HomeMy Public PortalAbout5470TEMPLE CITY BLVD_Building (2) APPLICATION FOR COUNTY OF LOS ANGEI.S.S
BUILDING PERMIT DEEER
PARTMENT AND SAFETY DIMIUNn ONN
BUILDING
FOR APPLICANT TO FILL IN ADDRESS D
BUILDING
ADDRESS Rl LOCALITY
NEAREST
CITY ( ZIP CROSS ST
N OF BLOGS ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
�I + DISTRICT GROUP CONST ZF)IRE SSED BY
TRACT / BLOCK LOT NO 1
TEL ✓ GJ
OWNER - NO STATISTICAL CLASSIFICATION
^J/ SEWER MAP
ADDRESS 'p CLASS NOf�DW ELL UNITS BK PG
,[ IftU ZONE NO
O�
CITY ` ZIP
ARCHITECT OR TEL SPECIAL
ENGINEER NO 0 CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONTRACTOR TEL BLDG SETBACK FROM
LIG FR TPROP LINEOF (STREET)
ADDRESS NO HI WAY + YARD TOTAL SETBACK PROM TYPE OF E%ISTI NG
LIC FRONT PROP LINE HIGHWAY WIDTH
CITY CLASS
CONSTRUCTION LENDER +
NAME AND BRANCH BLD TRACK FROM
ADDRESS ' CITY SIDEP ` (STREET)
SO FT NO OF NO OF CHECK HIGHWAY + YARD TOTAL SETBACK FR YPe OF EXISTING EC
SIZE TORIES FAMILIES ONE SIDE PROP LINE H WAy WIDTH o
DESCRIPTION OF WORK NEW ❑ + 6.
N
DD ❑ CORNER CUTOFF YES ❑ NO ❑
—REP:
IR R
IN OPEN SPACE YES ❑ NO ❑
USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑
EXISTING SLOG ��QQ- . EMOL
APPLICANT TEL
(PRI NTI ND
BY (SIGNATURE)
I HEREBY ACKNOWLEDGE L[DOL THAT NAV[ READ THIS APPLICATION
AND STATE THAT THE ABOVE le CORRECT AND ALR[[ TO COMPLY
WITH ALL ORDINANCE! AND LAWS REGULATING BUILDING CON-
STRUCTION I C[RTI FY THAT IN DOING THE WORK AUTNORIIlD
HIKES
I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STAT[ OF CALIFORNIA IN RELATING TO
WORKMEN S COMP NSATION INSURANCE
SIGNATURE OF FINAL C �7� BY
PERMITTEE DATE 1V"l
ADDRESS
TEL
CITY NO PC Fee S Permit Fee
t '7 InuaRCe Fee
VALUATION$ o�OO
Toml Fee
PLAN CHECK VALIDATION CK KID CASH PERMIT VALIDATION CK MCA:—
696-MAY 5 11) 6.00At�6
Tfwf[eA CKOWSD 1E/I5