HomeMy Public PortalAbout5014AGNES AVE_Building (2) TEMPLE CITY
7GA638A CE 803263 APPLICATION FOR BUILDING PERMIT '
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS �J
BUILDING AND SAFETY DIVISION LOCALITY * —
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
DISTRICT NO GR P TYPE O E D B
FOR APPLICANT TO FILL IN `J CONST j
BUILDING � STATISTICAL CLASS( (CATION SEWER MAP
ADDRESS o /V �'S' AVP (
r` K
CLASS NO DWELL UNITS — ,
LOT NO BLOCK WATER
CERTIFICATE NOT REQUIRED RECEIVEDEL
TRACT MAP HIGHWAY
NO OF BLDGS NO (CIRCLE) STATE MAJOR SECOND LOCAL
SIZE OF LOT NOW ON LOT USE ZONE SPECIAL
USE OF / CONDITIONS
EXISTING BLDG
EL
OWNER dPo r E t4o Y O m. oq 147 �7s� BUILDING EXIST
AI //�� SETBACK YARD HWY S�EET NAME WIDTH
ADDRESS �(�/y N l P.Sl WU P l FRONT
ARCHITECT OR ev TEL P L (� , 0
ENGINEER NO SIDE a
9 P L O
ADDRESS
TEL I V
CONTRACTOR NO
O
ADDRESS U
DESCRIPTION OF WORK a
' Z
NEW ADD ALTER REPAIR DEMOLISH
SO FT NO OF NO OF
SIZE STORIES FAMILIES
USE OF A,
c
STRUCTURE r I
a5 ov 8 U
SIGNATURE O
APPLICANTF
VALUATION $ ,
APPROVALS DATE INSPECTORS SIGNATURE
PC PMT f y� FOUNDATION LOCATION
FEE $ FEE $ /sa ov 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 RNACE -LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING INA S VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK i
9 If
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT (f
ING TO WORKMEN S COMPENSATION INSURANCE I
LATH EXT
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE RECT AND POSTED j
ADDRESS FINAL O� z+'
w JOHN F LEWIS PRINCIPAL STRUCTURAL EN
PLAN CHECK VALIDATION GK M O CASH _ PERMIT VALIDATION CK
MO
CASH
LAL_- 51b3L FEB 3 1D 4 0 0~ "
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