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APPLICATION FOR BUILDING -PERMIT , �.
COUNTY OF LOS ANGELES BUILDING
DEPARThUM OF COUNTY ENGINM ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE. COUNTY ENGINKGR NEAREST
WILLIAMA JENSEN Bur TO B CRO8S 8T
DISTRICTNO GROUP TYPE' P EBBED BY FOR APPLICANT TO FILL IN CONST
BU ILDINO STATISTICALCLASSIFICATION 1 SEWER MAP -
(/•J�'�' ��� BK
ADDRESS Q� CLASS NO�LnELL UNIT ��
LOT NO - MAP STATE YES O
NUMBER HWY
TRACT !' USEZONE -SPECIAL
SIZE OP LOT IUO NOW ON LLOS r.. /.Z CONDITIONS
USE TI ...i �� ✓
EXISTING BLDGBUIlAZ
TEL BETBAICK YARD HWY STREET NAMH W,Ip
OWNER - NO FRONT
P L
ADDR GL/ SIDE _
ARCHITECTOR - TEL P
ENGINEER NO JNSPECr I•lON RECORD
&D ES
TEL <
CONTRACTOR NO
ADDRESS
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SO FT NO OF NO OF
SIZE I STORIES FAMILIES
USE OP
STRUCTURE
�wJ �• '
SIGNATUREOP C"
APPLICANT B /�
LI �-
VALUATION -
APPROVALS DATE INSPEROR!SIGNATURE
PC PMT FOUNDATION LOCATION
FEE FORMS MATERIALS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AR FRAME BRACING FIRE STOP
BOLTSS
PLICATION AND STATE THAT THE ABOVE 18 CORRECT AND FURNACE LOCATION.
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS -
STATE LAWS REGULATING BUILDING CONSTRUCTION
I CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH INT
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
WORKMEN 8 C014PENSA AWS OF CALIFORNIA LATH EXT L`
BIG NATU RE O HOUSE NUMBER COR- /
PERMITT RECT AND POSTED
AD R--- FINAL
CLYDE N DIRLAM, PRI CIPAL S 511AL ENGINEER
PLAN CHECK VALIDATION HO CASH PERM VALIDATION�u J M o CASH
LIP 6008 0' 25 1 0 900 O mT
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