HomeMy Public PortalAbout5132TEMPLE CITY BLVD_Building (2) BI 76A6 A
L6/60J IXfY 6/961 �
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGE S BUILDING AND SAFETY
FOR APPLICANT TO FILL IN ]HIGHWAY
DDDRESS 15-137-
BUILDING
BUILDING 7
ADDRESS OCALITY / ��I��-� �F T`�
CITY ' ZI �' ROOSSIF
- - - NO OF BLDGSSSESSOR =--
SIZE OF LOT CC NOW ON LOTAP BOOK PAGE PARCEL
TRACT d � BLOCK LOT NDISTRICT)Q G/R/�O�UPZ CPE
ONST ZONE PE FIREP ESSE V
OWNER r L /\�/
ATISTICAL CLASSIFI CATION SEWER MAP
ADDRESS CLASS NODW ELL UNITS BK PG
Cry ZIP
ENGINARCHITE OR TELALUATION $ Z
ENGINEER NO
ADDRESS SETBACK FROM
TEL- ONT PROP LINE OF (STREET(
CONTRACTOR OGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
IC FRONT PROP LINE HIGH WAV WIDTH
ADDRESS O
LIC +
CITY CLASSCONSTRUCTION LEN R DG SETBACK FROMNAME AND BRANCIiDE PROP LINE OF (STREET(
+ YARD TOTAL SETBACK FROM I TYPE OF 1EXISTING IL
ADDRESS CITY SIDE PROP LINE IHIGHWAYI WIDTH C
SO FT NO OF NO OF CHECK + - V
SIZE / INTO
FAMILIES ONE 0
DESCRIPTION OF WORK NEW PC Fee 5 Perm It Fee
ADD
aIssuorxe Fee
D 9S3`/O ALTER
EPAIR ElTotalFee
EXISTING BLDG
Er DEMOL
-
APPLICANT TEL F
(PRINT) NO t
O BY(SIGNATURE)
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THEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE rT CSLC]0 /�
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES C J A
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN WING THE S
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF 6
THE LABOR CODE OF TH E STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM Y - /f
PENSATION INSURANCE
PERMATURE •�• • 4 Q Q
ADDRESS ('" Z 0 2 0 21_7 9
TEL O
CITY NO
D
USE ZONE NO
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lSPECIAL
CONDITIONS
FINAL G BV
DATE