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HomeMy Public PortalAbout9966 DUFFY ST_Building__ FOR APPLICANT TO'FILL,IN (Print or type only) BUILDING COUNTY OF,LOS ANGELES ADDRESS Cy DEPARTMENT OF COUNTY ENGINEER CITY ZIP BUILDING AND'SAFETY DIVISION . 4N .OF BLDGS. BUILDING / v^ SIZE OF LOT^ N WON LOT ADDRESS TRACT BLOCK" LOT NO. LOCALITY -� TEL. NEAREST OWNER E O. 4117. CROSS ST. e • r a' ASSESSOR ADDRESS' p ��r y,- - MAP BOOK I PAGE PARCEL DISTRICT GROUP -TYPE FIRE 'PROCESSED BY -CITY ,: ZIP t-�' CON ZC3f� -ARCHITECT OR TEL. �--� ENGINEER NO. STATISTICALCLASSIFI� SEWER MAP ' ADDRESS �y�r` f CLASS NO. / DWELL.UNITS BI P TEL:CONTRACTOR i „ C L:FN0.-y 7 3;-616 USE ZON NOP Q. " yy LIC. SPECIAL ADDRESS,[�i NO. `��, ONDITIONS "� CITY5; .J6E/ CLASS CONSTRUCTION LENDER, ROAD DEPARTMENT APPROVAL REQUIRED YES ❑' NO NAME AND BRANCH BLDG.SETBACK FROM- FRONT PROP. ROMFRONT'PROP.LINE OF (STREET) ADDRESS CITY', TOTAL SETBACK FROM TYPE OF EXISTING SO.FT. NO.OF NO.OF CHECK HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE } DESCRIPTION OF WORK NEW ❑ + O ADD ❑. BLDG.SETBACK FROM SIDE PROP.LINE OF (STREET( O,- ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING w HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY WIDTH 'N USE OF REPAIR Z_ EXISTING BLDG. DEMOL ❑ + APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO. IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE( //rrte� IN COASTAL PERMIT ZONE YES NO O VALUATION ' ll I HEREBY 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 - - - 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 41 PERMITTEE' ADDRESS �' '•-gTEC -' / FINA e4/G G"&� t NO. DATE BY CITY,fes �•- - MAKE CHECKS PAYABLE TO: F.EE $ FEET s HARVEY T.BRANDT,.COUNTY ENGINEER PLAN CHECK VALIDATION . CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH ►aQ i.5 1 X 3 5,2 5 es 76A638A CE#803 3.75 G -PERM HT BUILDING FO.R APPrL!..CANT TO FILL:IN ADDRESS 9 Cv BUILDING_ j ! p1v' y tit ..y: ,LOCALITY ADDRESS (Q(9 C/ NEAREST. CITY i�;A LG .04.F ZIP /'1 ib CROSS ST. ; s,,041A! /.l�f �.- NO.OF BLDGS. :_ ASSESSOR SIZE OF LOT Ca '1Sl.. NOW ON LOT :` MAPBOOK PAGE, 'PARCEL ' •' DISTRICT GROUP YPE, FIRE PR SED BY - TRACT �`O. B�LOCK. LOE NlO ) NST, ZQJNE. 47-Z ~ OWNER �dV N 7�6J NO .�( • ADDRESS'" Tzf(P (J % .,STATISTICAL NOCLASSIFICATION.DWELL.UNITS SBKG STA CITY �M�L� C.1 ZIP l ..d V USE ZONE MAP ARCHITECT OR TEC SPECIAL ENGINEER NO. CONDITIONS.,' ADDRESS ROAD DEPARTMENT APPROVAUREQUIRED YES❑, NO'❑ TEL.. . CONTRACTOR NO'. BLDG.-SETBACK PROM: LIC. FRONT.PROP LINE OF -(STREET) 'ADDRESS' NO. TOTAL SETBACK FROM . TYPE OF EXISTING HIGHWAY t .-YARD`,:.' = FRONT PROP.LINE HIGHWAY WIDTH LIC: CPTY CLASS _ CONSTRUCTION,LENDER' +' a NAME AND BRANCH - BLDG.SETBACK FROM 0 ADDRESS ,� CITY SIDE PROP NE O LI OF � � (STREET) .. SQ..FT' NO.•OF Na OF CHECK HIGHWAY + YARD. _ TO L S ACK FROM TYPE OF EXISTING SIZE STORIES FAMILIES ONE a PROP LINE HIGHWAY WIDTH', DESCRIPTION OF WORK,(- NEW L O,ciz W L L ADD ,❑ CORNER:CUTOFF "YES ❑ NO, ❑ s. ALTER ❑ N OPEN SPACE YES ❑ •. NO ❑ REPAIR ❑ - _ EUSE XISTING BLDG DEMOL 'El, IN COASTAL PERMIT ZONE'•` 'YES ❑ NO' APPLICANT TEL PRINT( .r�� �C NO.