HomeMy Public PortalAbout5426 ACACIA ST_Building_10/7/1974_Bedroom Addition -. --��, T
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BU I��i'rr, 'tom '.9 '' ;� T� �� ' A` COLTNTYOWN�1�2"OS AADORE3S: f i d�: t r �1 tI �r a- . r_ DEPASRbTMEIVT OiJNTYEclrY Tem leCit ZI�1MILkDING A`NDAFBTNYW= IWISIOIV"
NO OF BLDGS BUILDING
SIZE OF LOT NOW ON LOT 1, ADDRESS l
TRA'`T�i BLOCK_ LOT JO LOCALITTE
OWNER Joseph D'Elia NOL(�22kaAm .CROSSEST STASS
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ADDRESS 5426 Acacia 2859520 MAPESSOR BOOK ,,.:) rJ PAGE PARCEL %5
DISTRICT GROUP TYPE FIR [7SED
CITY Temple City ZIP 91776 fo CONST z
ARCHITECT OR " TEL
ENGINEER k NO
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO�� DWELL UNITS____�j BK PG
CONTRACTOR TEL US20NE MAP j
LIC NO /a
ADDRESS - _ NO v I SPECIAL
CITY LIC 1 CONDITIONS
CLASS ROAD DEP RTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER }
NAME AND BRANCH BLDG/SETBACK-FROM a
CITY FRO PROP LINEOF ' (STREET)
ADDRESS TOTAL SETBACK FROM TYPE OF EXISTING
HIGH AY } YARD HIGHWAY WIDTH
SFT OF NO OF CHECK _ FRONT�PROP LINE C
SIZE STT ORIES 1 FAMILIES 1 ONE
DESCRIPTION OF WORK NEW [Ell } � I ,a
ADD ® BLDG SETBACK - - Z
Bedroom Addltion SIDEPROP LINEOF ETI
ALTER ❑ TOTAL SETBACK FROM TYPE OF E STING
HIGHWAY } YARD = HIGHWAY WIDTH
REPAIR❑ SIDE PROP LINE -
USE OF }
EXISTING BLDG _ D_EMOL ❑ ' <
APPLICANTTEL CORNER CUTOFF' YES ❑ NO ❑
(PRINT) 5r M. D'Eli ;; ND
BY (SIGNATURE) ���pB_ ' IN OPEN SPACE ` YES ❑ NO ❑
Q IN COASTAL ZONE " YES ❑ NOjudsmERNIIIA
❑
VALUATIONYfiii" CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 'IMPACT EXEMPTION-DECLARATION SIGNED (DATE)
W ITH,ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORTlPROCESSED (DATE)
WHEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE d.s
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATION INSURANCE —9 — �ywexi e0—;udV dr n AV
5 I G N c T U R E OF , , Q '�
PERMITTEE
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ADDRESS /6,
` TEL FINAL .�r�' 1a' ,i} r„/ �;��
CITY NO DATE •V%
MAKE CHECKS PAYABLF 70 p E
HARVEY T BRANDT COUNTY ENGINEER / C
,PLAN CHECK VALIDATION cK 1M o CASH _ PERMIT VALIDATION CH N o CASH
1
76A638A CE#803 7/73