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ILDIN PERMI�
TA �c9 _ ► PLICATION FORBU
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.
DI ICT GROUP I TY E \P O
01512
FOR APPLICANT TO FILL IN 40 CO ST.
UILDING • STATISTICAL CLASSIFICATION SEWER MAP
DRESS 6� S' S Lt�
CLASS. NO.--92-DWELL.UNITS
LO Tie/►/ o-r BLOCK WATER
CERTIFICATE: NOT REQUIRED RECEIVED
C
TRACT !� 0yy// t� QIs
MAP IGHWA
/ NO. oG O (C IR STATE MAJOR SECOND, OCAL'
SIZE OF LOT l�7 p� ( / NOW ON LOTS
USE ZONE SPECIAL
USE OF '��t �p ,/ CONDITIONS
EXISTING BLDG. IG.�.t/1 /eVI�ryO r°7
OWNER ,$0/ A O.(r1 dDSQ B I DING YARD HWY STREET NAME EXIST.
SETBACK WIDTH
ADDRESS 17 6 e^l,a a !y
, 11A 0.,v +E FRONT j
ARCHITECT OR TEL. P- L.
��v ��
ENGINEER NO. SID)E
P. L/J >
ADDRESS A C
CONTRACTOR .5A All E NO. v� /
ADDRESS
DESCRIPTION OF WORK
NEW LooeADyD ALTER REPAIR DEMOLISH
NO.OF NO.OF
SIZE T JV D STORIES / FAMILIES/ ?
USE OF
STRUCTUREfy
SIGNATURE O /
APPLICANT
VALUATION
APPROVAL D TE INSPECTOR'S SIPA6TURE
P.C. PMT. �7eQ FOUNDATION: LOC TIO J
FEE $ FEE $ "FORMS, MATERIALS
FRAME: FIRE STOPS.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS b
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. 1 CERTIFY THAT IN DOING THE WORK ,/
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- 1�� /7.+f//j
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- LATH,.INT. FFF"'
ING TO WORKMEN'S COMPENSATION INSURANCE. LATH,EXT.
SIGNATURE �i��9� i HOUSE NUMBER OR-
PERMITTE A CT AND POSTED
ADDRESS FINAL
JOHN F. LEWIS, PRINCIPAL ST R RAL ENGINEER '
PLAN CHECK VALIDATION CK. M.o. CASH _ PERMIT VALIDATION CK. M.O. CASH
Lclbo z 9 ,lW 2 7 2 3 D 2 8.5 A.
JIG 7 7'2' rel 7 5 7.� J
;��o ��Iv 1 1 D ;r.