HomeMy Public PortalAbout5430TEMPLE CITY BLVD_Building (2) nASSSNt09d_te APPLICATION FOR ILDING P R IT [I'111II
COUNTY OF LOS ANGELES BUILDING /
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY y
OJOHN A LAI COUNTY ENGINEER NEAREST _ I
COLEMAN W JENKINSSUP T OF BUILDING CROSS ST -
OISTR C7�140 GROUP TYPE P SED BY
/ FOR APPLICANT TO FILL IN ONST
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ADDRESS
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TRAC / NO
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USE OF
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ARCHITECT OR TEL OLDS SETBACK FROM
ENGINEER NO SIDE PROP LIME OF (STREET)
TYPE 0I EXISTING SETBACK HIGHWAY + YARD = TOTAL r
ADDRESS HIGHWAY WIDTH FROM CL 1
TEL } = Q
CONTRACTOR NO
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ADDRESS NO CORNER CUTOFF YES NO rO
IL SEE REVERSE SIDE FOR SPECIAL APPROVALS
DESCRIPTION OF WORKw
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SIZE ��U STORIES FAMILIHS NONE rermitscurb, guffer, sidewalk a rivswey epproec i In-
USE OF
STRUCTURE Office, or T C Co Engineers Office Immediately In order to
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I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AOR[[ TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING GAS VENT DUCTS
SUILOINO CONSTRUCTION 1 CERTIFY THAT IN DOING THE .--
AUTHORIZED HEREBY 1 WILL HOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR COD[ OF TH[ STAT[ OF CALIF RNIA R[LAT _
ING TO WORKMEN S COMP[NM N INSURANCE LATH EXT
OSTED
11IGNATURE OFj7M c HOUSE NUMBER COR-
PERMITTEE p
ADDRESS FINAL '
JOHN F LEWIS PRINCIP ST RAL ENGINEER
PLAN CHECK VALIDATION CK M O DASH _ PERNIIT VALIDATION
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