HomeMy Public PortalAbout8862 LONGDEN AVE_Building__ 76A638A CE4803 8-64 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING /`
DEPARTMENT OF COUNTY ENGINEER ADDRESS ((J DA)6v'
BUILDING AND SAFETY DIVISION LOCALITYiU
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS,SUP'T.OF BUILDING CROSS ST. d
DIST NO,NO: 'GR TYPE 'P ESSEX Y
FOR QAPPLICANT TO FILL IN `/J� CONST.
ADDRESS �. CLASSSNO DW EILL U7v PGINI TS SEWER Mpq
B
LOT NO. BLOCK USE ZONE MAP
TRACT SPECIAL
NO. OF BL . , 1 CONDITIONS
SIZE OF LOT /� NOW ON'LL .
- -
USE OF
EXISTING SLOG. .BLDG.-SETBACK FROM
TEL/'�'/7- FRONT PROP. LINE OF (STREET)
OWNER ,.L /I NO. O ' TYPE OF EXISTING. SETBACK _HI,GHWAY -+ YARD TOTAL' `
ADDRESS O �� "' HIGHWAY WIDTH ''FROM C.L.
Zo�.4L p
+ -2-0 Sd
CITY BLDG. SETBACK.FROM
ARCHITECT OR TEL. SIDE PROP. LINE OF (STREET)
ENGINEER NO, TYPE OF EXISTING SETBACK" HIGHWAY + YARD = -TOTAL
ADDRESS
HIGHWAY WIDTH FROM C.L. d
ITEL�C/ O
CONTRAC NO . - V
ADORES 7 NO 19S%, ,l 7 CORNER CUTOFF - YES 1:1 NO E] .0
CI H
cl�Ass� SEE REVERSE SIDE FOR SPECIAL APPROVALS w
. 15ESCRIPTIOlq OF WORK Z
NEW ADD ALTER REPAIR DEMOLISH
SQ.FT. NO. OF / NO. OF
SIZE /�O STORIES / FAMILIES
USE OF
STRUUyCTURE1J
1 ,/j,,
4v
O (/
SIGNATURE O
APPLICANT
VALUATION$ nl��
(/ APPROVALS DATE. INSPECTOR'SSIGNATURE
P.C: _ PMT. 0 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 -u9
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 CODE OF THE STATE OF CALIFORNIA RELAT. _
ING TO WORKMEN'S C MPE NSATI N IN AN E.
/ LATH. EXT.
SIGNATURE O HOUSE NUMBER COR-
PERMITTEE, �^ RECT AND POSTED
ADDRESS m 7` �� FINAL u9-/r)/4(,
_ JOHN F. LEWIS. PRINCIPAL ST CTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
IN
L.A,Cc4 9 1 a AUG 2 4 1 A 8.00-
WORKERS'COMPENSATION DECLARATION _
I hereby affirm that I ,have a certificate of consent.to self LIU D v n (�
insure, or a certificate-of Workers'Compenstion Insurance, or [/=�1 /�=�1 jJ �J�J �fv (wu
a certified copy thereof (Sec. 3800,tab. C.) COUNTY OF,LOS ANGELES BUILDING AND SAFETY
Policy No. Company 1
❑ Certjfied,copy.is hereby furnished. FOR APPLICANT.TO FILL IN I BUILDING
ADDRESS
❑ Certified copy is filed'with the county building inspec- BUILDING
tion deportment. ADDRESS e<J� j LOCALITY
NEAREST
Date Applicant CITY`' CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' F BLDGS., ASSESSOR
NO O
-COMPENSATION INSURANCE SIZE OF LOT. ON LOT I MAP BOOK PAGE PARCEL
(This section need not be completed if the permit is for one �!' USE ZONE MAP
huridred dollars ($100)or less.) TRACT BLOCK T NO. � NO.
JT
EL ` ( SPECIAL ' p,
I certify that inA6performance of the workfor which this J OWNER O. CONDITIONS
permit is issued, I shall not employ any person in an,y,manner P SS L1
TYPE FIRE
(. DISTRICT. GROUP, PRO ED„,�Y '
ADDRESS CONST. ZONF a
so as to become subject to the Workers'Compensation Laws. i17
`,f -� _ :J-�
Date Applicant CITY IP STATISTICAL CL•'ASSIFICATION APT. CONDO. U
NOTICE TO APPLICANT: If, 'after.making this Certificate of
ARCHITECT-OR TEL.-
ENGINEER NO. CLASS NO. DWELL. UNITS
Exemption, you' should become subject to,the' Workers' �
Compensation provisions of the Labor Code, you must-forth- ADDRESS _ SEWER M P
with comply with such provisions or this permit shall be ` �t�
deem'ed'.revoked. ;' R TEL. BK. (�' PG, VALIDATION,
CONTRACTOR NO.
