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►.Ilee8.C19#.09 -61 APPLICATION FOR EUILDING PERMIT-
COUNTY
ERMIT COUNTY OF LOS ANGELES BUILDING /
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN SUPT of BUILDING CROSS ST.
DISTRICT NO. G BY
FOR APPLICANT TO FILL IN j CONSTCON l�
.
BUILDING //�� STATISTICAL C FICATION SEWER MAP
ADDRESS . .i!
CLASS.NO. DWELL.UNITS
LOT NO. BLOCK WATER . NOT REQUIRED RECEIVED
�j CERTIFICTE:
TRACT •� I O MAP HIGHWAY TATE MAJOR SECOND LOCAL
NO.OF ILDGS. NO. (CIRCLE)
SIZE OF LOT. S I NOW ON LOT USE ZONE tSPECIAL
USE OF CONDITIONS
EXISTING BLDG. Blip
/n�^^ pp /
OWNER �P.EJC NO 4 B ILDING EXIST.
SETBACK YARD HWY STREET NAME W DT,H
ADDRESS 2-904W6FRONT /�
ARCHITECT OR TEL P.L. CSL (/
ENGINEER NO. SIDE
ADDRESS TEL. INSPECTION RECORD O
CONTRALTO NO
ADDRESS " iW� 0
DESCRIPTION OF WORK G
a
h
NEW ADD ALTER REPAIR DEMOLISH Z
SQ.F NO.OF NO.OF
IZE STORIES FAMILIES
USE OF
STRUCTURE
1
SIGN RE OF n..
APP ANT -
VALUATION$ .•t I' �
APPROV.ALSI�1 1� ATE ( INSPECTO/RuISSIGNATURE
FEE $ FEE $ FOFORMS,MATER ALS LOCATION I1 1 I/I I /Ir A_A�/i
FRAME:FIRE STOPS. ` (� v 1
1 HEREBY ACKNOWLEDGE THAT 1 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- LATH.INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE.
LATH.EXT.S�GNATURt
PERMITTEEE OF HR CT AND POSTEDOUSE NUMBER R l '
ADDRESS ` FINAL
CLYDE N. DIRLAM. PRINCIPAL STRUCTURAL EN911UMP
PLAN CHECK VALIDATION 'cr. M.o. CASH PFJMW'VALIDATION cK. m.o. CASH
�:c '4.'g-e Dec 13 � D 2.00
TEMPLE CITY
16A686A CE#806. 1-61 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES B JILDIN
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCAL ITYy�___4.o
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST.
DIST NO. GROUP TYPE RO ESS BY
el-12 V OR APPLICANT TO FILL IN U CONST.
BUILDISTATISTICAL CLASSIFICATION SEWER MAP
ADDRESS Randho Real Raod BK
CLASS.NO.�DWELL.UNITS PG
LOT NO. 9 BLOCK B WATER
�1�f1 CERTIFICATE: NOT REQUIRED RECEIVED
TRACT 1 j G1g �J11
SIZE OF LOT 62x185 I NNO.OF OW ON LOTS NOP. ({CIRCLE) STATE MAJOR SECOND, OCAL"
3 USE ZONE SPECIAL (7
USE OF CONDITION
EXISTING BLDG.Dwe111np, RumyusRm & Garam n ��
OWNER Harold R. Ballard NI AT 6644 BUILDING ,1� EXIST.
SETBACK YARD TREET NAME WIDTH
ADDRESS9122 Rancho Real Road.T.C. FRONT
ARCHITECT OR EL. P.L.
ENGINEER none NO. SIDE
P.L.
ADDRESS ;INSPECTION RECORD a
CONTRACTOR Santa Anita Const TO. I Q
ADDRESS8717 E. Las Tunas, San Gabriel
DESCRIPTION OF WORK
W
d
NEW XXADD ALTER REPAIR DEMOLISH _ to
SO.FT. NO.OF NO.OF Z
�IZE 906 ggiz�@ STORIES 1 FAMILIES 1
USE OF
STRUCTURE
Dwelling & Attached Garage _
SIGNATU
APPLICANT
VALUATION$ ,
T� APPROVALS DATE INSPECTOR'S SIGNATURE
FP C.EE $ /tel FEE $ FOUNDATION: LOCATION
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- LATH, INT.
TION OF THE LABOR CODE OF THE STA E OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATIO RANCE.
LATH,EXT.
SIGNATURE HOUSE NUMBER COR-
PERMITTEE REIT AND POSTED
ADDRESS — FINAL
CLYDE N. DIRLAM, PRINCIPAL STR RAL ENGINEER
PLAN CHECK VALIDATION (�.o. CASH PERMIT VALIDATION CK M.O. CASH
U ,o5686: DEC 423 D 15,00
M5855=0 DEC 7 1 D 3 0.0 0