HomeMy Public PortalAbout5615 MCCULLOCH AVE_Building__ Y_ DEPARTMENT OF BUILDING AND SAFETY. APPLICATION FOR PERMIT
_COUNTY OF LOS ANGELES BUILDING
^ vm. J. FOX, CHIEF ENrmm.EkI.j _.
-,"FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
_ DISTRICT NO. PLAN-CK:'NO:-'-` PERMIT NO.
BUILDING
ADDRESS �/ "'/ •! ., �.'. 4d Ft•i'( �:dt(�'+'' P� .. g c� CO
LOCALITY /L�):'- ��;i a r l jar` Via' RECEIVED BY DATE'OFAPPL// DA E�1y68UED
NEAREST ��i r• :r.J ! �'W '{ �� / ��
CROSS ST. !,•� o:-t = _:++ ,i v �� n
ADDRDESS, `�ticsi / zes, _
OWNER
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MAIL f� /) , + , ,y LOCALITY
ADDRESS / r��;O �� //�•`• {%1971�i�[] �iJ NEAREST i
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TEL-1�-y� w !0 I� CROSS ST. /r, /G/ � �<2
CITY //1 L ✓'7�. / f NO. I_ d Q
FIRE NO.OF TYPE GROUP
ARCHITECT OR TEL ZONE PLANSI
ENGINEER NO.
/ BLDG. ORD. NO.
ADDRESS .r / SETBACK LINE / /
// APPROVEDTE
-
CONTRACTOR (/—lr'�'�J G-� C.A NOL BY y DATE
USE APPrR�OVED
ADDRESS '/ ZONEBY'
DATE
LEGAL CORRECTIONS
DESCRIPTION LOT NO. J3V BOCK
TRACT115%e'-7S ofJ / �•.a-� V G I`l��G/t B f�
l NO. OF BLDGS. r
SIZE OF LOT G - I NOW ON LOT
USE OF_: L+ NO.OF NO.OF
EXISTING BIDG. ///1 3'C I FAMILIES�I r2COMB ---
DESCRIPTION OF WORK
NEW v~ ALTERATION ADDITION
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REPAIR MOVING DEMOLISH y p J/ I Jill m
SIZE ROOMS STORIES ,v ,� 7r'� IJ.H,G�tPT r
WALL �, ROOF //r 1� .�
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USE Or J
d rA�/'rn.•i!e+ 1//
BUILDING 1�'�1� ✓� ✓ct:S:R,44 / n Til
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I HEREBY ACKNOWLEDGE THAT 1 HAVE READ ti-Illi APPROVALS �®
APPLICATION AND STATE THAT THE ABQVE IS CORRECT
AND AGREE TO COMPLY NT
WITH ALL COUNTY ORDINANCES ; FOUNDATION:LOCATION INS ECTOR DATE
AND STATE LAWS REGULATING BUILDING CONSTRUCTION..' FORMS,'MATERIALS
_ .. __ FRAME: FIRE STOPS,
SIGNATURE OF� ,y ' BRACING,BOLTS �lG '
PERMITTEE , -�'r�1•'ri�2 �`hr�lebli irl'.:Cf(.�yi ,/�
LATH. INT. tc• rj�4//r
AUTHORIZED AOT.
LATH, EXT.
76A639A 3 70-SO $ P.C.$ -PLASTER, INT.
' FEE ' eo C5PLASTER, EXT.
VALUATION FEE $� FINAL l T w"+' /�- _f7
APPLICATION FOR BUILDING PERMIT `u
FOR APPLICANT-TO FILL IN (Print or type only) v
BUILDING1 COUNTY OF LOS ANGELES
ADDRESS5619 11DEPARTMENT OF COUNTY ENGINEER
CITY ZIP BUILDING AND SAFETY DIVISION
NO.OF B BUILDING
SIZE OF LOT x Q NOW ON LOT
T ADDRESS l�
TRACT BLOCK LOT'NO. �V -LOCALITY
TEL NEAREST
OWNER l4arV Altadonna NO.448-0704 CROSS.ST.
ASSESSOR
ADDRESS k MAP BOOK PAGE PARCEL
DISTRICT 1GROUPITYPE _ FIRE O ESS BY
CITY Temple City ZIP CONS -ZOf�
ARCHITECT OR TEL.
ENGINEER _ NO.
STATISTICAL CLASSIFICATION', SEWER14AP
ADDRESS CLASS NO..9(—DWELL.UNITS BK PG
CONTRACTOR Virgin Roof CO. NOL 287-0507 U ,TE FNAP
��c IO �ADDRESS 600S. San Gab. B1 ' 160650 � VPECIAL
ONDITIONS
CITY San- Gabriel Ca. I CLASS C-39 ROAD`DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
-CONSTRUCTION LENDER
NAME AND BRANCHBLDG.SETBACK FROM C
FRONT PROP.LINE OF___v •(STREET) C
ADDRESS CITY HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING C
SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH
SIZE I STORIES .FAMILIES ..ONE
+ I C
DESCRIPTION OF WORK NEW ❑ ,` C
BLDG.SETBACK FROM
Reroofing residence using ADD, C] SIDEPROP..LINEOF (STREET)
built-up rootingmateria S ALTER® _ TOTAL SETBACK FROM TYPE OF EXISTING
P HIGHWAY } YARD
REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH
USE OF
EXISTING BLDG. I DEMOL(❑ +
APPLICANT TEL CORNER CUTOFF F YES ❑ NO ❑
(PRINT) NO.
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
IN COASTAL,ZONE YES.,❑ NO ❑
VALUATION - / CATEGORICAL EXEMPTION YES❑ NO ❑
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMppCT 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 PERS IN. VIOLATION OF THE �1
LABOR, CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATI INSURANCE.
SIGNATURE OF ��J� ti0 s
PERMITTEE �®
ADDRESS 00 r -
FINAL
TEL.
CITY San Gabriel, Ca 9177 TEL. 287-050 DATE
JPMT.
MAKE CHECKS PAYABLE- TO: F E � FEE
HARVEY T. BRANDT, COUNTY ENGINEER - 21.75
.PLAN CHECK VALIDATION CK. M.O. CASH ® PERMIT VALIDATION CK. M.O. CASH
fi=G 5 JUL
7GA6384 CE@a03 7/73 _ �• r