LICENSED CONTRACTORS DECLARATION ,. LIC
I hereby.affirm that am licensed under•pcovisions of Chapter 9 ADDRESS NO. _. VALUATION
(commencing with Section 7000)of Division 3 o the Business and LIC.
Professions
'Code, and my license-is in full force'and effect. CITY CLASS
• � - SQ.-FT. NO. OF NO. OF CHECK - -
' License Number Lic.Class- - n SIZE STORIES FAMILIES ONE
$
Contractor' Date. DESCRIPTION OF WORK "
NEW,
❑ I am.exempt from the licensing'requirements as.l am a ADD ❑
licensed architect or'a registered professional engineer_ ;ALTER ❑ FINAL
DATE'
acting in my professional capacity (Section 7051, p
REPAIR
Business and Professions Code), USE O,i' ❑ FINAL
EXISTING BLDG. DEMOL ❑ B
Lic.-or Reg. No. Date APPLICANT TEL. Y
OWNER-BUILDER DECLARATION (PRINT)"' NO.,
I hereby affirm that,l am exempt from the Contractor's License -
Law for the following reason (Section 7031.5; Business and ADDRESS
Professions Code): o PRESENT
F-1 ) BUILDING.
I, as owner of the property, or m,y employees with ADDRESS
wages as their sole compensation;will do the work and
the`structure is not intended or offered for sale(Section" a LOCALITY �'3 O Z.
9'.A
7044, Business and Professions Code), MOVING TEL. 1
❑ I, as owner of the property, am.exclusively contracting CONTRACTOR NO. ka,°,° ° °
with licensed.contractors to construct the project (Sec- ADDRESS ' 2'° ° 2&O O
tion7044, Business and Professions Code).
REQUIRED TOTAL SETBACK FROM EXIST. _
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.. LINE WIDTH ° O 2 8, O'er
I hereby affirm-that there is a construction lending agency for -;'FRONT
the performance of the work for which this permii is issued P.L. 0 2 2'2',8 2
(Sec..3097, Civ. C.). SIDE 6 .
P.L..
Lender's Name
o O Lender's Address P.C.Fee$ Permit Fee
,', I certify-that I.have read this application and state that'the Issuance Fee fJ ✓'J
eabove information is correct. I agree to comply with all County Investigation'Fee
ordinances and'State laws'relating to building,construction, �p
Total Fee ,
and hereby authorize representatives of this County to enter
a upon.th6 above-mentioned prop'erty'for ins ection pu'rpooses:
a GA_a�Qti 43 SEE REVERSE FOR EXPLANATORY LANGUAGE
Si nature of Applicant or Agent Date - _ Os
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS DEMOLITION
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0102120014
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
TR: 5904 LT: 58 SQ. FT STORIES TYPE 8862 LONGDEN AV
STRUCTURE: TEMP CA 917801502
ASSESSOR INFORMATION NUMBER:
NEAREST CROSS STREET: RENO
5384-001-026 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG USE: RESID USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 02/12/01 UT 08/11/01
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FIN BY: CODE:
MC DONALD THEODORE D;SHARI A (626) 287-2621- 1 0 I
8862 LONGDEN AV o 0(
TEMP 917801502 FEES PAID D CRIPTION OF WORK
DEMOLISH RESIDENTIAL SWIMMING POOL
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. 90:
SAME AS OWNER AA BLDG PERMIT ISSUANCE 27.75
02 DEMOLITION INSPEC_TN, 163.50 SPECIAL CONDITIONS:
TOTAL--FEES 191.25
CONTRACTOR: TEL. NO:
SAME AS OWNER �� �� APPROVALS DATE INSPECTOR SIGNATURE
LIC. NO �,� �ri �•'.� �� ���;�� PEDESTRIAN PROTECTION
SEWER DISCONNECTION
ARCHITECT OR ENGINEER: TEL. N0: \ ABANDON PRIVATE DISPOSAL
I
LIC. N06 — -�' -� �, 11!lll UNDERGRND STRUCT REMOVAL
llaz -
AND SOIL RECOMPACTION
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: OMP: `
153H265 01
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
NO 24
SCHOOL WITHIN HAZARDOUS
AIR QUALITY: 1000 FEET MATERIALS �i 1
NO NO NO 7 t
Eo
REPORT ID: DPR261 ROUTE TO: BS0508
w.
