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APPLICATION FOR BUILDING PERMIT �! 1
COUNTY OF LOS ANGELES BUILDING
ADDRESS
DEPARTMENT OF COUNTY ENGBIEER
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BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN GU"OF BUILDING CROSS ST
DISTRICT NO G PTYPE P OCESSE
FOR APPLICANT TO FILL IN CONS
ADDRESS STATISTICA IFICATION SEBUILDING KR PG
CLASS NO ELL UNIT110
LOT NO BLOCK MAP STATE
NUMBER HWY YES NO
TRACT Z E ZOfIF S CIAL
NO OF BLDG // CONDITIONS
SIZE OF LO NOW ON LOLn
USE OF
ILDG. BUILDINGEXIST
SETBACK YARD HWY STREET NAME WIDTH
OWNER FRONT
MAIL P L
2z 71
ADDRESS SIDE
EL P L
CITYNo INSPECTION RECORD
ARCH ITECT OR TEL
ENGINEER NO
ADDRESS 91
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TEL O b 4�
CONTRACTO NO
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DESCRIPTION OF WORD '"
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NEW ADD ALTE REPAIR DEMOLISH
SQ FT NO OF NO OF oa %,j Loa x 94
SIZE STORI FAMILIES
USE OF 017RUCTURN 2_/ O
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SIGNATURE OF APPROVALS
APPLICANT
DATE+ INSPECTOR S SIGNATURE
ADDRESS FOUNDATION LOCATION k
$ O O FORMS MATERIALS
P C. S FRAME FIRE STOPS
`/ FEE BRACING BOLTS
VALUATION f — - E s �� FURNACE LOCATION
GAS VENT DUCTS I S
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP LATH INT �.
PLICATION AND STATE T THE ABOVE 18 CORRECT AN
AGREE TO COMPLY Wt LL COUNTY ORDINANCES STH EXT
STATE LAWS REGU G BUILDI RU N
SIGNATURE OF USE NUMBER COR K
PERMI RECT AND POSTED
JIV I i 1 �1
ADDRESSFINAL
CLYDE N DIRLAM PRINCIPAL RUCTURAL ENGINEER
GH=VALMATION cK. M o cwsH MEOW VALID TION, CK M o CASH
L-&2208M FEB 4 1 A 600
DEPARTMENT OF _ ING AND.PMM AJ nkTZOn,F9R MllpoaT
COUNTY OF LOS ANGELES
WM J FOX. CHIEF ENGINEER la u it ® I N G
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
DISTRICT
I NO PLAN CK. NOV- PERMIT NO
BUILDING ^ /VADO8JV Z+ /
LOCALITY 6 ` I ` I� RECEI Y DATE
DATEOr APPLDATE
ATE ISSUED
NEAREST
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BUILDING
OWNER p�L / ADDRESS
MAIL 143/ / �r /AJ / v//ofV O�
ADDRESS ✓ LOCALITY
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FIRE NO OF TYPE I GROUP
ARCHITECT clit Z TEL ZONC PLANE , /
ENGINEER NO
BLDG �y f- ORD NO
ADDREBB �� SETBACK LINE / Y / ���+
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CONTRACTOR/'i4/1 f /V�/y NIS � 4 BY4"m� DATE
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ADDRESS T/��y ,�(/� ZONE BY DATE
LEGALCORRECTIONS
DESCRIPTION LOT NO � I BLOCK ,'(f'(�
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size OR LOT"X I O I NOWOON LOOTS &d A
USE OF I NO OF NO OF/�/
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DESCRIPTION OF WORK • a
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size ICWALL ` 2 ROOMS STORIES /�
oar
COVERING S V 0 0 0 COVERING
USE OF NEW
BUILDING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IB CORRECT roUNDATIONi
, IONp INSPECTOR-- DATE
MATERIALB � � � ' .f'
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES i
ANDSTATE LAWS ULATINO 8 ILDI CONSTRUCTION FRAME FIRE STOPS,
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81GNATURE ACING, BOLTS OF �i � }
OWNER LATH, INT t _�
AUTHORIZED AST LATH OCT
�L \ P O • �,Q PLASTER INT
V FE6 PLASTER, OCT
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VALUATION •FEE ,)o FINAL
