HomeMy Public PortalAbout4915 HELEO AVE_Building__ 1
715A638A Cj PLICATION FOR BUILDING PERMIT .
Y OF LOS ANGELES BUILDING
DE 1T T OF COUNTY ENGINEER ADDRESS
ILDI AND SAFETY DIVISION LOCALITY',/'
HN LAMBIE. COUNTY ENGINEER NEAREST
OLEMA W. JENKINS,SUP'T OF BUILDING CROSS ST. - {
DISTRICT N91- GROUP TYPE PROCESSED BY
FOR APPLICANT TO FILL IN CONST.
BUILDING STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS I C I ..�,. -� Y CLASS NO.. DWELL UNITS j BK� PG
LOT NO. k BLOCK USE ZONE MAP
TRACT / . . "A C.
SPECIAL
NO. OF BLDOS. CONDITIONS
SIZE OF LOT 1. '�%�� NOW ON LOT JZ = i�t�
USE OF
EXISTING BLDG. - BLDG. SETBACK FROM j ,
TEL FRONT PROP. LINE OF (STREET)
OWNER ' Sj11 {{ NO. t TYPE OF EXISTI NO SETBACK HIGHWAY + YARD = TOTAL
ADDRESS r`.-_ Cl y �L.l �` ' F`�� HIGHWAY WI TH F.OM C.L.
CITY C C''• L:-C e.7,�"c'�.���� +
ABLDG. SETBACK FROM
ARCHITECT OR TEL.
ENGINEER NO. SIDE PROP. LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
TEL. + _ 0
CONTRACTOR NO V
LIC ADDRESS NO CORNER CUTOFF YES NO O
(—
CITY C L SEE REVERSE SIDE FOR SPECIAL APPROVALS w
DESCRIPTION OF WORK V)
z
NEW ADD ALTER REPAIR DEMOLISH
SO.FT. NO. OF NO, OF
SIZE I STORIES FAMILIES
USE OF 0
STRUCTURE
SIGNATURE OF IL
APPLICANT
VALUATION$ I` - '-
APPROVALS DATE INSP ECTOR'S SIGNATURE
P.C. - PMT. �] FOUNDATION, LOCATION
FEE$ FEE 0; F FORMS, MATERIALS
FRAME, FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
9UILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK t ,,
AUTHORIZED HEREBY I WILL NOT EMPL'qY ANY PERSON IN VIOLA. LATH. INT.
TION OF THE LABOR CODE OF T E ST 'TE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPEN SATID I URANCE.
_ ) LATH. EXT.
SIGNATURE OF-� ;! I ,! �� , HOUSE NUMBER COR- �� _
PERMITTEE = RECT AND POSTED
ADDRESS F I N A L
JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION cK� M.O. CASH _ PERMIT VALIDATION 'CK\ j M.O CASH
.� APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING r:.91�_� ;-;, JjCLeo AVC. COUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
CITY" Temple City ZIP 91780 BUILDING AND SAFETY DIVISION
80 x lOONOWOON LOTS 1 ADDRESS
SIZE OF LOT /- -
TRACT 13329 BLOCK LO.T.NO. Qg t 10 LOCALITY
NEAREST u
OWNER R• J•&I•R VatsOn NOTEL
CROSS ST. C.
ADDRESS 4915 N. Helen Ave. ASSESSOR
7 MAP BOOK PAGE PARCEL
CITY Temple City ZIP 91780 DISTRICT GROUP TYPE FIRE ROC SSED BY
,-y CONST. ZONE �
ARCHITECT OR TEL.
ENGINEER NO•
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO L_-OWELL,UNITS ,,j
BK
CONTRACTOR Owner NoL' USE ZONE NOP
LIC.
ADDRESS NO. iI SP IA Li
CITY LIC. CONDITIONS
CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES[] NO❑
CONSTRUCTION LENDER noneNAME AND BRANCH BL G.SETBACK FROM
F ONT PROP•LINE OF (STREET) >_
ADDRESS CITY H GHWAY + YARD - TOTAL SETBACK FROM TYPE OF EXISTING O
SQ. FT.252 NO. OF 1- NO. OF '1 CHECK - FRONT PROP. LINE HIGHWAY WIDTH V
SIZE STORIES FAMILIES 1• ONE 1=
+ - CD
DESCRIPTION OF WORK NEW H
U
�,��rry,
BLDG.SETBACK FROM a
Add f c-mily room ADD SIDE PROP.LINE OF (STREET) cn
Z
ALTER ❑ _ TOTAL SETBACK FROM E OF EX157(NG
HIGHWAY + YARD -
REPAIR❑ SIDE PROP. LINE HIG AY WIDTH
USE OF Mourne ❑ + _
EXISTING BLDG. pDEMOL
APPLICANT p irletSOn TEL 2878450
CORNER CUTOFF YES ❑ NO E]. (PRINT) NO.
BY (SIGNATURE) - IN OPEN SPACE Y..ES ❑ NOval�w� ❑
IN COASTAL ZONE YES ❑ NO ❑
VALUATION Q W '5�1 O0 I CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
-AND STATE THAT THE ABOVE IS "CORRECT AND.AGREE TO COMPLY IMPACT EXEMPTION.DECLARATION SIGNED (DATE)
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 ANY PERSON IN VIOLATION OF THE
LABOR CODE OF TH STATE OF CALIFORNIA IN RELATING TO
WORKMEN'S COMP SN INS URAN -
SIGNATURE Or/PERMITTEE -
ADDRESS
TELFINAL BY CJ^
N '
CITY O. . DATE � ////CCCfffLLLGG7S77 ���"'
IIAKE CFlL-(-KS P:a}"ABLE 70: FEE � FEE $
FEE �P
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
76A638A CE#803 12/72