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#003-9-130 APPLICATION FOR BUILDIN PERMIT _
COUNTY OF LOS ANGELES 'x BUILDING
ADDRESS
DEPARTMENT OF COUNTY ENGIlMB. ,
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN SUPT OR BUILDING CROSS-ST. VK JI
DISTRICT NO. ROUP td P SSED BY
TYPE �„
FOR APPLICANT TO FILL IN .d Lt— CONST:
l STATISTICAL CLASSIFICATION S ER MAP
:BUILDING / .rza f . 4 K P
u'ADDRESS ��//�� // J�7 qy[ CLASS.NO. DWELL.UNITS
LOT NO. )V& (a Q p SID 12% OC^ - NUMAP MBER H ATE YES N '
TRACT IgF USw 7yONE SPECIAL
LOGS.
NO.OF Ss � CONDITIONS
SIZE OF LOT 6o'X 1#0
:I NOW ON LOT
USE OF
EXISTING BLDG. - n� SETBACK YARD HWY STREE N EXIST.
Gf4 Wma eve • NO. FRONT
� FWIDTH
OWNER • FRONT �} ,-
r•ADDRESS SIDE e
ARCHITECT OR TEL. P.L.
ENGINEER N SPECTION RECOAD
ADDRESS "� VLc C
TE N. 0
CONTRACTOR, g >-r NO 17O
ADDRESS_.
�Z —jE, 41 ad wil g' �' r tam {•r r 0
DESCRIPTION OF WORK
NEW A"ADD ALTER REPAIR DEMOLISH
SQ.FT. NO.OF NO.OF / Y� f'eelA� �Ce
SIZE STORIES FAMILIES
USE OF .p y (.7.7�f / e7(�?i1' �:;.4i 1 L:�-+•rL._ .
STRUCTURE )CO -2_6 Q&,a
or
oil
y /
SIGNATURE OF
APPLICANT
VALUATIO
APPROVALS E# INSPECTORA SIGNATURE
P.C. cL I PMT. D.e FOUNDATI
$ ON:LOCATION
FEE.. '�� FEE FORMS,MATERIALS 1f Y `i = •L CGG��r__
FRAME:FIRE STOPS,• / /y�� �� ✓�
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING,BOLTS !dI
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. CERTIFY THAT IN THE PERFORMANCE .'�„ •f f f
OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED I SHALL NOT LATH,INT.
EMPLOY ANY PERSON IN ANY MANNER 50 'S TECOME SUBUECT �J�! ^
TO THE WORKMEN'S CO PEN TION LAW O ?.1LIFORN:I �•J ,,. I I —A— +'
LATH,EXT. P
SIGNATURE OF HOUSE NUMBER
PERMITTER RECT AND POSTED
ADDRESS
FINAL hi
CLYDE N. DIRLAM, PRhNCIPAL STR URAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIO CK M.O. CASH
2 3 2JUM27 2 3 D .24.0U '
U"' 0 0 1 5 JUL 14 1 D 5 .1 .yti