7114e311A CC#Sol-S SO APPLICATION FOR BUILDING PERMIT \
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGIIVEER ADDRESS
BUIMMG AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
DISTRICT NL GROU TYPE O S Y
FOR APPLICANT TO FILI.IN �; 0 coNsr
BUILDING STATISTICAL C FICATION SE MAP
K
ADDRESS C2/ CLASS NO DWELL UNITS _ P�
LOT NO BLOCK MAP NUMBER d STATEj.WYES NO
TRACT 00 USE ZONE SPECIAL
NO OF SIZE OF LOT �'lp IZ O I NOW ON LOTS CONDITIONS
USE OF
EXISTING BLDG BUILDING EXIST
TEL SETBACK YARD HWY STREET NAME WIDTH
OWNER NO FRONT 1 ! e t
ADDRESS 10Z 1Z AE, / SIDE
ARCHITECT OR TEL P L
ENGINEER NO INSPECTION RECORD
ADDRESS �� �
CONTRACTOR ` NO V
ADDRESS 0
O
DESCRIPTION OF WORK
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NEW ADD ✓ALTER REPAIR DEMOLISH N
SO FT .4 NO OF NO OF Z
SIZE STORIES FAMILIES
USE OF
STRUCTURE
SIGNATURE OFC:,;Z&& ® �
APPLICANT ��c�
VALUATION
APPROVALS DATE OF INSPECTO S SIGNATURE
PC PMTFOUNDATION LOCATION
FEE S FEE S FORMS MATERIALS 3 �N
FRAME FIRE STOPS
1HEREBY 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 SUBU ECT
TO THE WORKMEN S COMPENSATION LAWS OF CALIFORNIA
LATH EXT
SIGNATURE HOUSE NUMBER COR
PERMITTE RECT AND POSTED
ADDRES oZ/2 FINAL
CLYDE N DIRLAM PRINCIPAL STRUCTURALE R
AN
PLCHECK VALIDATION CK. M o CASH PERICT VALIDATION CK NO
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TBA9cENe.s ° °°APPLICATION FOR BUIL • NG PER IT ,ul
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
COLEMAN W JENKINS SUP T OF BUILDING CROSS ST
FOR APPLICANT TO FILL IN DISTR�I r'T 1 o r P B1170.
(Print ort a only rJ CONSTYPE T
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BUILDING STATISTICAL C IFICATION SEWER MAP
ADDRESS CLASS NO DWELL UNITS BK
LOT NO 2 BLOCK USE ZONE MAP �j O
NO l/
TRACT �S `p Z SPECIAL
NO OF BLDGS CONDITIONS
SIZE OF LOT X /Z 40 NOW ON LOT
USE OF
EXISTING BLDG BLDG SETBACK FROM
OWNE NOL FRONT PROP LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS !/
A HIGHWAY WIDTH FROM C L
CITY T +
BLDG SETBACK FROM
ARCHITECT OR TEL SIDE PROP LINEOF (STREET)
ENGINEER NO TYPE OF 1EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAYI WIDTH FROM C L
CONTRACTOR p /a/3 NOL +
ADDRESS N ,ON `�� Y3 CORNER CUTOFF YES ❑ NO ❑ C
CITY Q �i �' CLASS 6 �' SEE REVERSE SIDE FOR SPECIAL APPROVALS
CONSTRUCTION LENDER CL
NAME AND BRANCH i
W.
ADDRESS 5
Sq FT NO OF No OF / NEW ❑
SIZE Z .0 STORIES FAMILIES
USE OF "` S ADD
STRUCTURE �'f/ Cp /0
ALTER ❑
SIGNATURE REPAIR❑
APPLICANT EMOL ❑
VALUATI /�^O L�
APPROVALS D TE INs CTOR 3 G TORE
PC PMT FOUNDATION LOCATION
FEE S FEES / FORMS MATERIALS (h
FRAME FIRSTOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACINGE BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON GAS VENT DUCTS
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH INT
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN S COMSATION NSURANCE LATH EXT
SIGNATURE O D �/ HOUSE NUMBER COR
PERMITTEE RECT AND POSTED
ADDRESS
FINAL r $ O
PLAN CHECK VALIDATION CK M o CASH JOHN F LEWIS PRINCIPAL STR RAL ENGINEER
PERMIT VALIDATION CK M O CASH
2022% hnu 7 1D 17.25- 40
t
A ROAD DEPT PERMIT IS REQUIRED '
FOR ANY MATERIAL STORAGE OR WOPK
DONE IN ThE POAD RIGHT OF WAY
APPLICATION FOR BUILDING PERMIT 1
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COUNTY OF LOS ANGELES BUILDING
DEPART1VIENT OF COUNTY ENGINEER ADDRES8
BUILDING AND SAFETY DMSION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST
