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'SAGSBACRIBOS-11.37 APPLICATION ION FOR BUILDING PF- IT . ],
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A.LAMBIE,COUNTY ENGINEER NEAREST '
CASSATT D.GRIFFIN,SUP`7 OF BUILDING CROSS ST.
DISTRICT NO. OU TYPE SEWER MAP
FOR APPLICANT TO FILL IN TYPECONSf
BUILDING p �t
ADDRESS 57 ' B IV U I. d►iJ�► ° STATISTICAL CLASSIFICATION
LOT NO. V 0 K BLOCK CLASS.NO. DWELL.UNIT
MAP �7 STATE YES O
5 NUMBER �K' HWY.
TRACT �y USE Z NE SPECIAL
x j3�° J
NO. BLDGS. CONDITIONS
SIZE OF LOT ° NOW ON LOT
USE OF
EXISTING BLDG. -�®!!1� W AI BUILDING YARD HWY STREET NAME EXIST.
I SETBACK WIDTH
OWNER FRONT
MAIL ^ O P.L.,
jj
ADDRESS '14
SIDE
TEL
I CITY ®�Sa\�w� NQL g ` : P.L.
ARCHITECT OR i TEL INSPECTION RECORD
ENGINEER { C. TNO.ELA r
ADDRESSAm N. A L11�;
TEL.Awl
CONTRACTOR L IrZC+ NO. Mv _
ADDRESS 4C12 9969& Ivu Rd
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
T. NO.OIF NO.OF �J�,� "� �f' rj��-- ,� F/ Js`Gr'b
SIZE � STORIES FAMILIES
USE OF STRUCTURE 14
•„ip
`
SIGNATURE OF ° APPROVALS
APPLICANT
DATE INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION: LOCATION
FORMS,MATERIALS Z�0 YJ �IIG?.YI/1�
P•C $ FRAME: FIRE STOPS. i
FEE BRACING.BOLTS c�� (5 /%,,f--/�/yryj
VALUATION
- - FURNACE: LOCATION.
FEE -?) GASVENTDUCTS � IJ�/10
/
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THJ'S AF- LATH.INT. i /VIII
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND '
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND U (/YI I I
STATE LAWS REGI fIINGJ9UILI5tN CONST UCTION. LATH,EXT.
SIGNATURE( �!///LL'll//GG�!��r/J \/ HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL
IOHN A.LAMBIE.COUNTY ENGINEER. CLYDE N.DIRLAM,PRINCIPAL STRYJgWRAL ENGINEER
PLAN CHECK VALIDATION &Pv M.O. CASH PERMIT VALIDATION Ctc. M.C. CASH
_. �'0 4 8 0 21n CECT 4 1. 6 1 6.75 A a ®v
„ACo5073D; DEC-13 1 3 3.5 0