SA N INSURANCE. LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL _ 0
JOHN F. LEWIS. PRI CIIPAL STRUCTURAL EN R
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
LA
4 2 3 .8% SEP12 1D 6.00- 1