DISTRI O GR,pJP I TYPE E
E Y
FOR APPLICANT TO FILL IN .i--
BUILDING STATISTICAL SIFICATION EWER MAP
ADDRESS � B
Ct.A.. NO DWELL UNIT
LOT NO BLOCK MAP STATE YES NO
NUMBER HWY
TRACT / USE ZONE SPECIAL
NO OF BLDGS CONDITIONS
SIZE OF LOT I NOW ON LOT �
USE OF
EXISTING BLDG BUILDING YARD HWY STREET NAME EXIST
SETBACK WIDTH
OWNER /Q 6e FRONT
ADDRMAILESS /rj S`� SPID,E
CITY ) - �'' No r INSPECTION RECORD
ARCHITECT OR TEL
ENGINEER NO
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ADDRESS
TEL
CONTRACTOR NO
L
ADDRESS
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR✓DEMOLISH
SQ FT NO OF NO OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE
•
O /Y/
SIGNATURE OF
APPLICANT
APPROVALS DATE INSPECTOR S SIGNATURE
ADDRESS /OZ/Z GC' FOUNDATION LOCATION
a FORMS MATERIALS
VALUATION $ �Qa �� FRAME FIRE
STOPS
RACING BOLTS
PC PMT FURNACE LOCATION
FEE FEE $
t GAS VENT DUCTS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP LATH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULATING BUILDING CONSTRUCTION LATH EXT
,SIGNATURE OFHOUSE NUMBER COR
PERMITTERRECT AND POSTED
ADDR 'm FINAL S 6/
CLYDE N DIRLAM RINCIPAL STR RAL ENGINEER
PLAN Q= VALIDATION CK M O G"H PERMIT VALIDATION aK w G CASH
LACo 6 3 5 2% FEB 11 1 A 3 D 0 ,
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7GA638A CE #808 1/71
APPLICATION FOR BUILDING PERMI _
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS �� I
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
(Pri for nl CROSS ST
BUILDING w' DI COT NQy GRO CONST S B
ADDRESS
STATISTICAL L SSIFIC TION SEWER MAP
LOT NO BLOCK CLASS NO DWELL UNITS BK— PG
TRACT USE ZONE MAP
�/ NO OF BLDGS NO
SIZE OF LOTf�� A NOW ON LOT SPECIAL
USE OF I CONDITIONS
EXISTING BLDG
TE _
OWNE NO BLDG SETBACK FROM
ADDRESS FRONTPROP LINE_OF - - (STREET)
L.. ^ TYPE OF EXISTING SETBACK HIGHWAY t YARD = TOTAL
CITY /VV HIGHWAY WIDTH FROM C L
ARCHITECT OR TEL t
ENGINEER NO
BLDG SETBACK FR
ADDRESS SIDEPROP LINEOF (STREET)
TEL TYPE OF EXISTING SETBACK HIGHWA YARD = Y TOTAL
CONTRACTOR 0 W e NO HIGHWAY WIDTH FROW C L CC.i
LIC
ADDRESS NO t - O
LIC
CITY CLASS CORNER CUTOFF YES ❑ NO ❑ a
ON
NAME AND BCONSTRUCTIRANCHVDER SEE REVERSE SIDE FOR SPECIAL APPROVALS z
ADDRESS
SQ FT NO OF NO OF NEW ❑
SIZE STORIIES/( FAMILIES
USE OF
STRUCTURE w1-�4 /� WAL-1-- ADD
ALTER ❑
SIGNATURE OF REPAIR❑
APPLICANT DEMOL ❑
VALUATION $ to 0 APPROVALS PATIPP N8P' TORS 81 TORE
P C PMT FOUNDATION LOCATION
FEE$ FEE$ • (/ (/ FORMS MATERIALS 044 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
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON GAS VENT DUCTS
STRUCTION 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THELATH INT
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN 8 COMPENSATION INSUIPANCk �4LLATH EXT _
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE RECT AND POSTED
ADDRESSii I N A
PLAN CHECK VALIDATION CK M 0 CASH LEWIS TVALIDATION TRCKTURM O E0
,4 8 9:32113
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COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0308180022
PHONE (626) 285 0488 EXT
' LEGAL 10 NO OF LMNST NEW BUILDING ADDROS
TR 15862 LT 25 SQ FT STORIES TYPE OCCUP GROUP 10212 NADINE ST
STRUCTURE 559 1 VN R3 TEMP CA 917802727
ASSESSOR INFORMATION NUMBER GARAGE NEAREST CROSS STREET ARDEN
8586 026-014 OTHER THOMAS PAGE 597 GRID B3 LOCALITY TEMPLE CITY
