HomeMy Public PortalAbout4841TEMPLE CITY BLVD_Building (2) APPLICAiVO FOR B ILDING PERMIT
.FOR APPLICANT TO FILL IN Wont;r type on)y)
BUaowG COUNTY OF LOS ANGELES
ADO REss �� p DEPARTMENT OF COUNTY ENGINEER
CITY ZIP 7,9 U BUILDING AND SAFETY DIVISION
NO OF BLDGS` BUILDING
SIZE OF LOT y NOW ON LOT / ADDRESS
TRACT (��/ p BLOCK LOT NO LO LOCALITY
EL NEAREST
OWNER I / e-ISE� TNO CROSS ST
ADDRESS C// MAP BOORK PAGE PARCEL
LITY G ZIP - DISTRICT GROUP TYPE FIRE p ED BY
�..+ q ONST E
ARCHITECT OR TEL
ENGINEER - - NO STATISTICAL CLASS.II F�TIC��A//TION SEWER MAP
ADDRESS OASS NO DWELL UNITS C� BK a
CONTRACTOR �IVJ'O.Y NO�)I-613' YSEJ/O�1E �P �O/
ADDRESS <S Z CLO NO LIC — /C/ IAL
7a DITIONS
CITY 7- G ass / ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDER _ _
NAME AND BRANCH � Eq - BLDG SETBACK FROM
FRONTPROP LINEOF (STREET)
ADDRESS - CITY TOTAL SETBACK FROM ` TYPE OF EXISTING
SQ FT NO OF NO OF (5j CK HIGHWAY + YARD FRONT PROP LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE y
DESCRIPTION OF WORK_ _ NEW ❑ + O
�J BLDG SETBACK FROM
/G
pT/!� OOF O '"J SIDE SIDE PROP LINE OF (STREET) rO
7( Z ST/A. lc .54c-/;t5
ALTER ❑ HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF I EXISTING r
USEOF - - REPAIR ❑ SIDE PROP LINE HIGHWAY1 WIDTH Z
EXISTING BLDG r� � DEMOL ❑ + _
IPRINTII 14 J /MU 72 ,Al ANO 2-5-7470 CORNER CUTOFF YES o NO
o
APPLICANTTEL
IN OPEN SPACE YES C:] NO ❑
BY(SIGNATURE( 121 IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION 19,070-
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE G CORKER AND AGREE TO COMPLY WITH ALL ORDINANCE -
AND LAWS REGUATING BUILDING CONSTRUCTION I CERTIFY THAT IN DING THE
WORK ANlK)RIZED HEREBY WILL NOT EMPLOY ANY f4R5dJ IN VIOLATION OF
THE LABOR CODE OF THE STATE OF
CA FO
IN RELATING TO WORKMEN S COM
PBNSATICN INSURANCE - --
SIGNATURE OF - --
PERMITTEE
ADDRESS -
(� FINAL BY
TELRN -- �p DATE / 7�
MAKE CHECKS PAYABLE TO FEE $ FEET
HARVEYT BRANCIT COUNTY ENGINEER a/. .755
PLAN CHECK VALIDATION CK mo CASH PERMIT VALIDATION K MO CASH
l ti r°SEP 17 1 D 2 1.7 5 •96
01 )AA6]1EIA CE RBD]]]9