M A ROA15 DEPT. PEpPAIT -IS` REQUIMM' T
FOR ANY AAATERIAI STORA;,E C W0--Rk� t
DONE IN THE I r `
- ® / ,r'�I 1171 pqy/ FOR
(�Heg, CY r NpV[[[b���AY��.a►q PERMIT ,.
��/1p��j��(p'�/❑�111�®j
78A898A CE#809 8-59 l PPL I.C/-1 LL tl®l �. R ®� L./U Y ®9 \i• Y Yr.tl \�V 6 Y 9 •
`COUNTY-'OF LOS ANGELES BUILDING
DEPARTMENT /
ADDRESS b -
.OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALiT >✓
JOHN A. LAMBIE, COUNTY ENGINEER' NEAREST
CASSATT D. GRIFFIN,.SUP•T OF BUILDING .CROSS ST, -
DISTRICT_ NO GROUP TYPE •- PROCESSED.BY
FOR:APPLICANT TO FILL IN -�J I cONsr.
BUILDING pp STATISTICAL CLASSIFICATION SEWER MAP BK G
ADDRESS OB162 L 'toi.7GQc/V, TelypI.E ;T Y' - CLASS.`NO�DWELL.UNITS ' p y'
LOT NO: BLOCK. -
_ :.,,.-MAP
S UMBER 'z�. 6 " HWY. S N
STATE
p YE
TRACT {Q USE ZONE SPECIAL -
` '/,.i• / I - NO.,OF BLDGS.• �,.-..� ' CONDITIONS
SIZE OF LOT IL'ri.•�X,/A I �I. N/O!W'ON'LOT
USE OF [l W L' /-/I T_. ,
EXISTING BLDG. - .. - BUILDING •• ,ARD HWY. STREET NAME .EXIST ,
RICHK SETBACK WIDTH •_.
0WNERVtVe_j %A CogZIT'ER FRONT -
P:L. r.. �
ADDRESS 8802 E; .Lol i GLEN. - . SIDE .
.. P..L. -
CITY No AT�8128INSPECTION-RECORD.
ARCHITECT OR - - ' TEL.'
ENGINEER .NO. '
,ISL•13C
ADDRESS"
TEL". 1:5: �n,
CONTRACTOR /�/ T NO.
�• _
ADDRESS. .. -
DESCRIPTION. OF,WORK
EW ADD. ALTE `:REPAIR DEMOLISH - -
SQ. FT. NO. OF NO. OF - A- A,
SIZE. STORIES FAMILIES
USE OF: T.
STRUCTURE .E+CiSC�PrQA�rL �u 4Y/N�.,
-.j.[d6 Rr�CT / TFIRAGE 2f3Gl G«r.dr� c rfe�±r/d Lr!�icf. -a�'c .< <aFs�� Y
SIGNATURE OF
APPLICANT
,_,; 'APPROVALS - DATE- INSPECTOR'S-SIGNATURE
po 'FOUNDATION:,LOCATION _
ADDRESS r9rl t? ' ' D �G `- FORMS,MATERIALS
VALUATION.$ •�"�. �-" .. .. - FRAME: FIRE STOPS, -
.. ..BRACING. BOLTS-.
.. r.
FURNACE: LOCATION;
P.C. PMT. _ _ GASNENT,DUCTS • _ -
. FEE $ ` ' I FEE. ..
1_HEREBY ACKNOWLEDGE THAT I-HAVE READ THIS'AP-
-
t..
PLICATION AND STATE THAT THE-ABOVE IS CORRECT AND LATH, INT.. _ 3, , 'ate'/
-` AGREE TO COMPLY WITH,ALL COUNTY.ORDIN LACES AND -
STATE .LAWS REGJLATING U DI/p}/� O TRUCTION._ LATH, EXT.
t
SIGNATURE'OF /� /'�'• '. - HOUSE NUMBER COR--
PERMITTEE-
OR-PERMITTEE [��.t*lZCY/ C ^ RECT AND POSTED
ADDRESS-`E�62 E•- /.DN�,UcN TE/yP�� �•Tl FINAL'- `c
CLYDE N. DIRLAW PRINCIPAL STRUCTURAL EN R
PLAN CHECK VALIDATION CK M o: CASH. ::` 'PERMIT-VALIDATION CK.
