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78A888A CE0809 889 APPLICATION FOR BUILDING PERMIT
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COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER
SS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN,SUP'T OF BUILDING CROSS ST.
DISTRICT NO. GROUP TYPE OCESSED Y
FARCHITECTOR
OR APPLICANT TO FILL IN 57,o e 5 i 4� CONST. V
NG Q STATISTICAL CLASSIFICATION r WER MAP
SS CLASS. NO.�DWELL.UNI�TSp` f BK .PS O
. BLOCK WATER NOT REQUIRED 1V1 RECEIVED /❑J
CERTIFICATE: - 111111--
MAP - HIGHWAY STATE MAJO SECOND LOCAL
NO.OF BLDGS. NO. D_0 Q (CIRCLE)
LOT NOW ON LOT USE ZONE SPECIAL
CONDITIONS
NG BLDG.
TEL.
q>� NO. BUILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
S FRONT /�
ECT OR TEL. P• L• I L C/ER NO. SIDE
P. L.
ADDRESS
TEL 6` {O7
CONTRACTOR TNO
E
ADDRESS
DESCRIPTION OF WORK , W
IL
NEW ADD ALTER REPAIR DEMOLISH r gn
SQ.FT. / NO.OF _ NO.OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE
i
SIGNATURE O
APPLICANT
VALUATION $ Q -�
APPROVALS DAT ` INSPECTOR'S.SIGNATURE
FOUNDATION:FORMS, MATERIALS
P.C. PMT. j
FEE � FEE � , of tr _
FR S,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION RACING. BOLTS
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 y
AUTHORIZED HEREBY i WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. f
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE. LATH. EXT.
SIGNATURE OF I l 'HOUSE NUMBER COR- /
PERMITTEE W f RECT AND POSTED
ADDRESS FINAL
• JOHN F. LEWIS. PRINC+fPAL STI RALrENGAfER
PLAN CHECK VALIDATION CK. M.O: CASH PERMIT VALIDATION CK. M.O. CASH
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65 8 0 •DLc 8 1 D 6.00-