TENANT EXIST BLDG USE USE E PROCESSE"r-- EXPIRES ON
EXIST OCC GRP 09/02/03 JK 08/27/04
OWNER TEL NO BLDGS KOW ON LOT VAL ION F L DATE F By CODE
GUGAJEW ROBERT $ PAULINE (626) 447 1288 7,000
10212 NADINE ST
TEMPLE CITY 91780
FEES PAID JOR*-
CONVERT EXISTING PATIO TO RECREATION RM (399SF) 8 CONVERT
APPLICANT TEL 10 FEE DESCRIPTION QUANTITY UDM AMOUNT PORTION OF EXISTING WORKSHOP TO BEDROOM (160SF)
SAME AS OWNER AA BLDG PERMIT ISSUANCE 27 75
AC STRONG NOTION RESID 7000 00 VAL 0 70 SPECIAL CONDITIONS
81 PLANCHECK W/ENERGY- 7000 00 VAL 155 40
82 PERMIT W/ENERGY -_ ' _ 7000 00 VAL 182 82
TOTAL- FEES 366 67
APPROVALS DATE INSPFffM-ffMlVff0ffF--
CONTRACTOR
SAME AS OWNERSOILS ENGINEER APPROVAL
LIC NO LOCATION AND SETBACKS
ARCHITECT OR ENGINEER TEL NO FOUNDATION/TRENCH FORMS 72f-—5_
LIC NO � � -- Q /►�
i
RAISED FLOOR FRAMING
MAP NO SEWER 14AP BOOK PAGE FIRE ZONE C14P UNDERFLOOR IN§MWffMT-
3 d '101 fI- IST LEVEL FLOOR SHEATH
' '
NO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS
NO 21 `r - _ - - - - _ - -
SCHOOL WITHIN HAZARDOUS
1ROOF SHEATHING
AIR QUALITY 1000 FEET MATERIALS / r
FIRE DEPT FRA E INSPEVr
REQUIRED TOTAL SETBACK FROM EXISTf
-F - ' BLDG DEPT FRAME INSPECTIr
SET BACK YARD HWY PROP LINE WIDTH
FRONT PL y; c ti - - ;„ P
SIDE PLINSULATION/WEATHER STRIP
�_- /0-/- 3 �'
INTERIOR LATH/ORYWALL
EXTERIOR LArH
LOT DRAINAGE
SMOKE DET&17M-RVrMT-
FIRE DEPARTMENT APP
REPORT ID DPR261 ROUTE TO BS0508
I
COUNTY OF IAS 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 1307240039
PHONE (626) 285 0488 EXT
ILEGAL ID I NO OF CONST I BUILDING ADDRESS I
ITR 15862 LT 25 I SQ FT STORIES TYPE 1 10212 NADINE ST 1
ISTRUCTURE V B I TEMP CA 917802727 1
(ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET ARDEN I
18586 026 014 I I THOMAS PAGE 597 GRID B3 LOCALITY TEMPLE CITY CAI
ITENANT EXIST BLDG USE RESID USE ZONE R 1 JISSJED ON PROCESSED BY 1
EXIST OCC GRP 107/24/13 SR 1
(OWNER TEL NO IBLDGS NOW ON LOT VALUATION IF Aa, DATE FYALqy CODE 1
IGUBAJEW ROBERT (626) 277 7109 1 4 650 1 / I
110212 NADINE ST I 1 o- I
ITEMP 917802727 1 FEES PAID 1 SSL IP ION OF WORK 1
I I J KIT HEN R 40DEL 1
1 'FEE DESCRIPTION QUANTITY UOM AMOUNT I I
(APPLICANT TEL NO I I I
ISAME AS OWNER IAA BLDG PERMIT ISSUANCE 27 80 1_ I
I IAB STATE GREEN BLDG FEE 4650 00 VAL 1 00 ISPErIAL CONDITIONS 1
IAC STRONG MOTION RESID 4650 00 VAL 0 50 1 I
JB2 PERMIT W/ENERGY 4650 00 VAL 145 90 J I
I I TOTAL FEES 175 20 I- I
(CONTRACTOR TEL NO I JAPP&OVALS DATE INSPECTOR SIGNATURE 1
(SAME AS OWNER I-
I
I
LIC NO 1 ILOCATION AND SETBACKS I I I
I 1 (SOILS ENGINEER APPROVAL I I I
JARCHITECT OR ENGINEER TEL NO 1 IFOUNrATION/TRENCH FORMS I I I
f
1 LIC NO 1 ISLAS/JNDER FLOOR I I I
I I (RAISED FLOOR FRAMING I I
I II I I
IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I (UNDEIRFLOOR INSULATION I I I
3 001 1--
I
-_I IFLOCa SHEATHING I I I
INO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS I I I I I
NO 21 I IROOFISHEATHING I I I
SCHOOL WITHIN HAZARDOUS I ISHEA PANELS I I I
JAIR QUALITY 1000 FEET MATERIALS J I_ I I I
1 NO NO NO IFRA, INSPECTION I I I
I I — IFIREtSPRINKLER HANGERS I I I
lIINSULATION/WEATHER STRIP( 1 1
I IINTEDIOR LATH/DRYWALL 1 I
I i II I I
1 I (EXTERIOR LATH
I I IRATEp FLOOR/CEIL ASSEM I I I
I JRATLD WALL ASSEMBLIES 1 1
(RATED SHAFTS/OPENINGS 1 I 1 I
l I
I I IT BAR CEILINGS I I a I
I I ILOT DRAINAGE 1 I I
y IREPORT ID DPR261 ROUTE TO BS0508