�( 7 �C7 BY ISIGNATUREI /1 ( - ) I-HEREBY„ACKNOWLEDGE THAT-I HAVE READTHIS 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 -WORK,AUTHORIZED. I WILL-NOT'EMPLOY:ANY.PERSON IN-VIOLATION:OF ' - - ' •• THELABOR CODEOF THESTATEOF,CALIFORNIA.IN RELATINGTO-WORKMEN'SCOM i '„ • .. PENSATION INSURANCE: SIGNATURE'OF FINAL BY PERMITTEE; V -` G' DATE ` ADDRESS -�_ TEL ? P:C.•Fee$ Permit Fee / •yv V ClTY- L �.�. No. =VALUATION -� O.V ,. .• . •, i _ - - ` -. . Issuance Fee Total Fee ` PLAN CHECK. ALIDM1I0N .. CK. M O. CASH PER tl LDA CIN CK:' M.O. CASH ©S -76A63813 CE#8036'6/76 - - -- - A P P L I CAT I®N ; O COUNTY .OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BSS U I L DN I P E R W I T BUILDING AND SAFETY DIVISION Y BUILDING FOR APPLICANT TO FILL IN ADDRESS - 9 96 411 BUILDING / ADDRESS ! 6 LOCALITY ' �,+ - 'NEAREST CITY / ZIP CROSS ST. reool, NO.OF BLDGS. ,•ASSESSOR SIZE OF LOTNOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCES D BY TRACT BLOC/K-/ LOT NO ✓ �/ 0`Q •�� CONST ZpNT� ,OWNER Llj �4 No. STATISTICAL CLASSIFICATION ::::- `: .SEWER-MAP ADDRESS �t .. CLASS No, !q:7:�OWELL•UNITS BK/(�PG. S ONE MAP CITY_ ��:" ZI,P NO. - ARCHI ECT OR TEL.- SPECIAL ENGINEER NO. 7 CONDITIONS ' ADDRESS. ROAD DEPARTMENT APPROVAL REQUIRED YES❑• NiO ❑ CONTRACTOR NEOL• r►-"Jy3 BLDG.SETBACK FROM LIC. FRONT PROP.LINE OF (STREET) ADDRESS NO, HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING CITY !_ LIC. FRONT PROP. LINE HIGHWAY WIDTH !,o' . CLASS 8. _ CONSTRUCTION LENDER + �. NAME AND BRANCH BLDG.SETBACK FROM - o ADDRESS_ - CITY SIDE PROP. LINE OF (STREET) G) SQ. FT NO..OF NO. OF, CHECK HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING SIZ� STORIES FAMILIES ONE SIDE PROP. LINE HIGHWAY WIDTH DESCRIPTION OFWORKNEW1 + 0- 0 ADD ❑ CORNER CUTOFF. YES ❑ NO ❑' z ALTER ❑ REPAIR❑ IN OPEN SPA C,E - YES ❑ NO ❑ USE OF IN COASTAL PERMIT ZONE YES-E] NO ❑ EXISTING BLDG:. 'A .r- f DEMOL ❑ ,r �m �J APPLICANT TEL 2777 77 ®/K . 7-� (PRINT) NO. 4• M l� BY (SIGNA T•U RE1 Q,6/ I -HEREBY ACKNO41_E1DGE THAT I HAVE READ THIS APPLICATION AND STATE THAT {NE' ABOVE IS CORRECT.AND AGREE TO COMPLY' WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CE RTIFY 'THAT IN DOING THE WORKAUTHORIZED . HEREBY, I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR' CODE OF THE STATE OF CA OR NIA IN RELATING TO WORKMEN'S COMPEN ION IN URANC SIGNATURE OF FINAL L/ BY, PERMITTEE � ADDRESS r• TEL' P.C. Fee$ Permit Fee CITY NO. ^ O Issuance.Fee VALUATION$ //� / B/ Total Fee ` s PLAN CHECK VALIDATION CK. M.O. CASH a PERMIT VALIDATION cK. ` M.O. CASH 82144 11 1 0 21.75 ,&1°,. 76A638A CE*803B 12/75 .. - DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES 'WM. J. FOX,, CHIEF ENGINEER V F R APPLICANT TO FILL IN FOR OFFICE. USE..ONLY. ' . DISTRICT NO. • PLANCK. N0. PERMIT NO BUILDING ADDRESS �VV/J'�. `.9' �J•d.