HomeMy Public PortalAbout4829TEMPLE CITY BLVD_Building 76A630A CE0E03 5 65 APPLICATION FOR BUILD114IG PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS I
BUILDING AND SAFETYDIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
COLEMAN W JENKINSAUP T Of BulLolnc CROSS ST
CIS Tp T N G TYPE PRO 9
FOR APPLICANT TO FILL IN r , b CONST
BUILDING u G�Q IG _ /I V� STATISTICAL C IFICATION 9E ERR MAP
ADDRESS 1 E 1 1- ` CgL�A'99ON�1O WELL UNI T9 8K /♦PGZ
LOT NO BLOCK U/[/ �/_ ,.E, MAP ECTAL O _V
TRACT I (R T�J9.J
MO OF SLOGS CONOI IONS
SIZE OF LOT MOW ON LOT -
USE OF
T= 00-E SLOG SETBACK FROM
TEL FRONT PROP LINE OI (STREET)
OWNER ACOLD NO.�t66GO TYPE Or I EXISTING I SETBACK HIGHWAY YARD = TOTAL
ADDRESS a %.) TfBlj?I-Pc,-ryuvt) X IHWAY WIDTH FROM C L
CITY C `AwIF + -
BLOC RN FROM
ARCHITECT OR �� TEL SIDE PROPOP LLlINE 01 (STREET)
ENGINEER NO
TYPE
ADDRESS
EXIST,NO SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C L
TEL PTO j } _
CONTRACTOR c p NO 6
ADDRESS 1I2a - NO CORNER CUTOFF YES NOIC
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CITY LIC SEE REVERSE SIDE FOR SPECIAL APPROVALS O
DESCRIPTION OF WORK l�yl
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NEW ADD ALTER REPAIR DEMOLISH
Sp FT NO OF NO OF
SIZE STORIES FAMILIFS
USE OF
STRUCTURE V-
A
SIGNATURE OF
APPLICANT
VALUATIONS q Ol' 0. 1 APPROVALS DATE INSPECTOR'S SIGNATURE
/yam FOUNDATION LOCATION
FEES FEES (JV FORMS MATERIALS
FRAME FIRE STOPS
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORO,NANCEB AND STATE LAWS REGULATIND GAS VENT DUCTS
TIT
9UILOING CONSTRUCTION I CERTIFY HAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABORCODC OP TH IA RELAT
ING TO WORKMEN SC
O INSURA�
LATH EXT
SIGNATURE HOUSE NUMBER COR- '
PERMITTEE�RECT AND POSTEP
AND P09TE
ADDRESS FINAL /
JOHN F LEWIS PRINCIPAL S UCT RAL ENGINEER
PLAN CHECK VALIDATION CK M O DASH _ PERM VALIDATIO CK .O CARH
LA,07 6 8 9�2 DEC 1 1 D 6.00- D