HomeMy Public PortalAbout5441TEMPLE CITY BLVD_Building APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Pnnr or ryp. only)
FRE
./ COUNTY OF LOS ANGELES '
V DEPARTMENT OF COUNTY ENG12CM
zip' 9190 BUILDING AND SAFETY DIVISION
NO OF BLOGS BUILDING
/ NOW ON LOT ADDRESS
BLOCK LOT NO I LOCALITY
TEL NEAREST
OWNER NO CROSS ST
,1 ASSESSOR
ADDRESS 7, MAP BOOK PAGE RCEL
DISTRICT GROUP TYPE FIR PR ESS BY
CITY ZIP / O CONST ZON
ARCHITECT OR TEL �. Di ,
ENGINEER NO
STATISTICAL CLASSIFICATION � EWER MAP
ADDRESS CLASS NO�DWELL UNITS a 03PG
CONTRACTOR TEL ZONE MAP
LIC /� NO
ADDRESS NO \ SPEC AL
CITY LIC �� CONDITIONS
CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONSTRUC ON LENDER
NAME AND BRANCH `11.0-A-f � BLDG ETBACK FROM
FRON PROP LINEOF (STREET)
ADDRESS CITY HIWN Y } 'YARD TOTAL SETBACK FROM TWE OF EXISTING
SQ
FT NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
+ -
DESCRIPTION OF WORK NEW ❑ O
BLDG SET ROM GO
DD SIDEPROP LINE - _ (STREET) C
O1�-
ALTER HIGHWAY } YARD TOT T CK FROM TYPE Of EXISTING U
—REPAIR SID PR LINE NIGH WAV WIDTH w
USE OW ,// O
EXISTING BLDG /LA.ft/_! EMOL ❑ + Z
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
IPflINTI NO
W oo r / ' IN OPEN SPACE 1 YES Cl NO ❑
BY (SIGNATURE)TUR EI ��/
IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION$ f3 Q
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND !TATE THAT THE ABOVE I! CORRECT AND AOR[[ TO COMPLY _
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRVCTIO N 1 C[RTI IY THAT IM DOING THE WORK AV THORIZfD
HEREBY I WILL NOT EMPLOY ANY PERSON IM VIOLATION Of TN[
LABOR COO[ OF THE !TATE Of CALIFORNIA IN RLLATINO TO
WORKMEN S CO MP[NSATWN INSURANCE _
SIGNATURE OF
PERMITTEE
ADDRESS
IF EL FINAL BY
CITY NO DATE
JIT CNE hS PO rIH Y EN FEE Y FEE
HARVEY T BRAN DT, COUNTY ENGINEER
PLAN CHECK VALIDATION- CK NO CAB. VALIDATION CK M Q cAeN
1 5.0 0
7EA43BA CiaOL 5/74 I _