OP s 76A638A
CE#803(REV.1V/•78)
APP UCATHON FOR BUH. LDING. PERMIT.
COUNTY OF LOS ANGELES BUILDING,AND SAFETY ..
FOR APPLICANT TO FILL IN BUILDINGtom.,
C1 ADDRESS
AD DRESS
IDING $ So t✓Y1 LOCALITY /
NEAREST
CITY ZIP ' , l J CROSS ST.
J {p
Nb.OF BLDGS. ASSESSOR PAGE PARCEL
SIZE OF LOT <<F 1( NOW ON LOT MAP BOOK
DISTRICT GROUP` TYPE FIRE PRO ESSED BY
TRACT BLOCK LOT NO. / / CONST?- ,ZONE'
EL. Ij,CK ' ,3 J
OWNER O.�
STATISTICAL CLASSIFICATION W ERR''M,A'PP
ADDRESS E. �n .CLASS NO. �/ DWELL.UNITS IVB BK ( "PG
.�
CITY (1 ZfP
ARCHITECTOR / TEL. VALUATION $ J:7
ENGINEER j NO. V
ADDRESS_ BLDG.SETBACK FROM
FRONT PROP.LINE OF (STREET)
TEL
;
CONTRACTOR NO. NOTAL SET CK FROM TYPE'OF EXISTING .
LIC. HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH
ADDRESS NO.. �o
LIC. - - + O. _ O '
CITY CLASS BLDG.SETBACK FROM
CONSTRUCTION LENDER SIDE PROP:LINE OF (STREET)
NAME AND BRANCH Z'
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING O,
ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH. Ol
SO.FT. NO.OF NO.OF CHECK + _ cc
SIZE STORIES FAMILIES 1 ONE p®
O ZONE: MAP'
DESCRIPTION OF-WORK ' NEW-' USE
[/i NOS' 66369
SPECIAL
• r CA ADD �3I �d CON�DIITIIONS g
ALTER- _0 FINAL
BY ��47_Q
USE OF W f
EXISTING.BLDG. DEMOL a Z
APPLICANT TEL C
(PRINT) NO. a
BY(SIGNATURE(' a
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE,.IS CORRECT AND,AGREE TO•COMPLY WITH ALL ORDINANCES ., .. •_ „, W �q p
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE x O
.Z 4 1.7,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'S COM '--„ - I g - �,'# p O O;O O. 1 -
PENSATION INSURANCE.' -
IL
2:-. --34,00
SIGNATURE F•� � • ^•
'
PERMITTEE O - �42
0,o 0 3'4,0 0 U
ADDRESS t°
Z
2g 12,31 '-79
TEL.. ._ ... _ �
CITY NO
P.C. Fee$ Permit Fee >
r _
Issuance.Fee W
d
Total Fee,.
l!
76A638A C60803 8-64 APPLICATION FOR BW Ln PERMIT
II ERIT
COUNTY OF LOS ANGELES BUILDING f
DEPARTMENT OF COUNTY ENGINEER Ao.oREss ,
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE'. COUNTY ENGINEER NEAREST
COLEMAN-.W. JENKINS,SUP-T.OF BUILDING CROSS ST. f
- - DISTRICT NO. GROU TYPE. 'P SSED.B'Y
FOR APPLICANT TO FILL IN coNST.
BUILDING y`_. o STAATISTICAL'CLASSIFICATION'' SE ER MAP
ADDRESS �1" a CLASS NO. DWELL UNITS BK PG/ „
LOT NO. I BLOCK Ej
ZONE MAP IC JJJ
. NO. -CTL-
TRACT I � j 'SPECIAL -
' '.� f NO. OF BLDGS.. `� CONDITIONS
SIZE OF LOT/lij NOW ON LOT J
USE OF - - _ - -
EXIST N B G. - .ai.c�. - BLDG. SETBACK FROM
t__TEL mCt ` FRONT PROP. LINE OF (STREET).
OWNE NO• G TYPE OF EXISTING SETBACK,_ HIGHWAY + YARD _ = TOTAL.
ADDRESS - HIGHWAY WIDTH 'F FROM C.L.
