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FOA980A CC#110*1-01 APPLICATION 'FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGII�IEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST.
DISTRICT NO. GROU TYPE P CESSED BY
FOR APPLICANT TO FILL IN CON
BUILDING STATISTICAL CLASSIFICATION SE ER MAP
ADDR Qt!//G/� D/e. K PG
CLASS.NO.-99---DWELL.UNIT
LOT NO. BLOCK WATER NOT REQUIRED ❑ RECEIVED
CERTIFICATE:
TRACT O MAP HIGHWAY STATE MAJOR SECOND, L CA
NO.OF BLDGS. NO. (CIRCLE)
SIZE OF LOT _X NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG. y� ,r. p
00'
OWNER • Egg B2 C�I -- NO.' /d BUILDING YARD HWY STREET NAME EXIST.
ADDRESS J72-4o [&WZOi C,/L 7 gj/Q• SETBACK WIDTH
FRONT
ARCHITECT OR TEL P.L.
ENGINEER NO. SIDE /
P.L.
ADDRESS ]]/J �� /�r,� TEL p I INSPECTION RECORD �1 R d
CONTRACTOR•\J•B-&W� !�/. C0• NO./JT Fwd/� /�_L- UO
ADDRESS
DESCRIPTION OF WORK
/ W
a
eNES ADD ALTER REPAIR DEMOLISH h
SQ.FT.' f•� / NO.OF NO.OF
$IZE !g qJ STORIES FAMILIES I
USE OF
STRUCTURE
17 ui 1 A16 �' C �
SIGNATURE O �uP�
APPLICAN
VALUATION
APPROVALS QATM INSPECTOR'S SIGNMORE
FEE $ O FEE $ FOUNDATION:LOCATION
FORMS.MATERIALS
I FRAME:FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICABRACING,BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COFURNACE:LOCATION. Ilk
/•
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULAGAS VENT DUCTS J. V-
BUILDING CONSTRUCTION: I CERTIFY THAT IN DOING THE W (f -
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VILATH.INT. I �/(! ./! p11"'fC•'�.il`
TION OF THE LABOR CODE OF THE STATE OF AL NIA RE
ING TO.WORKMEN'S COM S ION I SURA E. 'O 7/'? J
LATH,EXT. O /J J
SIGNATURE OF HOUSE NUMBER COR- g/ ,J/�� -iP
PERMITTE RECT AND POSTED ,0 61 Pei !J !, '1
ADDRES FINAL
CLYDE N. DIRLAM, PRINCIPAL STTd
CT RAL ENGINEER
PLAN CHECK VALIDATION M.O... CASH PERMIT VALIDATION CK, Am. cmH
6622 NOV 723 D 28.50614
F' " LtAll iUo 7 3 1 2 tdDU 2 3 '! D 5. 7.0 0- Z