HomeMy Public PortalAbout5120TEMPLE CITY BLVD_Building (2) APPLICATION FOR BUILDING PERMIT
FOR AP'ILICANT TO FILL IN (P,io,G, type oD IY)
BUILDINGS Lo -, Cp/ LUD COUNTY OF LOS ANGEL
DES
ADRESS DEPARTMENT OF COUNTY ENGINEER
clTv T G ZIP /7B0 BUILDING AND SAFETY DIVISION
nn NO OF BLDG'S BUILDING
SIZE OF LOT V NOW ON LOT ADDRESS O
TRACT 5683`nE BLOCLKB I'E� / LOT NO S � LOCALIT
NEARES
OWNER • II ep-PA IV I/ ` NO CROSS ST
ADDRESS 5120 T, L.VD MAP BOOK PAGE PARCEL
CITY I G ZIP l 7B D �08 DIST HICTG�ROUP CONST�/ ZONE SSED BY
ARCHITECT OR TEL �3(
ENGINEER NO
_ STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO,,;?/—DWELL UNITS----] BK PG
CONTRACTOR (i jqJ EL 2?7-173 USE ZONE NOP D
ADDRESS 3 • L VEXJ,, NO r �I SPE IAL
-r G LIC CONDITIONS
CITY 1 CLASS I
CONSTRUCTION LENDER ^ R O DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
NAME AND BRANCH / A B DG SETBACK FROM
F ONTPROP LINEOF (STREET) d
ADDRESS CITY
HI HWAY } YARD TOTAL SETBACK PROM TYPE OF EXISTING
SO FT "j' NO'OF NO OF
CHECK FRONT PROP LINE HIGHWAY WIDTH V
SIZE 00 STORIES 4 JFA MI LI ES`�- ONE
191> b . NEWS ❑ + LD
DESCRIPTION OF WORK
NH '314 F3ATH TD DD BLDG S CK FROM
L ��11 T� SIDE PROP OF -(STREET) Z
G V f" EX QST LTER ❑ HIGHWAY } YARD TBACK FROM TYPE OF EXISTING
EPAIR❑ 4 E P O E HIGHWAY WIDTH
USE OF } _
EXISTING BLDG��I ;� EMO�L/❑ - -
APIPL CANT 1 M�� II I VV S O,A NO zg�G /3 CORNER CUTOFF YES ❑ NO
BY (SIGNATURE) al& IN OPEN SPACE YES ❑ NO ❑
( IN COASTAL ZONE YES ❑ NO ❑
VALUATION Y 47bO
CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE REA. THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOYf 18 CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT FROCES SED (DATE)
HERE BY WILL No
EMPLOY ANY PERSON IN VIOLATION OF TX[ (i
LABOR CODE OP THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN S COMPENSATION 1 URA CE I
SIGNATURE OF �,
PERMITTEE .01
ADDRESS Z / :)V 1
FINAL / BY
T TEL DATE /I
CITY / � NO TG L�
tI EAI_ ( !/L( RE 1111 A HLL /O FEE Y � / FEE Y
HARVEY T BRANDY COUNTY ENGINEER `/C///` ICJ I FIAT �G
11
PLAN CHECK VALIDATION cN Mo CASH PERIL VA TIO cN No CASH
i ir, 2 1 3 773 JUL 1 1 D 4 2.0 0" i
76A638A CEN80312/72 ' -