CITY
BL
ARCHITECT OR - TEL. DG.. S TBACK FROM
ENGINEER .. NO. SIDE PROP. LINE OF (STREET)
_ TYPE OF EXISTING SETBACK 'HIGHWAY -FYARD _ '"'TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L. d
O
CONTRACTO dKhN SVT p� "� V
LIC.'Qrye D ' CORNER CUTOFF YES NO - O
ADDRESS12Z NO.LIC
CITY CLASS-_ .SEE REVERSE SIDE FOR SPECIAL APPROVALS u
DESCRIPTION OF WORK i H
7 G/ e� z
NEW ADD Woe ALTER REPAIR DEMOLISH
T N O: O F N O. O F
SIZE
,STORIES FAMILIESI++ / wY �—•v
USE OF T./,J// /f A �
STRUCTURE ,
SIGNATURE OF • -/•/.G . >L'�''f� d�/d�d/ //_.:.�'�lfi! �e�: d
APPLICANT gn moi..
VALUATION$
APPROVALSIf Jpr DATE INSP ECTOR'S SIGNATURE
P.C. - PMT. FOUNDATION, LOCATION
FEE V;— FEE$ FORMS,.,MATER.IAL_S,___ �r/r2� +� �'�" _ ✓'�
'FRAME, FIRE STOPS, J'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT [o --
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- LATH. INT. �� ��f_1
TION OF THE LABOR CODE.OF THE STATE F CALIFORNIA RELAT;•
ING TO WORKMEN'S COMPENSATION INSUR E. w LATH. EXT.
_ SIGNATURE OF 12el , .HOUSE NUMBER-COR- /
PERMITTE/E RECT AND POSTED
�.
ADDRESFINAL
.
ly-1
JOHN F. LEWIS. PRINCIPAL S78).5
RAL ENGINEER
PLAN CHECK-VALIDATION' CK. M.O. CASH _ PERMIT' VALIDATIONM.O. CASH
LACo.3 6.3 6-1-- JUL iL 1 4 1 A 0—
,
76A638A CE#803 8-63 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ABUILDING ril�DDRESS .Z-. /vG 1�G
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY �R F n f7f?l C
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. C7-3,614 ;74 D �
DISTRICT NO. OU TYPE P SSED BY
FOR APPLICANT TO FILL IN CONST. t ,/
BUILDING V (. I�✓ STATISTICAL CLASSIFICATION SE ER MAPx�
ADDRESS v 1 ��/ T.. BK PG
CLASS. NO. DWELL. UNITS
LOT NO. BLOCK WATER NOT REQUIRED RECEIVED ❑
CERTIFICATE: I LIS
TRACT L' MAP HIGHWAY STATE MAJOR SECOND, AL
NO.OF BLDGS. NO. (CIRCLE)
SIZE OF LOT NOW ON LOT USE ZONE SPECIAL
USE TI ^� CONDITIONS
EXISTING BLDG. J �/ �^ V/j ALJ
OWNER c'n IZi'c , NO/1� ep / BUILDING EXIST.
• /
2- k O&& PF
.V/ SETBACK YARD HWY REET NAM WIDTH
ADDRESS II / FRONT
ARCHITECT OR TEL. P. L. ?
ENGINEER NO. SIDE
P. L.
ADDRESS �j� IL
CONTRACTOR IaOCK jCoo�.S NoPT7-S>"D; _ t:�•,��% g
ADDRESS yv L S. �R ��R/C LID w
DESCRIPTION OF WORK /f O
BJ
E ADD ALTER REPAIR DEMOLISH CL
~P P rn
S177 FT. NO.OF NO. OF
SIZE STORIES FAMILIES
USE OF �C' I�
STRUCTURE J
5 ,P R I V T &C-RR i l(y7.7 7 3 '
SIGNATURE OF CA-t
APPLICANT
VALUATION foe, v
APPROVALS DATE INSPEC IGNATURE
P.C. PMT. Ci FOUNDATION: LOCATION
FEE $ FEE $ FORMS, MATERIALS - {� ! -C L
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.
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH. INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT.
ING TO WORKMEN'S COMPENSATION INSURANCE.
�v` LATH. EXT.
SIGNATURE OF HOUSE NUMBER COR.
PERMITTEE RECT AND POSTED
ADDRESS FINAL
JOHN F. LEWIS. PRINCIPAL STRtTtTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. { M.O. CASH
2957 ?4 22 h 3.75-
{t,o 2 9 5 8 Mi 2 2 1 1 5.0 0� Z