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76A638A CE#803 3 66 APPLICATION FOR BUILDING PERMIT u
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY >
JOHN A LAMBIE COUNTY ENGINEER NEAREST
COLEMAN W JENKINS SUP T OF BUILDING CROSS ST
DISTRICTN�eR TYPE P B
FOR APPLICANT TO FILL IN « lN/) CONST
BUILDING STATISTICAL C ASSIFICATION SEWER/ MAP ry/
ADDRESS CLASS NO DWELL UNITS 8K / , PG 70'
LOT NO BLOCK USE ZONE MAP /� /`-(
N O -' AO
TRACT P SPECIAL
NO OF BLDGS CONDI IONS r
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLDG BLDG SETBACK FROM
TEL FRONT PROP LINE OF (STREET)
OWNER /�p NO TYPE OF EXISTING SETBACK HIGHWAY YARD I = TOTAL
ADDRESS 4851 est HIGHWAY F MC L
r + - C
20
CITY Temple City BLDG SETBACK FROM
ARCHITECT OR TEL SIDE PROP LINE OF (STREET)
ENGINEER NO
TYPE OF EXISTING SETBACK HIGHWAY + YARD ,= TOTAL
HIGHWAY WIDTH FROM C L
ADDRESS
CONTRACTORHOWa d RandoO288-4040 +
LIC CORNER CUTOFF YES E] NO per,
ADDRESS NO I s 6 Ins 6C
CITY San Gabriel LI` SEE REVERSE SIDE FOR SPECIAL APPROVALS
DESCRIPTION OF WORK
LL
a
NEW ADD ALTER REPAIR DEMOLISH
SO FT NO OF NO OF -
SIZE STORIES FAMILIFS
USE OF
STRUCTURE
SIGNATURE OF
APPLfCANT
VALUATION$ s I, . In OO
APPROVALS DATE INSPECTOR SSIONATURE
PC
PMT FOUNDATION LOCATION
FEE$ / (J'(l FEE$ FORMS MATERIALS
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THI APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
9UILDI NG CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR/COD OF THE TE OF CALIFORNIA RELATINC TO WORKMEN5CNS O ,,?T
RA E LATH EXT
SIGNATOR OF HOUSE NUMBER COR
PERMITTEE RE AND POSTED147
ADDRESS 529 F Valle , San Gabxr 1NAL
JOHN F LEWIS PRINCIPAL STURAL ENGINEER
PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION cK M O CASH
_ALo 9 5 6 6' JUL 12 1 D 9 00,
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