HomeMy Public PortalAbout4918 BALDWIN AVE_Building__ CITY OF TEMPLE CITY
IAeaaAce#eoa 9 6D APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES , I BUILDING ,
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALI!n3
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING I CROSS S
DISTRICT NO GROUP I TYPE P 04 b BY
FOR APPLICANT TO FILL INcoNs
BUILDING �1 /_p Baldwin
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS �+7 / B
��i r, CLASS NO—/—DWELL UNITS
LOT NO N e)'( 15Y e?-, -38' OCK NUMBER H ATE YES O
RA
B.J Baldwins Addition NOS 1 USE ZONERI q SPECIAL
-onyr 8 OF BLDGS CONDITION
SIZE OF LOT UC4�fZn A—A� NOW ON LOT 2 A _ J g I
USE OF / !,)
EXISTING BLDG D{�jg� �71g Rr raragoE BUILDING YARD WY ST EET NAPE EXIST
LL.. L SETBACK WIDTH
OWNER M NOAT 6 FRONT
ADDRESS 9720 Live Oak, Temple City SIDE `
ARCHITECT OR none TEL P L
ENGINEER INSPECTION RECORD
ADDRESS ,,,5 t+ G a
CONTRACTOR Santa Anita ConstrNoAT 79744 ./ " ��' O
ADDRESS 8717 E. Las Tunas,San Gabriel / '"�" �� -�' ' -�, -' �' ��. a
DESCRIPTION OF WORK 046,2 � A� ` %�' � pO
uJ
v
CL
NEW �A ER REPAIR DEMOLISH
SO E,T�., 00 • NO OF NO OF
SIZE2 I8 y.fl STORIES 1 FAMILIES l
USE OF
STRUCTURE r
Dwelling i A t
SIGNATUR 4�
APPLICANT
VALUATION$ I
APPROVALS DATE LNSPECTOR S 5IGNATURE
P C PMTef� 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 THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I SHALL NOT LATH INT
EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBUECT
TO THE WORKMEN S COMPENSATION LAWS OF CALIFORNIA
LATH EXTSIGNATU
L 1 HOUSE NUMBER COR y�
PERMITTE / ECT AND POSTED fpI•v/�j� l'Jf i y
/r
ADDRESS -y INAL
CLYDE N DIRLAM PRINCIPALSTF57CTRALENGINEER
PLAN CHECK VALIDATION GM o CASH PERMIT VALIDATION c M D CASH
Li to,)2 .S 7 w-SES P. 7
4 7 �'o SEP ?) 2 1 G 3 S) CIG k
r
APPLICATION FOR COUNTY OF LOS ANGELES
BUILDING PERMIT DEPARTMENT BUILD NG AND SAFETY DIV SION ENGINEER ,
BUILDING
FOR APPLICANT TO FILL IN ADDRESS /
BUILDING
ADDRESS 4- k - 13 44o� (� LOCALITY
NEAREST 1 ,0
CITY Q/1N1 'L Ct, ZIP ( � D CROSS ST a.c,'.cr� �<J
O OF BLDGS ASSESSOR
SIZE OF LOT NOW ON LOT �r MAP BOOK PAGE, r PARCEL
FIFAC� � BL KL � LOT NO DISTRICT GROUP TYPE FIRE A=:4
�I ne CONST I r Z j
TEL V
OWNER N071;-0,
-� `� STATISTICAL CLASSIFICATION z. SEWER M
ADDRESS �' CtiI� J CLASS NO DWELL UNITS L BKtJ
CITY a'o ZIP 7177o USE ZONE OP
ARCHITECT OR fl + TELLV
ENGINEER - ^a T NO 14C / SPECIAL
CONDITIONS �
ADDRESS r ' ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO❑
TEL
CONTRACTOR NO BLDG SETBACK FROM
LIC FRONT PROP LINE OF (STREET)
ADDRESS NO TOTAL SETBACK FROM TYPE OF I EXISTING
LIC HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH
CITY CLASS
CONSTRU,2r1ON LENDER + - a
NAME AND BRANCH BLDG SETBACK FROM
ADDRESS CITY SIDE PROP LINE OF (STREET) Q
SQ FT NO OF NO OF CHECK HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING v
SIZ STORIES FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH N
DES ION OF WORK NEW
-if 13o , ADD CORNER CUTOFF YES ❑ NO ❑
ALTER IN OPEN SPACE YES ❑ NO ❑
USE REPAIR ElEXISTTIING BLDG DEMOL ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑
APPLICANT TEL
(PRINTI _ NO
BY(SIGNATURE)
\ `
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE �
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE I �J
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM
PENSATION INSURANCE
SIGNATURE OF FINAL BY
PERMITTEE _ DATE
ADDRESS
TEL P C Fee$ Permit Fee
LVALU:ATI:ONN
NO
Issuance Fee
r �
Total Fee
PLAN CHECK VALIDATION CK M o CASH PERMIT VALI ION CK M o CASH
82�AC� 14 1 D 2 5U0 ®w
tS 76A638A CE/803A 8/77
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