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TEMPLE CITY
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78A333A CC8803 1-62 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES I BUILDING
DEPARTMENT OF COUNTY ENGINEER` ' ADDRESS a
BUILDING AND SAFETY DMSION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST ✓L
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
DISTRICT NO GROUP I TYPEPR SSED BY
FOR APPLICANT TO FILL IN ,/� coNsr r
BUILDING , STATISTICAL CLASSIFICATION. SE ER MAP
ADDRESS L + RK
r CLASS NO DWELL UNITS "
LOT NO rr f BLOCK WATER
�ry j CERTIFICATE NOT REQUIRED RECEIVED Ll
TRACT99 a f MAP' 1 HIGHWAY
NO OFNB NO / (CIRCLE) STATE MAJOR SECOND CAL
SIZE OF LOT 4'6 I NOW ON LOT USE ZONE SPECIAL
USE OF A 1 CONDITIONS
EXISTING BLDG
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OWNER , J. 1 NO /y7�Zl BUILDING EXIST'
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS AK q c-� FRONT
ARCHITECT OR TEL P Lj
ENGINEER NO SIDE
r + P L
ADDRESS /�� �C
CONTRACTOR ! �IC NO (a`yL�JJ�7�1 INSPECTION RECORD f 0
ADDRESS 10 o IN 0,4 97-,%,s /a C/ Y 1 O
DESCRIPTION OF WORK U
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NEW ADD ALTER REPAIR DEMOLISH y
SQ FT NO OF NO OF t Z
IZE DRIES l FAMILIES
USE OF 0" Ole
STRUCTURE
SIGNAT RE OF '
APPLICANT
VALUATION$ 00,
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APPROVALS I DATE' INSPECTOR S SIGNATURE
PC PMT FOUNDATION LOCATION
FEE $ FEE $ v FORMS MATERIALS
FRAME FIRE STOPS
I 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 ICWILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR ODE OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN S COMPENSATION INSURANCE
LATH EXT
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE- 1 RECT AND POSTED
ADDRESS Q FINAL
# CLYDE N DIRLAM PRINCIPAL STRUCTURAL E
PLAN CHECK VALIDATION CK MO CASH PERMIT VALIDATION CK M o cwaH
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D 300 ID
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