HomeMy Public PortalAbout5753TEMPLE CITY BLVD_Building ®5.76A638A ;
SE 1903(Rr.V.6/78)
°APPLICATION �'OF� BUIL ING PERMIT
COUNTY OF LOS ANGELES LDING tB,UILDING AND SAFETY
BU
FOR APPLICANT TO FILL IN ADIDRESS v 7S
BUILDING �
ADDRESS // 3 l • jF j'(,,C C 1 L&A LOCALITY �f
'y-� NEAREST
CITY /tMAta C/ ZIP CROSS ST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT i z X J NOW ON LOT MAP BOOK PAGE I PARCEL
cl DISTRICT GROUP TYPE FIRE SSED BY
TRACT BLOCK A �p�LOTNO�EL_ 7�/' �V� _� CONST. ZONE
OWNER C /L A,60`NO. P�Sf✓�'
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STATISTICAL CLASSIN ATION SEWER P
ADDRESS S-2S.3 4V. L`��C C!?` cc, CLASS NOS DWELL.UNITS BK
CITY [ _ ZIP 90P.6
ARCHITECT OR NO VALUATION $ /! �n)
ENGINEER v
ADDRESS BLDG.SETBACK FROM
TEL FRONT PROP.LINE OF �C , (STREETI
CONTRACTOR _7C.L -NO. HIGHWAY + YARD _ TOA ETBACKFROM TYPEOF EXISTING
LIC. - FRONT PROP.LINE HIGVWAY WIDTH
ADDRESS NO. !� _
LIC. +
CITY CLASS BLDG.SETBACK AOM
CONSTRUCTION LENDERSIDE PROP.LINE OF (STREET)
NAME AND BRANCH N D 4e.-�
TOTAL SETBACK FROM TYPE OF EXISTING �
HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY WIDTH
ADDRESS CITY
SQ.FT NO.OF / NO.OF CHECK + _ �A
SIZE STORIES L FAMILIES ONE
DESCRIPTION OF WORK NEW El P.C.Fee$ - Perm it.Fee Oro
ALL. CL ADD NIssuance Fee UD
ALTER ❑
USE OF
REPAIR ElTotal Fee (J
EXISTINGBLDG. DEMOL El O
APPLICANT TEL �p
(PRINT) JZ/ /j, / NO-� 0�= G�j 0
BY ISIGNATURE)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIO AND STATE V
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH A ORDINANCES _ w
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY IN DOING THE �• L 1:0.
,O,O A
n
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF U G V
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- Z ,� ,
PENSATION INSURANCE. # 0 0 0 0.0 1
SIGNATURE OF 2 0 1 87,00
PERMITTEE dd"GG
ADDRESS IV /J�/J4 C � � Z o 0 1 � 1,G C
TEL.
CITY C. NO. 73 a 0 8. 1 3—7 9
0
US ZONE MAP
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SPE
I SPECIAL
CONDITIONS
FINAL y Y
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