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
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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
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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
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FINAL
ATE B
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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
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