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DMSION OF BUTl.DING AND SAFETY
COII m OF LOB MOE=
WILLMM J FOX. CouNTY ENSINEWI APPLICATION
CASSATT D GRIMM. SUPT OF BUILDING it
FOR AMOM TO ML INFOR OFFICE USE ONLY ,r
DISTRICT NO PLANCK OR RRec No PER T NO:-
ADDRB88 O �D D S rs fz- r
LOCALITY79 /M #L •T RECE VED BY VDATOF DAT SSU , 7 f
NEAREST c Spy 1
CROSS 8T BUILDING /
OWNER ADDRESS S(.0 ® /� .yLj,—
MAIL S I LOCALITY / V
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ARCHITECT Cie TEL FIRE NO OF 14YP GROUP ti
ENGINEER NO ZONE PLANS
BLDG r ORD NO
ADDRESS SETBACK LINE �D i
CONTRALTO TEL a USE APPROVED
Omwo ZONE BY DATE
ADDRESS HOU S NUMBERING (�
LEGAL MAP NUMBER 02®® O ASSIGNED BY ,•
DESCRIPTION NO K
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TRACT
2�jj NO OF BLDSS a
SIZE OF LOT (� L NOW ON LOTov SA
USE OR
NO
EXISTING BLDG N OR -r
DESCRWr= OF WORs vage., 'Pae " - O -
NEW ALTERATION ADDITION
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REPAIR DBMOLITION r
8Q FT idlop NO OR
SIZE ROOMS STORIES -
EXT WALL'STI ROOK C 4� �►6 B R s.�
COVERING + COVERING
USE OF STRJJCTURK
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APPROVAJA
7' INSPECTOR'S SIGNATURE DATE
FOUNDATION LOCATION
FORMS, MATERIALS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME FIRE STOPS,
PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING BOLTS
CORRECT FURNACE LOCATION ,Q
1 ASRBB TO PLY W ALL COUNTY ORD GAS VENT DUCTS b
AND STATE ESULATI BUI INS STRU
SIGNATURE OF LATH, INT
PERM rI
LATH EXT
ADDRESS •
4 PLASTER, INT
AUTHORIZED AST
PLASTER, EXT
'6 ���®Ap Fid S/� HOUSE NUMBER COR-
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RECT AND POSTED
VALUATION FEE $02 FINAL S Z
79AMBA JIM 3 9-42 � ,
76A698A CE 0803 3-69 APPLICATION FOR, BU I LDI N PERMI
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS 5616 NORTH NBEL DRIVE
BUILDING AND SAFETY DIVISION LOCALITY I'EWLE CITY
JOHN A LAMBIE, COUNTY ENGINEER
COLEMAN W JENKINS, SUPT OF BUILDING CROSS ST
PDRE
OR APPLICANT TO FILL IN DISTRICT GRO TYPE�T RO } Y
(PRINT OR TYPE ONLY) t�
STATISTICAL CLASSIFICATION SEW R MAP
NOL �.
CLASS NO DWELL UNITS BK PG
BLOCK USEjONE NOAP/rSPECIAL
NO OF BLDGSCONDITIONS
NOW ON LOT
G BLDG SETBACK FROM
MASON NOLFRONT PROP LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADORESS15616 N NOEL DR. HIGHWAY WIDTH FROM C L
CITY TEMPLE CITY +
ARCHITECT OR TEL BLDG SETBACK
ENGINEER NO SIDE PROP LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C L
CONTRACTORVIRGIN ROOF CO. NOL 287-0507 +
ADDRESS EL BL. LI 160650 CORNER CUTOFF YES ❑ NO ❑ L
LIC
CITY SM GABRIEL CLASS C-39 SEE REVERSE SIDE FOR SPECIAL APPROVALS C
CONSTRUCTION LENDER
NAME AND BRANCH LL
n
ADDRESS
SO FT NO OFNO OF ❑
SIZE STORIES FAMILIES NEW
USE OF
STRUCTURE REROOF WITH 300# ADD El
COMP..SHI ALTER 13
REPAIR 10
SIGNATURE OF DEMOL ❑
APPLICANT
VALUATION$807-00 APPROVALS DATE INSPECTOR S SIGNATURE
P C PMT 1300 FOUNDATION LOCATION
FEE$ FEE$ FOR S MATERIALS
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME FIRE STOPS,
BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION,
WITH ALL ORDINANCES AND LAWS REGULATING 0UILDIN6 CONSTRUC- A VENT, DUCTS
TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT
OF THE STATE OF CALIF RNIA IN RELATING TO WORKMEN 5 COM-
PENSATION INSURANCE
LATH, EXT
SIGNATURE OF
PERMITTEE HOUSE NUMBER CORRECT
AND POSTED
ADDRESS- FINAL 7
JOHN F LEWIS, PRI CI ALS URAL ENGINEER
PLAN CHECK VALIDATION CK M O CASH - PERMIT VALIDA ION t, CK M O CASH
' 5;.5511UR ,w24 1 0 12.0 Op w
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