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HomeMy Public PortalAbout4830TEMPLE CITY BLVD_Building APPLICATION FOR BUILDING PERMIT FOR APPLIL"ANT TO FILL IN (PIIAI Gr +YP6 G 10 BUILDING „ MLOT COUNTY OF LOS ANGELES ADDRESSDEPARTMENT OF COUNTY ENGIIQEER CITY BUII.DING AND SAFETY DIVISION BUILDING O SIZE OF LOT XADDRESS Q TRACT LOCALITYNEAREST OWNERCROSS ST ASSESSOR ADOR ESSMAP BOOK PAGE PARCEL DISTRICT GROUP ITYPE FIRE ESSED BY CITY ZIP /�j A ONSET ZON ARCHITECT TEL `/AOo ENGINEER STATISTICAL CLASSIFICATION ��J� EW ER�M�AyP ADDRESS CLASS NO o`' DWELL UNITS aft2O PG CONTRACT TEL USE ONE OP O/ LIC ADDRESS NO SPECIAL `/� LIC CONDITIONS CITY CLASS ROAD PARTMENT APPROVAL REQUIRED YES E] NO CONSTRUCTION LENDER NAME AND BRANCH 4AUTKORIZED LDG ETBACK FROM FRON PROP LINEOF (STREET) >- ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF E%ISTING 50 FT NO OF NO OFECK HIGHWAY\+ YARD - HIGHWAY WIDTH SIZE STORIES FAMILIESNE FRONT PROP LINE C } CD DESCRIPTION OF WORK CO �. BLDG SETBACK FROM d 510E PROP LINE OF (STREET) CO ER ❑ HIGHWAY } YARD = TOTAL SETBACK FROM T OF E%19TINGAIR❑g4,-7gj 70 SIDE PROP LINEHIG AY WIDTHUSE OF EXISTNG BLDG OL ❑ }APPLICANT TELCORNER CUTOFF YES NO(PAINT)BY (SIGNATURE) / IN OPEN SPACE YES NO-az ft / IN COASTAL ZONE YES j NO VALUATION 7 Q i` CATEGORICAL EXEMPTION YES NO I HEREBY ACKNOWLEDOE THAT I HAVE READ THCATION ENVIRONMENTAAND STATE THAT THE ABOVE IS CORRECT AMD AGCOMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS R[6ULATIMOG CON- STRUCTION1CERTIFY THAT IN DOING THE WOORIIED IMPACT REPORT PROCESSED (DATE) HEREBY I wILL NOT EMPLOY AMY P[RSOM IN VIOOf TN[LABOR CODE Df THE STATE OFCALIFORNIA IING TO WORKMEN S COMPENSATION IMSURANC[ SIGNATURE OFi PERMITTEE ADDRESS // /..,� d �!J' C-��L/ FINAL ATE B n TEL CITY 1JeP NO PMT tt 11Ih! ( HL( hS P 15 IHLL 10 FEE $ { FEE Y HARVEY T BRANDY COUNTY ENGINEER 1-57DO PLAN CHECK VALH)/F#TION cM MD CASH PERNQT VALIDATION cM Mo CASH 1 i 6�',►uov 4.5 0 A PNov JNo7 1 0 1 5.O 0 A� 76A636A CE%603 12/72 1 _ _