HomeMy Public PortalAbout5504TEMPLE CITY BLVD_Building APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Printortype only)
BUIL G O I e 717, COUNTY OF LOS ANGELES
ADORES$ w d DEPARTMENT OF COUNTY ENGINEER
ary L ZIP DGS ) (� BUILDING AND SAFETY DIVISION
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SIZE OF LOTffld X NOW ONNO OF LOTI ADDRBUILDESS J Q ry /�/N
TRACT BLOCK LOT O .3 LOCALITY J-
/Yi 10- C, ,_
OWNER NO �' CROSS ST (�
ADDRESS / �� I F V� MAP BOOK J p PAGE QQq PARCE
DISTRICT GROUP TYPE FIRE ROC BY
CITY ZIP `�-O� ) C ZOt�p
ARCHITECT OR TEL
ENGINEER O STATISTICAL CLASSIFICATION SEWER MAP
I ADDRESS CLASS NO OWELL UNITS BK /
CONTRACTOR / TELCLASS
tC3HIGHW,AY
NE D4P �Q 0
IC e� 45
IAL
ADDRESS O CONDITIONS
LIC CONDITIONS
CITY CLASSCONSTRUCTION LENDEREPARTMENT APPROVAL REOUIREO YE$ ❑ NO ❑NAME AND BRANCH ETBACK FROM
PROP LINE OF (STREET(
ADORES$ CITYTOTAL SETBACK FROFT O OF NO OF CHECAY + VARD FRONT PROP LINESIZE STORIES FAMILIES ONEDESCRIPTION OF WORK NEW O
ETBACK FROM
yT 121C " AOD OP LINE OF ISTREETI O
/ ALTER + YARD TOTAL SETBACK FROMUSEOF REPAIRSIDE PROPLINEZ
EXISTING BLDG DEMOL + _
APPLICANTE CORNER CUTOFF YES 0 NO El(PRINT) / OLe(Z 1 L/ 14 O 6'
37 IN OPEN SPACE YES 0 O
BY(SIGNATURE) IN COASTAL PERMIT ZONE YES NO ❑
VALUATIONS D _
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT ME ABOVE IS NRRECT AND AGREE TO COMPLY WITH ALL ORDNANCE$
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE
W AUT1 OMUD HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
ME LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN 5 DDM
PENSATgN INSURANCE
SIGNATURE OF
PERMITTEE _
ADDRESS
TELIt By
CITY O 6 DATE _L„3.-7G
MAKE EIEC PAYABLE TO FEE $ FET
HARVEYT BRANDY COUNTY HN6INHER
PLAN CHECK VALIDATION cm r o CASH PERMIT VALIDATION CK mo ASH
3 3gjuL 30 1 9 ; 6.00 •
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