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FUG38A C6#003-I-11I APPLICATION, FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST.
FOR APPLICANT TO FILL IN DISTRICT N G OUP TYPE. P ESSED BY
O CONST.
BUILDING STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS ,(C � P
B /,� / CLASS.NO.- DWELL.UNITS
LOT NO. ry BLOCK WATER NOT REQUIRED RECEIVED
� CERTIFICATE:
TRACT l:Q+ MAP ,gyp HIGHWAY STATE JOR ECOND, LOCAL
NO.OF BLDGS. NO. U � (CIRCLE)
SIZE OF LOT�r X �8 I NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG. Z,
TEL,
OWNER NO- BUILDING YARD HWY STREET NAM EXIST.
SETBACK WIDTH -
ADDRESS T' / FRONT
ARCHITE TOR TEL. P.L.
ENGINEER 4-:,-a NO. -SIDE
P.L.
ADDRESS
TEL. INSPECTION RECORD 0
' - -'
CONTRACTOR NO. 11ArT
ADDRESS
DESCRIPTION OF WORK _ �p f
NEW ADD ALTER REPAIR DEMOLISH3wrrt- I
IZE 0 S OR IF
A.OLIES r G '�r 1' A.
/
USE OF
STRUCTURE X.,i A -co
SIGNATURE OF -
APPLICANT
VALUATION$
APPROVALS DATE INSPECTOR'S SIGNATURE
P,C, FOUNDATION:LOCATION
FEE $ F E $ FORMS,MATERIALS
FRAME:FIRE STOPS, 6
1 HEREBY-ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS q
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE:LOCATION-
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS `,'Ii prI /'//��
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOINGPERSO THE WORK LATH,INT.
AUTHORIZED HEREBY 1 LL NOT EMPLOY ANY PERSON IN VIOLA-
TION OF THE LABOR OF THE�STATEOF CALIFORNIA RE AT- LATH-EXT.INC TO WORKMEN'S P ATI CE. U
SIGNATURE HOUSE'NUMBER COR- I /
PERMITT RECT AND POSTED
ADDRESS FINAL i !���7'"�' ✓�?n
CLYDE N. DIRLAM, PRINCIPAL ST RAL ENGINEER
V ATION cK. �I.o.. cAsll PERMIT VALIDATION M.o, cABIi
'_111,0.3 9 4 S t�=R 9 2 3 0 G .5 0 y
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