HomeMy Public PortalAbout5318TEMPLE CITY BLVD_Building (2) APPLICATION FOR BUILDING PERMIT �1
FOR APPLICANT TO FILL IN (p"I,t Gr 1YPB oIIY) LJ
UIy_DING " COUNTY OF LOS ANGELES
A❑DRESS DEPARTMENT OF COUNTY ENGINEER
CITY L. GT" zip BUILDING AND SAFETY DMSION
,C�y'3 v NO OF SLOGS iJ BUILDING ^�� /�� `
SIZE-OF LOT JJ NOW ON LOT 4 ADORE55�^ �`
^' LOT NO LOCALITY
TELTr�p� EAREST
OWNER G L NO •pv� ROSS ST
ASSESSOR
ADDRESS G/T MAP BOOK PAGE' P CEL
'-' - - - DISTRICT- GROUP TYPE '" FIRE OC SED By
TC ZIP �O CONST ZONE \
ARCHITECT OR TEL /--- 3
ENGINEER NO
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO.�DWELL UNITS PG
CONTRACTOR (_D �- USE ZONE NO
01
ADDRESS LIC
NO SPECIAL
CITY LIC � J� CONDITIONS
CONSTRUCTION LENDER
.tJGG L CLASS/ ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO C]
_
NAME AND BRANCH BLDG SETBACK FROM
ADDRESS CITY
FRONTPROP LINEOF STREET)
�- s
j[0] H"LG
WAY } YARD TOTA ETBACK FROM TYPE OF EXISTING
SI FT,�//pp ,�� ST OF n NO OF CHECFR ONT_PROP LINE HIG AV WIDTH
512E �{'OY' STORIES Z FAMILIES � ONE � yJ
DESCRIPTION OF WORK EX a0I) GSC_ NEW + LZ 6 a
. 1 DDG SETBACK FROM - Z
E PROP LINE OF (STREET)
LTERWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING
�10 -rk4S SIDE PROP LINE HIGHWAY WIDTH
REPAIR
USE OF� cjT6171 FOiL_TT'/b 87D�Y + _
EXISTING BLD ,S EMOL
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) L '�� NG _<7
BY ISI GNATUREI IN OPEN SPACE YES ❑ NO ❑
Q COASTAL ZONE YES ❑ NO ❑
-VALUATION$13 73� 0� CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND !TATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAW! REGULATING BUILDING RO CON-
STRUCTION CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY AMY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN S CO PENSATION INSURANCE
SIGNATURE OF �'G G O� (.
PERMITTEE
ADDRESS /G S G -71
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CITY IZ .NOL �O E
Mi KF CHECKS PAYABLE TO P C
HARVEY T BRANDT COUNTY ENGINEER dde
FEE z EO1X 4�
,PLAN CHECK VALID73t
cH o CASH PERMIT VALID TIO cK .0 CASH
4 1 9PtAY- 2s � 6 1.6 5 V
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1599JUL 2 1 A 102.75