HomeMy Public PortalAbout5015TEMPLE CITY BLVD_Building TEMPLE -0651 Y
79AC3EA LE#EDJ]6] APPLICATION FOR BUILDING PERMIT '
COUNTY OF LOS ANGELES SLIMING
DEPARTMENT OF COUNTY ENGINEER ODRESS
BUILDING AND SAFETY DIVLSION LOCALITv
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST `
DISTRICT NO GROUP TYPE (MESSED BY
FOR APPLICANT TO FILL IN coNSTe
BUILDING O , T STATISTICAL CLA651 FICATION 6 ER MAP
ADDRESS S K
CLASS NO DWELL UNITS
LOT NO 1 BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE
TRACT "3 3 a. MAP HIGHWAY
NO OF BLDGS NO ICIRCLEI STATE MAJOR 5 CON LOCAL
SIZE OF LOT NOW ON LOT USE ZONE SPECIAL
USE OF .�� Co N
EXISTING BLDG ''jjam��__
OWNER qk BUILDING EXIST
SETBACK ARD HWY ST E TNAM WIDTH
ADDRESS FRONT
ARCHITECT OR TEL' P L
ENGINEER NO SI 1'
P L a
ADDRESS O
TE
CONTRACTOR N A _ 0
ADDRESS •-jj M �'M G
DESCRIPTION OF WOR% a
I N
=1 AIX
EW ADD ALTER REPAIR DEMOLISH
st FT NO OF NO OF
SIZE STORIES FAMILIES
USE OF
STRUCTLJRE w
SIGNATURE OF
APPLICANT • Gr. A ^ r ��_
VALUATION S � Q A I —
APPROVALS DATE InN[CTOR
PCPMTQ FOUNDATION LOCATION u
FEES C5//�� FEE E FORMS MATERIALS �l ' 1 t/Ti-Ln1
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS /
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORDINANC ER AND STATE LAWS FIEGULATINO GAS VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN OOINO THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERBON IN VIOLA LATH INT
TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN OMPENSATION INSURANCE
LATH EXT
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE RECT AND POSTED
ADDRESS FINAL
JOHN F LEWIS I rINCIPAL ST RAL ENGINEER
PLAN CHECK VALIDATION M O CASH _ PERMIT VALIDATIO CK
CK M O CASH
L,'L4558Z JAN1723D 30.25A Q
Q_ LAC04 6 3 4Z JA,12 7 1 D 60.50-
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