HomeMy Public PortalAbout5524TEMPLE CITY BLVD_Building APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (PrI Dr or roB GDlbl
PE _
NG COUNTY OF LOS ANGELES
SS554 DEPARTMENT OF COUNTY ENGINEER
CITYempzIP BUILDING AND SAFETY DIVISION
NO OF BLOGS BUILDING `/,�
LOT NOW ON LOT ADDRESS �,J�/ 11,4
LOT LOCALITYTEL NEAREST
NO CR 055 STSSOR
S ti Blvd• MAPASSEBOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE SSED BY
't ZIPCONSTZONE
ECT OR TELER NOSTATISTICAL CL�A/SSSIFICATION SEWER P
S - - CLASS NOp2OW ELL UNITS BK PGCTOR - _ yTEL 282-1 O U ZONE MAP
LIC V V -N NO
ADORES NO �( SPECIAL
LIC ccclll CONDITIONS
CITY CLASS J
ROAD DEPARTMENT APPROVAL REQUIRED YES NO
CONSTR
NAME AND BRANCH BLDG SETBACK FROM
FRONTPROP LINEOF ISTREETI (-
ADDRESS CITY 08...•
SD FT NO OF NO OF CHECK HIGHWAY } YARD = TOTAL SETBACK FROM M G WAY EWIDTH QU
FRONT PROP LINE
SIZE STORIES FAMILIES ONE
DESCRIPTION OF WORK Re-rQof HoUlma NEW ❑ w
DD ❑ BLDG SETBACK FROM ZL
SIDEPROP LINEOF ISTREETI
Aad Garage W/ 235# Gempe LTER ❑ HIGHWAY } YARD -_ TOTAL SETBACK FROM TYPE OF EXISTING
- shingles- E PAIR®
SIDE PROP LINE HIGHWAY WIDTH
USE OF EXISTING BLDG E M 0 L ❑ }
APPLICANT TEL CORNER CUTOFF YES ❑ NO
PRINT) NO
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO
/�/�
IN COASTAL ZONE YES I] NO ❑
VALUATIONS 730.00 - - CATEGORICAL EXEMPTION YES NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT E%EM PTIOM DECLARATION SIGNED (DATE)
WIT ALL ORDINANCES AND LAWS REGULATING BUILDING CON
ITRUC TI OH I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE I
LABORCODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN S CO MPENRATION INSURANCE YI 11 I3 I I I �..�.
SIGNATURE OF �. R00��L •� ��. f S
PERMITTEE
ADDRESS 712 So.
pFINAL
B
CITY-Alhambra., 282 DATE
/
HARVEYITArBRAN T COUNTY ENGINEER FEE FEE 15A00
PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK M D CASH
5 4 1AJUN 17 1 1 5.0 O Abo
I]B g638A CE 980312/72
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