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76A638A CE#803 2-63APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION 11OCALIT'Y
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN, SUPT OF BUILDING CROSS ST.
DISTRICT NO. GROUP TYPE 'PROCESSED BY
FOR APPLICANT TO FILL IN } CONST.
BUILDING el �/ ij� STATISTICAL CLASSIFICATION WER MAP
ADDRESS y (/ CLASS. NO.�DWELL.UNITS BK mi
/ G
LOT NO. U BLOCK WATER CERTIFICATE: NOT REQUIRED ❑ RECEIVED ❑
TRACT V (/ MAP fd HIGHWAY
NO.OF BLDGS. NO."
O. (CIRCLE) STATE MAJOR SECOND,LOCAL
SIZE OF LOT NOW ONL'OT 'USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG. .� L 0%JA %4. 444A", '
TEL.
OWNER ALd AlwLL-UnNO. BUILDINGYARD' HWY STRE AME EXIST.
S^ Q SETBACK WIDTH
ADDRES
FRONT
ARCHITECT OR TEL. P. L.
ENGINEER NO. SIDE
ADDRESS P. L. C
O
TEL. V
CONTRACTO NO.
O
ADDRESS
DESCRIPTION OF WORK uVJ
' a
W
NEW ADD-' ALTER REPAIR DEMOLISH Z
SQ.FT. NO.OF . NO. Or
SIZE STORIES FAMILIES
USE OF
STRUCTURE sR.
SIGNATURE OF
APPLICANT.
VALUATION $ �O
`APPROVALS DATE INSPECTOR'S SIGNATURE
,R FOUNDATION: LOCATION
FEE $ FEE $ v"� LFURNACE:
S, MATERIALS
FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONNG. BOLTS
AND STATE THAT THE'ABOVE IS CORRECT AND AGREE TO COMPLY LOCATION,
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGENT, DUCTS
BUILDNG CONSTRUCTION. I CERTIFY THAT IN DOING THE WORKAUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- T.
TION OF THE LAB CODE- OF THE STATE OF CALIFOR IA RELAT-
ING TO WORKMEN OMPENSATION INSURANCE. LATH,EXT.
SIGNATURE HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL /�� ?, ��! �G✓b!
JOHN F..LEWIS, P IN IPAL STRUCTURAL EN R
PLAN CHECK VALIDATION CK. M.G. CASH _ PERMIT VALIDATION CK. M.O. CASH,
L.luo 7 5 7 1: JUL i 6 ' 1 D 4.C", 0IN
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