�s -. RECEIVED BY! ,DATE OFAPPL. DATE ISSUED LOCALITY --i cl .NEAREST - CROSS ST. '/,/ A�� BUILDING 12 OWNER % 'r ADDRESS MAIL may / LOCALITY ••/i-. ` , _ _ ADDRESS b �! _ �. ,ysy7ijf - NEAREST •� �/ •� - d ��. CROSS ST' i ry TEL. - CITY'../ l�i/9slsdt-E„'' NO.. >l/ O d FIRE�� "I NO OF. - I.TYPE �. GR , ARCHITECT OR. TEL. ZONE PLANS. ENGINEER , No. BLDG.„ / ORD. NO. SETBACK LINE +/ ADDRESS .� .,�� - APPROVED --- ' TEL. .. t BY DATE CON TRACTO �� � .NO. - - USE R. APPROD'1� r - ZONE "' BY �(�yq,. .. • DATE 3 ADDRESS- HOUSE NUMBERING. - - LEGXL DESCRIPTION I LOT NO. I.BLOCK MAP NUMBER ""` v FIELD CHECK BY TRACT NO.,ASSIGNED BY fe �b DATF // NO. OF BLDG3. CORRECTIONS :_—• SIZE OF LOT .. �j I NOW ON LOT yryp' -•- - USKOF #1 EXISTING:BLDG;; - FAMILIFS DESCRIPTION OF WORg. .NEW txfALTERATION ' ADDITION " REPAIR ".I.'. :I-DEMOLITION I I . S4. FT. . I1 NO OF ,. D SIZE- 'd V ROOMS- STORIES- 'Z EXT. WALL: ROOF .-.. .. r COVERING COVERING - USE OF STRUCTURE - - - - .APPROVALS' INSPECTOR,SSIGNATURE DATE I HEREBY, ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION, / i���%.. PLICATION AND STATE THAT•-THE. INFORMATION GIVEN IS FORMS, MATERIALS - / CORRECT.` I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS y. 'LAWS REGULATING BUILDING CONSTRUCTION. FURNACE: LOCATION- SIGNATURE OCA �/ TION,. 'SIGNATUREOF � . GAS VENT, DUCTS MITTE �,/. /•. PER LATH';INT. 7 ADDRE68 G r LATH, EXT. AUTHORIZED AGT. . PLASTER, INT. - -- - 7eAeaaA• Oeas to-e ms 7J " P. C. $ ® - .L•�' FEE PLASTER, EXT. VALUATION 1 FEE $ ,�, i:♦ .. finl,ti�V - '.76A 638A 'C Ey803 9-6:�;+ ®,� / OR MNGPEKMIT COUNTY OF LOS ANGELES BUILDING ' DEPARTMENT OF COUNTY ENGINEER ADORES, BUILDING AND SAFETY 'DIVISION LOCALITY77�,Ilx 1 JOHN A. LAMB]E, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BuILDING NEAREST ,CROSS ST. FOR APPLICANT TO FILL IN DISTRIC��Q�;. GROUP TYPE PRo Ess D Y (Print or type only) �•SC �JJjj//"" J CONST. t BUILDING ' STATISTICAL CLASSIFICATION. SEWER MAP ADDRESS C1, 4 E, bapizy CLASS NO. DWELL,UNITS 1 BYw'PG LOT NO. .BLOCK r, ONE MAP G _ NO. ' TRACT SPECIAL NO.OF BLDGS. - CONDITIONS SIZE OF LOT 740/ ) - / NOW ON LOTUSE OF {. /� EXISTING BLDG, r S /� �L�' BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF (STREET). 'OWNER E- NO.. TYPE OF EXISTING SETBACK HIG } YARD TOTAL ADDRESS - HIGHWAY.WIDTH FROM C.L. BLDG.SETBACK FROM ARCHITECT ORTEL. SIDE PROP.LINE OF % (STREET) ENGINEEROi'gi09(�` 'NO• TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL ADDRESS' - HIGHWAY WIDTH FROM C.L. - ^w' TEL. J.� . .. } V✓ . — �� n- CONTRACTOR 0 C NO. O ADDkES, S $OfIS; NO. CORNER CUTOFF YES ❑ NO ❑ U CITY •CILASS SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK Ll- cl- C/3 / z NEW ADD ALTER& REPA.IR DEMOLISH ` - r. SQ..FT. - NO. OF No. of A ' A 'AY SIZE V STORIES FAMILIES ' USE OF ' r I STRUCTURE .L ._ stallations should be-ta'e t, 'T I r `r,�pt., Alfaden A Uffice, Or 1. Co. E,O .,. •/: 1 in 'o.