HomeMy Public PortalAbout5460 TEMPLE CITY BLVD_Building APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Pnpr o. rYPB GOb)
ADDD155 COUNTY OF LOS ANGELES
RE .S� C ` (�, .) ..r�: [(��e 7 DEPARTMENT OF COUNTY ENGINEER
CITY i ' ti„ C.Y � ZIP BUILDING AND SAFETY DIVISION
L 1 �M1^T-NO OF SLOGS t BUILDING
SIZE OF _OT /-2�NOW ON LOT 'O-YL•v ADDRESS 7
TRACT• ')5S(0N� BLOCK LOT NO �Rf LOCALITY
TEL, NEAREST
OWNER ! _ dLIJ'�t`, N )- 0 7 CROSS ST ��RQtjv WA
ADDRESS `�(}/N L�fl�✓�L 1 �f �I/�- MAPASSESSOR BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE P SSED BY _
CITY '(l ,{ _ ZIP �(/ U CONST ZON �/_-
ENGINARCHIEERT OR SH L No
�J/O U3/�r�
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO DWELL UNITS BK G
[NAME
NTRACTOR j - TEL USE ZON MAP ��
LIC NO
DRESS NO SPECIAL
Y LIC CONDI TIONS
CLASS RO O DEPARTMENT APPROVAL REQUIRED YES❑ NOCON ❑
TAND BIRANCON FH DER``,IM BLDG SETBACK FROM
JFRONTPROP LINE OF STREET)
DRESS CITY TOTAL SETBACK FROM TYPEOF E%I STINGQUHIGHWAY } YARDTNO OF NO OF CHECK FRONT PROP LINE NIGH WAY WIDTHE STORIES FAMILIES / ONE /� L/
DESCRIPTION OF WORK
NEW } L) L tr I Lela!
DD ❑ BLDG SETBACK FROM 1
SIDEPROP LINEOF (STREET) Z
LTER ❑ HIGHWAY } YARD TOTAL SETBACK FgOM TYPE OF EXISTING
EPAIR❑ SIDE PROP LINE HIGHWAY WIDTH
USE OF } _
EXISTING BLDG DEMOL [E:3
APP LIGAN .--> _ TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) - LR ((J - NO
BY ($IGNA TU EI IN OPEN SPACE YES ❑ NO ❑ -
nnn 1 C IN COASTAL ZONE YES C] NO ❑
VALUATION$ UCLA p`S) $6 D
CATEGORICAL EXEMPTION YES[] NO ❑
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION 1 CERTIFY THAT IN DOING THE WORK AUTHOR'EED I IMPACT REPORT PROCESSED (DATE)
HEREBY 1 WILL NDT EMPLOY AHY PERSONIN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN S COMPENS TION 1 URANCE / n / // 0 n )i
SIGNATURE �Y
PERMITT E� �-'(/ _ '_L_
ADDRESS '
TEL
(/ ( FINAL BY
CITY /-(��'L�1�G`�Z�. NODATE _ A
! Q
ll IAf- ( IlI ( hS It l} Iffl_L !U FEE $may�//7�/ a3 $� FEE / 7J�F
HARVEY T BRANDT COUNTY ENGINEER (SJ(`..J( E'
PLAN CHECK VALIDATION (Ij. CASH PERMIT VA ON CK M 0 CASH
53MAN 312'3 0
75236 %RfM1� 2ZQ 2 3 0- 1 2 3.8 5 O PFEB 20 1 0 1 8 3.0 0 •'a