HomeMy Public PortalAbout4800TEMPLE CITY BLVD_Building APPLICATION FOR COUNTY OF LOS ANGELES
'BUILDING PERMIT DBUILDDING�ANDFSAi�DIIVVISIO�
FOR APPLICANT TO FILL IN ADDRESS �QO
Bu1LDING G� �'
ADDRESS LOGLI
NEAREST
CITY r ZIP CROSS ST
r NO OF BLOCS ASSESSOR
SIZE OF LOT �-f NOW ON LOT MAP BOOK PAGE PARCEL
LL / Z DISTRICT `GRO TYPE FIRE SED BY
TRACT 6� BLCCK LOT So C T �
/� TEL Z/
OWNER " /J.�-/�`pyc -NO STATISTICAV CLASSIFICATION SEWER MAP
ADDRESS s /-/T /^) CLASS N ��DWELL UNITS----] BK PG
CITY _TQ C ZIP USE ZONE MAP
NO
ARCHITECT OR TEL / _ L SPECIAL
ENGINEER NO l� CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONTRACTOR L TEL BLDG SETBACK FROM
LIC FRON PROP LINE OF ISTREETI
ADDRESS `� NO HIGHW Y } YARD -_ TOTAL SETBACK PROM TYPE OF "ISTING
CITY LIC FRONT PROP LINE HIGHWAY WIDTH
I S CLASS
CONSTRUCTION LENDER + y
NAME AND BRANCH BLDG SETBACK a
ADDRESS CITY SIDEPROP LINEOF (STREET)
SO FT NO OF NO OF CHECK HIGHWAY } YARD = TOTAL SETBA OM TYPE OF EXISTING Lr
SIZE STORIES FAMILIES ONE SIDE PROP LINE OHWAY WIDTH
DESCRIPTION OF WORK NEW + 9
6� DD ❑ CORNER CUTOFF YES 1:1 NO ❑
406A.4 /pZ
LTER ❑ IN OPEN SPACE YES ❑ NO ❑
USOil REPAIR E]EXISTING BLDG EMOL 13IN COASTAL PERMIT ZONE VES NO
APPLI CAN /J TEL /J 1 L Q G VN /JO Z- d N aCy?
(PRINT) C NO j
BY ISIGNATUR l� CL --7 A07-1Z /WV
AXD lTAT[yT HATNTHE
L ABOVE ISTCORR[CT READ IAMD AOR[•PO COMPLY IONz-S GY/.'.-� /NS�-
WITX ALL ORDINANCKS AND LAWS RCOULATINO ILDIXO
STRUC TION I CERTIFY THAT IN I N[ TX[ RK AUTHORIZED
HERESY I WILL NOT EMPLOY ANY PERSON IN VIOLA F TN[
WORK cone M THE
ONIN OF CALIFORNIA I RLL.TI 0 TO
LABOR CO OF
F[NSATHE STATE IMf URAM
SIGNATURE O FINAL ^-7 rBy
PERMITTEE DATE �j o -
ADDRESS
CITYrr
T o PC Fee$ Permit Fee OL
/ Ord Inuance Fee
VALUATIONS D Cx
Total Fee
zy
PLAN CHECK VALIDATION CK M D CASH PERMIT VALIDATION
9 4 2�-OEC 28 1 D 2 4.0 0 ASd
76AGUA CU*WSS +f/Te