HomeMy Public PortalAbout5476TEMPLE CITY BLVD_Building 1 APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (P,,.,., (Yoe only)
BUILDING COUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGWEER
cIT ZIP --ILDING AND SAFETY DMSION
NO OF BLOGS BUILDING `
SIZE OF LOT NOW ON LOT ADDRESS
TRACT BLOCK LOT NO5 LOCALITell
EL NEAREST
OWNER44�1 CROSS ST
ASSESSOR
ADDRESS44 Le MAP BOOK PAGE P RCEL
♦ DD IST RIOT GROUP TYPE FIRE CESSED BY
CITY ZIP l ``. CONST - E
ARC ITECT TEL `a\i
ENGINEER NO
STATISTICAL aSSIFICATION SEWER MAP
ADDRESS GLASS NOI DWELL UNITS SK PG
CONTRACTO TE ZONE MAP 114.
L NO
AODRp SPECIA
CIT L I CON DI T I ONS
o-gray, CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO C]CO TRU TI N FFNDER
NAME AND BRANCH BLD SE BACK FROM
FRO PROP LINEOF (STREET)
ADOPT CITY - TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY YARD _ C
Sp FT ST OF NO OF CHECK 'FRONT PROP LINE HIGHWAY WIDTH p
512E STORIES FAMILIES ONE( CF]
❑ }
O CRIPTION OF.WORK NEW
♦ ADD ❑ BLDG SETBACK FROM 7�
112 ofg
SIDE PROP LINE OF (STREET)
Al
YLTER ❑ HIGHWAY } - YARD - TOTAL SE ACK FROM TYPE OF EXISTING
REPAIR SIDE PRO LINE HIGHWAY WIDTH
USE OF =
EXISTING MOL ❑ }
APPLICANT EL
CORNER CUTOFF YES ❑ ,NO ❑
PRINT) N
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
ttSe
IN COASTAL ZONECATEGORICAL ExEMPEION❑ YES❑ NO ❑
VALUATION Y
I HEREBY ACKNOWLEDa THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS REGULATI MG UILOINO CON-
STRUCT104 1 CEPTIFY THAT IN DOING THE W N UTHORIIED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT PLO AMY PERSON IN V OLA ION OF TXE
LABOR CODE OF T-17
N ST OF CALIFORNIA IN ELATIN TO
WORKMEN 5 COMPEN TI MSURA
SIGNATURE OF
PERMITTEE
A DDRES�
T FINAL BY
CITY DATE
MA KF' CHECKS PAYABLC TO PC Q - PMT Q
Y
HARVEY T BRANDY COUNTY ENGINEER FEE FEE Y
PLAN CHECK VALIDATION cN M o us„ - PERMIT VALIDATI cN M D u3„
4 7 691OGi 24 1 0 2 1.7 5 �a
76A538A CEN803 7/73