-der t0 aV01 SIGNATURE OF a lengthy delay. Survey 8< Uarir-: APPLICANT until Permit has Ueen issued. Appy ic• pa kway tree permit AST. VALUATION $ �d � - - APPROVALS DATE INSPECTOR'S SIGNATURE • `P C - PMT. FOUNDATION: LOCATION - - FEE $ FEE - -- - 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 I WILL NOT EMPLOY ANY PERSON IN VIOLA- TION OF'THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. LATH, INT. - _ ING TO WORKMEN'S COMPENSATION INSURANCE. f ' LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE - NQ#POS D 1 47 ADDRESS I L, ��• �! ,7 G - JOHN F. LEWIS. PRINCIPAL STR TURAL ENGINEER PLAN CHECK VALIDATION . CK. M.O. CASH — PERMIT VALIDATION CK. M.O. CASH 3 3.x, 3 FE828 3 D 2 �7e7 J t APPUCAMON FOR BULONG PERNT COUNTY OF LOS'ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION WR APPLICAN O FILL BUILD DRE S ereby affirm that 1 have a certificate co se t to s insure, BUILDING ADDRE - or.a ce ifi r ers' ens on Ins ra ce,or ertifie cop re S 7140"T ' ZIP qlYO LOCALITYPO Cy C fik— NO OF BLDGS.NOW ON LOT El Certified copy is hereby Turn' ed. NEAREST CROSS ST ❑ Certified copy is filed with c n .buil ing i e, do TRACT BLOCK LOT NO. - department. / USE ZONE MAP NO. Date AIDant ASSESSOR MAP BOOK. PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF.EXEMPTION FROM WORKERS' :, OWNER / COMPENSATION INSURANCE L WITHIN 1000 FT.OF SCHOOL? YES No (This section need not,be,completed if the permit is for one hundred ADDRESS DISTRICT GROUP TY ONST. FIRE ZONE. PROCESSED BY dollars ($.100)or less.) " CITY - - ZIP I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER - .TEL NO. become subject t0 the,Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT, CONDO Date Applicant- ADDRESS. CLASS NO. 5� DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of 4 1REQUIRED TOTAL SETBACK FROM ;EXIST Exemption, •you should become subject to the Workers' CONT CT SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. S 0 Q, p L LICENSED CONTRACTORS DECLARATION SIDE - Y LIC.CLAS �'J P L I hereby affirm t at I am i ccaar�ii underproyisions of Cha 9 SEWER MAP >- (commencing wit Division 3 of B s and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES, a, Professions Cod liin full forced-ef NEW BK PG U License Nu C.Class ��� D P o F.w o/ -/ 'ADD ❑ VAL+U TI N �) D, Contractor ate Y (' ALTER ❑ $ w El am exempt under Sec. !t REPAIR El01� LJ $ O� BAP.C.for this reason U DEMOL ❑ LDMA P/C# _ I)L Date: ' USE OF EXISTING BLDG. URM ❑ - Hi_�.I �s Z Signature APPLICANT.(PRINT) TEL NO. - - LDMA Perm# ^_ _ ❑ I, as owner of the property, or my employees with wages as Z =`•_I•.1 2142-J their sole compensation, will do the work and the structure is ADDRESS, O a not intended or offered for sale (Section 7044, Business and FINAL DATE Q> I-i H_ P(OfeSS10DS Code.) O 8 WILL THE APPLICANT OR FUTURE BUILDING,OCCUPANT HANDLE A'HAZARDOUS MATERIAL � Ttl S�"tL 3 q,{ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ° d 25 El I, as owner of the property, am exclusively contracting with Q AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? licensed contractors to construct the project (Section 7044; FINAL BY > "HECK 14{,i5 Business and Professions Code.) ves❑ No❑ WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING CHANGE 1 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY. COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No❑ a the performance of the work for which thispermit is issued(Sec. f!