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APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
-47
FOR APPLICANT TO FILL IN ADDRESS
BUILDING 4
ADDRESS 5475 Temple City B I V I
LOCALITY
CITYTe a C '_ ZIP 91 88 =ST, C
_ t NO OF BLDGS_; _ - ASSESSOR
SIZE OF LOT NOW ON LOT MAPBOOK PAGE I PARCEL
DISTRICT GROUP TYPE FIRE PROCESSED BYN
TRACT BLOCK LOT NO ZO
OWNER Mrs .
1�IKathr n i' eta rson }
ADDRESS 750 W . Baylor STAT WICAL CLASSIFICATION SEWER MAP
QASSNO DWELL UNITS BKPG
CITY Claremont Ca . zip 41711
ARCHITECT OR _ TEL VALUATION $ 456.00
ENGINEER NO
ADDRESS 1 ' BLDG SETBACK FROM
L� FRONT PROP LINEOFr3e (STREET(
CONTRACTOR. L . Randol CO . O' 288-404 HIGHWAY + YARD - TOTAL SETBACK FROM TY OF EXISTING
ADDRESS 529 E. Valley NCO .186086
FRONT PROP LINE HIGHWAY WIDTH
CITY San Gabriel , Ca . Lass C-39 + O' G
CONSTRUCTION LENDER BLDG SETBACK FROM
NAME AND BRANCH SIDE PROP LINE OF (STREET)
HIGHWAY + YARD = TOTAL SETBACK FROM TYPEOF EXISTING
ADDRESS 'moi CITY SIDE PROP LINE HIGHWAY WIDTH O
SO FT 11 NO OF NO OF CHECK + - U
SIZE
SOS
FAMILIES ONE IN
DESCRIPTION OF WORK NEW PC Fee S Permit Fee 15 .00 0
Re—roofhouse only. UsinDD Issuance Fee 7 .00 1�
compo shingle 12x18 ALTER Z
REPAIR JNO Totol Fee 22.00
EXISTTIING BLDG TSD
DEMOL El
APPLICANT
(PpN ) Howard L . 'Randot 288-404 4br4349-'76
D
BY(SIGNATURE)
l
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE 614 Q 7 A
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF -'
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN 5 COM
PENSATION INSURANCE N 0 0 0
SIGNATURE L _ 12� 9 2200
PERMITTEE
ADDRESS 529 E- 'Valley Blvd , Z • • • 2 2 0'0 iS
CITY San Gabriel , Ca . 1IL288-4040 0904-79
0
USE ZONE MAP 1
NO
SPECIAL
CONDITIONS
FI AL RR BY
DATE