HomeMy Public PortalAbout5520TEMPLE CITY BLVD_Building APPLICATION POR BUILDING PERMIT
FQRAPPICANTJOFILL IN (Print or type only)
COUNTY OF LOS ANGELES
AUDR6S5 .O G� L DEPARTMENT OF COUNTY ENGINEER _
CITY L ZIP BUILDING AND SAFETY DIVISION
NO OF BLDGS BUILDING
SIZE OF LOT S O NOW ON LOT ADDRESS r!-
T C LOCALITY
C TEL (� NEAREST
OWNER L Q CROSS ST
ADDRESS ASSESSOR
qq Lv MAP BOOK PAGE PARCEL
Ott L�` a:.. 21P �7 Q DISTRICT GROUP TYPEFIRE
� FIpREN� BY
ARCHITECT OR TEL
.S'' 0� Z C y Z 3
ENGINEER NO STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO a' / DWELL UNITS .r BK `0 PG
TEL
CONTRACTOR N USE ZONEP
LIC LO O Q
C!
ADDRESS NO SPECIAL
LIC CONDITIONS
CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDER r
NAME AND BRANCH r C• BLDG SETBACK FROM
FRONT PROP LINE OF r ISTREETI
ADDRESS SO FT 3y NO OF NOYOF CHECK HIGHWAY + YARD TOTAL SETBACK PROP LIRNOE! TYPE OF
EXISTING
SIZE JL17 STORIES FAMILIES ONE
DESCRIPTION OF WORK 49ATE
❑ + /
E BLDG SETBACK FROM
SIDE PROP LINE OF (STREET) TO-
ER ❑ TOTAL SETBACK FROM TYPE OF EXISTING
yj
T• HIGHWAY + YARD SIDE PROP LINE HIGHWAY WIDTH ?,T
USE OF - IR ❑
FXISTINGBLDG pL ❑ +
APPLICANT TELCORNERCUTOFF V6 NO ❑
IPRINTI NO
IN OPEN SPACE YES NO ❑
BY GIGNATU IN COASTAL PERMIT ZONE VES ❑ NO ❑
VALUATION S _
I HEREBY AOOK)VAFOGE THAT I HAVE READ iNl$AP111STATETHAT THE ABOVE I5 CORRECT AND AGREE TO COAVLY WINANCBAND LAWS REGLAATING BUILDING CONSTRICTION I anti TNG MEWORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSONION OFTHE LABOR CODE OF THESTATEOF CALIFORNIIA IN RELATING TO S COM
PENSATION INSURANCE
SIGNATURE OF
PERMITTEE Z�
ADDRESS
FINAL BY
CITY �L..• TEL DATE NO EE $ FE
MAKE CHECKS PAYABLE TO FT $_ .. L
HARVEY BRANDT COUNTY ENGLNEER
PLAN CHECK VALIDATION cK r o CAIN PERMIT VALIDATION cK w o I m
4 6 JAN 3 1 D 1 5.0 0 •�lb
Sit 76 31LAUM3375 - _