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APPL)CATION FOR. RELOCATION BUILDINC ERM IT }
COUNTY OF LOS ANGELES 9ull-DING � �. M.'ay,61m zip
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING :AND SAFETY DMSION LOCALITY .
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING NEAREST
CROSS ST. Ste/
DIST'..N. . .GROUP TYPE . [SEWER AP' P O S BY
FADDRESS545-2
OR APPLICANT TO FILL IN BKPG
OSED
ING WATER
ADD V� CERTIFICATE: NOT REQUIRED ❑ RECEIVED
LITY ' L MAP HIGHWAY
NO,p (CIRCLE) STATE MAJOR SECOND LOCA
ENT
DING - USE ZONE SPECIAL
ADDRESS •�3 CONDITI:ONS'
LITY d,E. (�% ► y f :R11"'�'
ER BUILDING 4 (yid EXIST.
YARD HWY STREET NAME
MAIL.
;SETBACK W I DTH.
ESS 5�' A� (/4 •FRO'NTtIT TEL.NO. SIDE
NG TEL. PL..
RACTOR NO. _SURETY DATE RECD
ESS BOND--$ " _ FILED �+Y �-
BUI.LDING TEL. CASH. / /� DATE RECD O
CONTRACTOR' NO. DEPOSIT S �✓ V I - FILE , By V
APPROVALS- DATE - INSP.ECTOWS S'I.ONA•TURE at
ADDRESS
FOUNDATION: LOCATIONPRESEN ./t G` •' O
USE OF FORMS. 'NIATER,IALS n Vit./ �. j zt-rf
BUILDING FRAME! FIRE STOPS]
PROPOSED BRAC'I'NG, BOLTS
USE OF �h Z
BUILDIN /� E FURNACE: LOCATION /y -
. GAS VENTS, DUCTS
Sq..FT: NO. OF LATH, INT. fT Wfe,
SIZE Q ROOMS' STORIES
WALL • ROOF •SP0 V
COVERING )�,� COVERING 7 LATH, EXT. 7
LEGAL !iOUSE.NUNIBE)t.COR-
DESCRIPTION p LOT NO.. BLOCK RECT AND PO$TED
TRACT le Q eFiN'iAL
NO,:OF BLDGS. ® DIS G ER
SIZE OF LOTNOW ON.LOT BOND
REL..ASED
USE OF No. OF
EXIST.I!NG BLDG.. I .FAMILIES:
I HEREBY ACK149WLPDGE THAT I. SAVE AD TI315 APPI.).6A7.�ON.
I HEREBY STATE'T T THE INF A N GIVEN IS AND STATE THAT THE:ABOVE IS'CORRECT.AND:AGREE TO COMPLY
.CORRECT. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
SIGNATURE OF BUILDING CONSTRUCTION: I CERTIFY THAlr :I.N DOING: THE WORK
APPLICANT AUTHORIZED HEREBY 1. WILL NOT EMPLOY ANY PERSON M VIOLA..
TION OF THE LABOR CODE OF:THE STATE OF CALIFORNIA RELAT-
ADDRESS )Nr-.-TO WORK.MEWS CdMIP)VITSAT1.014 INS CE.
VALUATION $ $ -121!y,
� � SIGNATURE OF
vL EE 1!yr PER.W.-ITEE..
_ I
FEE $ t
ADDRESSVALIDATION �K. M•D•
CASK JOHN F. LE.WIS.-PRINCI AL STRUr.TURAL ENGINEER
PERMIT VALMATION m.o. CASH
0 3 2 3r:. RAT-1 9 2 5 D 2 5.00A
� P, 0403c'"— 966O.00A
r �', Ci 4 0 49 W24 6 D 9.00N