HomeMy Public PortalAbout4921 CLOVERLY AVE_Relocation__ APPLICATION FOR RELOCATION BUILDING PERMIT ],
DIVISION OF BUILDING AND SAFETY
Department of County Engmeer ADDRESS
County of Los Angeles
7EA899
DBS•79 WM J FOX, COUNTY ENGINEER LOCALITY
12 sa CASSATT D GRIFFIN SUP T OF BUILDING NEAREST /�
CROSS ST a
FOR APPLICANT TO FILL IN DISTRICT O I GROUP� I TYPE CONST
PROPOSED ..��
BUILDING �,n q / ryTp7
ADDRESS 0 C�loyerly Rye- TeATE
Tela Ci ty NUMBER /\0f C7 H
_LOCALITY / 'C• USZONE SPECIAL ,
PRESENT CONDITIONS
BUILDING 1 `
ADDRESS 21
LOCALITY Alhambra, California BUILDING. YARD HWY STREET NAME ` EXIST
SETBACK" WIDTH
OWNER Rolly R and Myrtle FPOLT
MAIL 9905 B. Woodruff Ave , P L
ADDRESSq� Q Q
CITY Temple City, Calif. NO At 6�-9839 SURETY , —�O �� DATE - REC
MOVINGis A BOND FILED �`16SS Y
CONTRACTORJ.G. Poyorena Co NO At 6-0,371- CASH DATE REC
ADDRESS 623 s. San Gabriel Blvd., San G v€� IT s FILED By
BUILDINGOt�71ex• EOL - APPROVALS
CONTRACTOR
DATE IASPECTOR S SIGNATURE
ADDRESS
PRESENT FOUNDATION LOCATION
FORMS MATERIALS
USE OF
BUILDING Residence -A- CAI Acc FRAME FIRE STOPS. -1n
PROPOSED BRACING BOLTS
USE OFFURNACE LOCATION
BUILDING__Recid-c a GAS VENT DUCTS
LATH INT
SQ NO OF
S ZE T 715 Approx ROOMS 5 STORIES 1 LATH EXT
WALL ROOF
HOUSE NUMBER COR-
COVERING Plaster COVERING Compw RECT AND POSTED
LEGAL K -1.k
DESCRIPTION I LOT NO 10 I BLOCK FINAL
TRACT 114-11 L. A. Co. ST T ENGINEER
yu NO OFBLDGS OUSe WORK COMPLETED 10_�1
SIZE OF LOT w g 1 6 NOW ON LOT ar a NO OF SURETY BOND ��77
RELEASED O` b'SY"
UXISTOIONG BLDG Residence FAMILIES 1 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
1 HEREBY STATE THAT THE INFO MATION GIVEN IS R- APPLICATION AND STATE THAT THE ABOVE IS CORRECT
RECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
SIGNATURE
AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION
APPLICANTQ
OF
ADDRESS 990 E• OOdrU-ff — Temple Ci SIGNATURE OF `
PERMITTEE
VALUATION $ 'r
- FEE $ ADDRESS O"
O
FEE$
WILLIAM J FOX, COUNTY ENGINEER VALIDATION
BYXD2 9 9//61R�25 1 7 1 0 4 0 e BY 16 : 6 10 .00
- DEPUTY 3 ?-6 S DEPUTY
BY BY
® DEPUTY I EPUTY
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