HomeMy Public PortalAbout5967 ENCINITA AVE_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (PdR1 ., t,D< ORIY(
BUILDING_. N COUNTY OF LOS ANGELES
ADDRESS - 6 o cinita DEPARTMENT OF COUNTY ENGINEER
CITYzIF• 91780 BUILDING AND SAFETY DIVISION
NO.OF BLOGS. BUILDING p` �J
SIZE OF LOT X NOW ON LOT ADDRESS
T FI
RAC Q BLOCK LOT NO.-34Z LOCALITY
.. TEL. NEAREST
OWNER NO. - CROSS ST.
M322 Dbfto
ASSESSOR
ADDRESS 5967 - EncinitA
MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE SSED BY
CITY Temple C1ty zIP 91780 T CONST. CON A
ARCHITECT OR TEL. �U
ENGINEER - NO. STATISTICAL CLASSIFICATION
_ <'�% SEWER AP
ADDRESS j [p CLASS NO�/ DWELL.UNITS BK PG
CONTRACTOR' O NOL282�1 58 U E ZONE NADP +J^LIC
� -
ADDRESS I_h ambre Calif. NO. z53�63 11 SPECIAL
V CONDTIONS
CITLIC.
Y
_ CLASS ROOI ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG,SETBACK FROM }.
FRONT PROP.LINE OF ISTRE ETI
ADDRESS CITY _ TOTAL SETBACK FROM TYPE.OF EXISTING U
SO. FT. - NO. OF NO. OF CHECK- HIGHWAY + YARD - FRONT PROP. LINE HIGHWAY WIDTH 5
SIZE STORIES FAMILIES ONE O
+ = U
DESCRIPTION OF WORK NEW d
�. BLDG.SETBACK FROM
ec F/0
f Tile install ADD' SIDE PROP. LINEOF (STREET) Z
reset Tile. ALTER HIGHWAY } YARD o TOTAL SETBACK FROM TYPE OAY E.I�THG
REPAIR SIDE PROP. LINE
USE OF pEMOL 1:1I +
EXISTING BLDG. _ -
APPLICANT TEL CORNER CUTOFF YES. ❑ NO ❑
(PR NT) NO.
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
IN COASTAL ZONE' YES ❑ NO
VALUATION$ 200.00CATEGORICAL EXEMPTION YES NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIED NMENTpL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED GATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
.HEREBY I WILL NOT EMPLOY ANT PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN'S COMPE NSATIO INSURANCE.
SIGNATURE OF GOA L6'+ 6,16
/NSf
PERMITTEE /�,p.../ .ems
ADDRESS r OU TG0-611 %/V CQAOG
(12 O. - e o FINAL
CITY Alhambra, Ca22arNo.L282- 1958 DATE �if—Zo-77 ..
MAKE CHECKS PAYABLE 7'0: FEE $ FEE Y 6.00
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN CHECK VALIDATION C, N.o CASH ;6 PERMIT VALIDATION. CK. ' N.o. CASH
7..2 1:=FE13 7 1. D_ II/nI Y 6_.0 0 Ase
76A630A CE9003 12/72 /.)/J