HomeMy Public PortalAbout5029TEMPLE CITY BLVD_Building (2) - I I APPLICATION FOR: BUILDING PERMIT
FOR APPLICANT TO FILL IN (PODt GI 1YPR GDIY) '
BDILDING COUNTY OF LOS ANGELES
AO Es O / i DEPARTMENT OF COUNTY ENGINEER
CIT;-- zip 1 BUILDING AND SAFETY DIVISION
NO OF BLOCS BUILDING
SIZE OF LOT NOW ON LOT ADORES Q
TRACT( ZLOCK /� L NO LOCALIT
OWNERn /f'J E.2 NOL CROSS ST
ASSESSOR
ADDRESS E MAP BOOK PAGE RCEL
DISTRICT G TYPE FIRE PRCH9ESSEO BY
CITY E ZIPQ ZON
ARCHITE � Up '
ENGINE
STATISTICAL C�,ASSIFICATION ' fVrEi�2MA
ADDRESS T CLASS N //_ DWELL UNITS BKJ G
CONTR ZONE MAP
NO
ADORE s SPEC( L
CITY LICCONDITIONS
CONSTCTION LENDER I '
CLASS _ ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
NAME AND BRANCH BLDG SETBACK FROM
FRONT PROP LINEOF ISTREETI
ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY } YARD — C
SQ FT NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH
SIZE Q STORIES FAMILIES ON
} -
DESCRIPTION OF WORK NEW
DD BLDG SETBACK FROM
SIDEPROP LINEOF (STREET)
LT
TOTAL SE TRACK FROM TYPE OF EXISTING
3Z� HIGHWAY } YARD
_ EPAIR SIDE PROP LINE HIGHWAY WIDTH
EXISTING NG BLDG OF EMOL ❑ }
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) NO
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
I IN COASTAL ZONE YES ❑ NO ❑
VALUATION OO CATEGORICAL EXEMPTION YES[] NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND 9TATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIONED (DATE)
W IIHALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION I CERTIIY THAT IX GOING E WORK AUTHORIZED IMPAC REPORT PR SED (DATE)
HEREBY 1 WILL NOT E ANY PERSO N VIOLATION Ol THE
LABOR CODE OI T ST OI CAL II IA IN RELATING TO
WORKMEN 9 COMPE AT ANCE
Al
SIGNATURE
PERMITTEEtV
ADDRESS • �Q L� l�.cC(/
FINAL BY 1
TEL DATE O'
CITY NO
MAKF CHECKS PAYABLE TO FEE E v ✓ FEE PUT �� _
HARVEY T BRANDY COUNTY ENGINEER /QNN Z 3PC 1 as
PLAN CHECK VALIDATION KID cABN � PERMIT 71� cK N o uBH
8 6 3AW '11 2 3 e1 .J AW
]BA 83BA CEX803 7/73 6 4ASEP 11 3. 0 3 52 5Aad