HomeMy Public PortalAbout4819TEMPLE CITY BLVD_Building APPLICATION FOR BUILDING PERMIT
FORAPPI. NTTOFILL IN (Pr,nt m type only)
COUNTY OF LOS ANGELES
ADDR T r DEPARTMENT OF COUNTY ENGINEER
IT �A �) BUILDING AND SAFETY DIVISION
SIZE OF LOT ,;,� V X J " NOW ON�25 2� AUDDLR NG /
TRACT///6"/-7BLOCK TNOJ-5 -3(6 LOCALITY'
TEL NEAREST
OWNER O CROSSST
ASSESSOR
ADDRESS = MAP BOOT. PAGE PARCEL
DISTRICT GROUP tt FIRE ESSED BY
{Jtt ZIP L T
ARCHITECT OR TEL J 11� _
ENGINEER STATISTICAL C I ON SEWER MAP
ADDRESS
TEL CLASS N0 •ZZ�-DWELL UNITS BK PG
CONTRACTOR NO USE ZONE MAP
IC N
ADDRESS SPECIAL ,
LIC _ CONDITION$
CITY CLASS G ROAD DEPARTMENT APPROVAL REQUIRED YES C] NO ❑
CONST ION LE E
NAME AND BRANCH BLDG fETaACK FROM
FROM PROP LINEOF (STREET)
ADDRESS NOCITTOTALSETBACKFROM TYPE Of EXISTING
SO FT NO IE FA OF HIGH AV + YARD FRONT PROP LINE HIGHWAY WIDTH
512E STORIES FAMILIES ONE _ y
DESCRIPTION OF WORK NEW + O
ADD ❑ BLDG SETBACK
SIDE PROP LINE OF (STREET) O
;4x2_40,/
2 ALTER ❑ HIGHWAY + YARD TOTALS FROM TYPE OF EXISTING
USE OF IDEMOL
SIDE PROP L HIGH WAV WIDTH 2
EXISTING BLDG APPICCANT rNTIn r TESLCORNERCUTOFF rC� IN OPEN SPACE YES ❑ NO
BV 151IN COASTAL PERMIT ZONE YES ❑ NO ❑VALUATI O1�6 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCA
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY MATH ALL ORDINANCES
AND LAWS REGUATING BUILDING CONVRLCt10N I CERTIFY THAT IN DONG THE
WOW AUTH(MZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR COOS OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN 5 COW
PENSATION INSURANCE
SIGNATU
PERAVTTE
ADDRESS
FINAL —L^ BY
EL DATE
cltt � NO
MAKE CHECKS PAYABLE TO PC PMT
HARVEYT BRANEYT COUNTY ENGINEER FEE $/�• y `t �C O� FEE $ 9R W
PLAN CHECK VAUDATION K JV 0 c""
/PERMIT VALIDATION c R FR o C 8H
3 9 �'�nn: 18 3 3,..D__ _ 1 4.4 0
8 s 2;7.0 O 8 5 1�hPR 22 1 9 6 9.0 0 A•`8
0P ]EAO CER803375 _ T-� —