_I 4 f E?�`7•_. p1 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, C{ 5 TITLE 2,CHAPTER 2.20 SECTIONS 2,20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS' S{:11 S L. Lender's'Name MATERIALS REPORTING AND FOR OBTAINING,A PERMIT FROM THE SCAQMD. o Lender's A ress O OWNER OR AGENT o I certify tat I have ad this p Ica' and state under penalty 0 of perjur that thea 0% inform tion is OrreCt. I agreeto comply P.C.FEE PERMIT FEE - 7 N with ounty r Hanes an State ws ®relatingoconst ion, an y tho pr entatISSUANCE FEE co toe r eon t abov doe r rty for i INVESTIGATION FEE TOTAL FEEspnaiure a Aodlram o.agem SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0811120001 PHONE: (626) 285-0488 EXT: (LEGAL ID: I NO. OF CONST I BUILDING ADDRESS: 1 ITR: 17200 LT: 3 I SQ. FT STORIES TYPE I 9966 DUFFY ST - 1 I (STRUCTURE: V-B I TEMP CA 917802609 1 (ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: BALDWIN 1 18588-014-003 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl I I I (TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: 1 I (EXIST OCC GRP: 111/12/08 SR 1 (OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: 1 (KALE, TONY H (213) 434-1199- 1 4,000 1 19966 DUFFY ST Ifll 3n I ITEMP 917802609 FEES PAID IDESCRIPTIONMI-- OR I (INSTALL 8 RETROFIT WINDOWS SLIDE INTO (E) FRAMES AREA OF THEI I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IWINDOWS IS APPROXIMATELY THE SAME AS THE WINDOWS THAT ARE * 1 (APPLICANT: TEL. NO: I I I ISAME AS OWNER - 1AA BLDG PERMIT ISSUANCE 27.75 1 I IAC STRONG MOTION RESID 4000.00 VAL 0.50 ISPECIAL CONDITIONS: 1 I ID2 PERMIT W/0 EN-HC 4000.00 VAL 115.80 1 1 1FR INV•WORK W/O PERMIT 127.50 DOL 127.50 I I TOTAL FEES 271.55 I (CONTRACTOR: TEL. NO: 1APPROVALS DATE INSPECTOR SIGNATURE ISAME AS OWNER - I I I I LIC. NO I ILOCATION AND SETBACKS I i I ISOILS ENGINEER APPROVAL I I (ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I LIC. NO: ISLAB/UNDER FLOOR I I I (RAISED FLOOR FRAMING I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ( 1UNDERFLOOR INSULATION I I I I 115OH269 3 001 1 1 I I I I IFLOOR SHEATHING I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I NO 21 1 (ROOF SHEATHING I I I 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR' PANELS I I (AIR QUALITY: 1000 FEET MATERIALS 1 NO NO NO FRAME INSPECTION I I I IREQUIRED TOTAL SETBACK FROM EXIST I IFIRE SPRINKLER HANGERS 1 I I I ISET BACK YARD: HWY: PROP LINE: WIDTH: 1 I I I (FRONT PL- I (INSULATION/WEATHER STRIPI I I I SIDE PL- I I I I I I _I (INTERIOR LATH/DRYWALL I I I I 1 1EXTERIOR LATH I I I I I I I IRATED FLOOR/CEIL ASSEM. I I I IRATED WALL ASSEMBLIES I I I I I I RATED SHAFTS/OPENINGS I I I I I I IT-BAR CEILINGS I I I I* ADDITIONAL DATA ON FILE I I I I ILOT DRAINAGE I I I IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I