HomeMy Public PortalAbout5759TEMPLE CITY BLVD_Building APPLICATION FOR BUILDING PERMIT
POR APPLICANT TO FILL IN (Print or type only)
BUILDING —
COUNTY OF LOS ANGELES
ADDRESS E _ �� DEPARTMENT OF COUNTY ENGINEER
C I TYTZIP BUILDING AND SAFETY DIVISION
•
NO.OF BLDGS. BUILDING r
SIZE OF LOT NOW ON LOT ADDRESS
� D
TRACT . `L V BLOCK LOT NO. O LOCALI Y
�H1f EL. O NEAREST
OWNER NO. D�% CROSS ST.
ASSESSOR
ADDRESS 171 PIZ C,`tVMAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRED BY
CITY " �j. ZIP 1�J f Q CONS
ARCHITECT ORD S TEL. v(/
ENGINEER ^
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS �l• CLASS NO.11—OWE LL.UNITS BK PG
CONTRACTOR NO, USE ZONE NOP
L"41 7
ADDRESS Jp SPECIAL
LIC, .. CONDITIONS
CITY .. �. �.- CLASS
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONS RUCTION LENDER
NAME AND BRANCH BLDG.SETBACK FROM `f (STREET)
I FRONT PROP.LINE OF
ADDRESS CITY HIGHWAY + YARD - TOTAL SETBACK FROM TYPE OF EXISTING
? SQ. FT NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH
SIZE (} I STORIES FAMILIES ONE
DESCRIPTION OF WORK NEW + o C
ADD ❑ BLDG.SETBACK FROM
` 1SIDE PROP.LINE OF (STREET) C
ALTER ❑ HIGHWAY + YARD = TOT SETBACK FROM TYPE OF EXISTING F
REPAIR[] SIDE PROP. LINE I HIfPWAYj WIDTUSE H
v
EXISTING NG BLDG. DEMOL ❑ +
APPLICANa' IN
8/A/ CORNER CUTOFF YES ❑ NO ❑
(PRINT) 6 N0. 0
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION$ 2— D
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY �J
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- / V
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE ' rP//A•dY//
LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATION INSUR NCE. n /
SIGNATURE OF �U
PERMITTEE
prof
`. ADDRESS n
J '
FINAL '�L- BY,{AV, 1h.0'[f/�.//
"TTlr" NEO L. D 9 DATE
MAKE CHECKS PAYABLE TO: FEE FEE
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN'CHECK VALIDATION CK. M.O. CASH o PERMIT VALIDATIONcK. M.O. CASH
6 9 N ►ant e_6 1 D 2 8.5 0
76A638A CE#803 574 �'r