HomeMy Public PortalAbout5319TEMPLE CITY BLVD_Building '9, 76A638A
CE#803(REV 11,78) -- -
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES I I BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING Sc3�
ADDRESS (�iL
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ADDRESS ` LITY 7 1.f
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ZIP CROSSST
SIZE OF LOT SS S '-NOW ON LOT `ry MAP BOOKASSESSOMAP - - - PAGE - - PARCEL _ - -
TRACT BLOCK LOT NO J i - DISTRICT GROUP TYPE FP ESSED�Y
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OWNER
/! STATISTICAL CLASSIFICATION SEWER MMP
ADDRE137 ` CLASSNO DWELL UNITS BK/O PG
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ARCHITECT ENGINEER OR TEL NO _ f ATION $ qO
ADDRESS SETBACK FROM C�
TEL TPROP LINEOF ISTREETI
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T FRONT PROP LINE HIGHWAY WIDTH
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HiU G LIC - + -
CIT TIC �- -
CONSTRUCTION LENDER- - - _- SETBACK FROM
NAME AND BRANCH ROP LINE OF ISTREETI
AY + YARD TOTAL SETBACK FROM TYPEOF EXISTING
SIDE PROP LINE HIGHWAY WIDTH
ADDRESS CITY V
SO FT NO OF NO OF _ CHE + d
SIZE STORIES - FAMILIES ONE
ONE MAP O/ `
DESCRIPTION OF WORK NEW O SPECIALgelADD �O CCRJDITIONS dc
ER '7 BY L _ . _
&1671120PAIR DATE ��J �8� �V
USE OF DEMOL
EXISTING BLDG
APPLICANT TEL F
(PRINT) NO
v G= � 1050A
BY ISIGNATUREI _ ;
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATKM AND STATE
MPLaCe� Z A H.O O
THAI THE ABOVE IS CORRECT AND AGREE TO COY WITH AlL ORDINANCES 1 FLL • J
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE S
WORK ADTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOIATION OF U Z O O
THE LABORCOOE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN SCOM- _ _ _ • J
PENSATION INSURANCE
_ - - 07L02!r80
SIGNATURE OF
PERMITTEE
ADDRESS
TELT 6 -
CITtzow N
PC Fee$ Permit Fee
Issuance Fee Q
Total fee v