HomeMy Public PortalAbout5811-5811 1/2-5813TEMPLE CITY BLVD_Building 76A636A CE 0803 1/ 71 �
APPLICATION FOR BUIL.®�IIV PERMIIT
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER . MAP BOOK P/1GE PARCEL
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
Print or tvoe onl CROSS ST.
BUILDING DISTRICT NO GROUP TYPE PRQqp
ADDRESS r D CONST.
LOT NO. BLOCK STATISTICAL CLASSIFICATION SEWER MAP
CLASS NO..cZ.2.DWELL.UNIT3 BK ✓PT
TRACT NO.OF SLOGS. USE ZONE MAP NCZj r)
n O. VV
SIZE OF LOT NOW ON LOT / SPECIAL
USE OF -CONDITIONS
EXISTING BLDG.
TELUl .
OWNER NO. BLDG.SETBACK FROM
ADDRESS 1 FRONT PROP.LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
CITY NJ HIGHWAY WIDTH FROM G.L.
ARCHITECT OR TEL. + _
ENGINEER NO. BLDG.SETBACK FROM
ADDRESS SIDE PROP.LINE OF (STREET)
TEL,,yy�� AA TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL d
CONTRACTOR NO. �L.� L U HIGHWAY WIDTH FROM G.L. L
ADDRESS LIC.NO. •+ C
LIC.
CITYQ'=4kaLill' CLASS CORNER CUTOFF YES [J' NO ❑ LL
CONSTRUCTION LENDEIJ u
NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS ?
ADDRESS
SQ. FT. NO. OF NO. OF NEW E]SIZE STORIES FAMILIES
USE OF , ADD ❑
STRUCTURE
ALTER ❑
REPAIR
SIGNAT RE O
APPLICANT DEMO
❑
VALUATION O APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION: LOCATION
FEE 5 FEE S FORMS, MATERIALS
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS
STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT.
LABOR CODE OF THE STATE OF CALIFORNIA• IN RELATING TO
WORKMEN'S COMPE! ATION 75URA�CE. LATH, EXT. '
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL
JOHN F. LEWIS. PRINCIPAL STRLW URAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION cK. M.O. CASH
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