HomeMy Public PortalAbout5460 TEMPLE CITY BLVD_Building (2) APPLICATION FOR. BUILDING PERMIT
-FOR APPLICANT TO FILL IN fPn DT GI IvoB only)
FRESS COUNTY OF LOS ANGELES
G�> DEPARTMENT OF COUNTY ENGINEER
ZIP BUILDING AND SAFETY DIVISION
NrO OF BLDGS BUILDING- NOW ON LOT - ADDRESS BLOCK LOT NO LOCALITY
TEL NEAREST
OWNER y �� NO CROSS ST
ASSESSOR
ADDRESS �Q.)y,� MAP BOOK PAGE- - PARCEL
DISTRICT- GROUP TYPE - FIRE ESSED BY
CITY ,f.N�G ZIP -z0 J CONST/ ZONE 'N
ARCHITECT OR � - - TEL - -
ENGINEER NO
STATISTICAL CLASSIFICATION SEWER p
ADDRESS CLASS NO/DWELL UNITS B Z�
rNAME
RACTOR 46'16 Cer NEL Of U ZONE LI, NOP /,
ESS t `'i,� E ff NO ,j�y� �I SPECIAL 49
'
4y� CONDITIONS
N/G�Ay CLASS /
RUCTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED YES NO ❑
AND BRANCH BLDG TRACK FROM - a
FRONT ROP LINEOF ISTREETI �j
ESS CITY HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING C
T NO OFNOOFCHECK FRONT PROP LINE HIGNO
FAMILIES ONE
DESCRIPTION OF WORK - ' NEWj
BLDG SETBAC OM Z
DD SIDE PROP LINED fSTREET)
G G E PAIR❑
ALTER ❑ _ TOTA K FROM TYPE OF EXISTI NO
-....�_ HIGHWAY } YARD - SIDE PROP LIN IGHWAY WIDTH
USE OF 1 } _
EXISTING BLDG �-0/�j % EMOL E] 4
APPLICANT ^ TEL ig, CORNER CUTOFF YES ❑ NO
RINT) NO
(PID r la
BY IStGNATU E) IN OPEN SPACE _ YES ❑ NO
( IN COASTAL ZONE YES NO ❑
VALUATION�7 I O _ _ - -
CATEGORICAL EXEMPTION YES 'NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS REODLATING BUILDING CON-
STIR TIC
[ERTI IY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED GATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE9 TE OF CALIFORNIA IN _RELATING TO
WORKMEN 9 COMPCNSAT TE OF
SIGNATURE OF
PERMITTEE eee /0
-
ADDRESS
FINAL BY
CITY >/�iT�L�/IKK� NO DATE •_ �-
MAKF CHECKS PAYABLE TO P c PMT $
FEE FEE
HARVEY T BRANDT COUNTY ENGINEER _ 2-5-
PLAN
SPLAN CHECK VALIDATION CK M o -CAB- PERMIT VALIDATION cK _ o AaH
4 7P&I 9 1 U 3 5.2 5
76AG38A CE0803 7/73