HomeMy WebLinkAbout1486TEA E3EA CE9tE03 E 63 Ai I ICI FOR
BUILDINGPERMIT
COUNTY OF LOS ANGELES
BUILDING _"Ole 7
ADDRESS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
LOCALITY���
JOHN A. LAMBIE, COUNTY ENGINEER
NEAREST
Q
WILLIAM A. JENSEN, SUP'T OF BUILDING
CROSS ST.
DISTRICT NO.
GR U TYPE
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PROCESSED BY
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FOR APPLICANT TO FILL IN
BUILDING ;j
STATISTICAL CLASSIFICATION SEWER MAP
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CLASS. N�DWELL. UNITS
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LOT NO. ..� _ y S BLOCK
WATER RECEIVED
NOT REQUIRED
_
CERTIFICATE: ll�J
TRACT
MAP HIGHWAY STATE MAJOR SECOND, LOCAL
NO. (CIRCLE)
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT
USE ZO E SPECIAL
USE OF
EXISTING BLDG.
CONDIT ON 3
TEL
V
OWNE
. NO.
BUILDING
SETBACK YARD
EXIST.
HWY S ET NAME WIDTH
ADDRES
FRONT
ARCHITECT
R TEL.
P. L.
ENGINEER
O.
SIDE
P. L.
ADDRESS
TEL.
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CONTRACTOR
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ADDRESS
DESCRIPTION OF WORK
NEW/,"' ADD
ALTER REPAIR DEMOLISH
% !%L`�
SQ. FT.
NO. OF NO. OF
f L ..,/ %
� '��(_A;
"r
SIZE
STORIES FAM LIES
(�
/. 6,%!
USE OF
STRUCTURE
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A�./��. trwz�f. C
% , -/ x
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SIGNATURE OF
%`'" °�''�"'-' �'`"
APPLICANT
'
VALUATION $
APPROVALS DATE
INSPECTOR'S SIGNATURE
P C
PMT'C�i
FOUNDATION: LOCATION
FEE $
FEE $
FORMS, MATERIALS
FRAME: FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
BRACING. 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. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY i WILL NOT EMPLOY ANY PERSON IN VIOLA-
LATH,INT.
TION OF THE LABOR CODE O THE STATE F CALIF F RELAT-
ING TO WORKMEN'S COMPE TION INSUR CE.
LATH, EXT.
SIGNATURE O� r
HOUSE NUMBER COR-
PERMITTEE
ADDRESS
RECT AND POSTED
x--«,
JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH
PERMIT VALIDATION
M.O. CASH