HomeMy Public PortalAbout5758 ROSEMEAD BLVD_Building__ 76A638A
GE#803(REV.6/78)
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APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
oFOR APPLICANT TO FILL IN BUILDING
ADDRESS r
BUILDING
ADDRESS LOCALITY
NEAREST
CITY ZIP CROSS ST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE PROCESSED BY
TRACT BLOCK LOT NO CONST- ZONE
TEL.
OWNER NO.
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO. DWELL.UNITS BK PG
CITY ZIP
ARCHITECT OR TEL. VALUATION $
ENGINEER NO. I : A
ADDRESS BLDG.SETBACK FROM
TEL FRONT PROP.LINE OF (STREET)
CONTRACTOR NO. " HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING
LIC. FRONT PROP LINE HIGHWAY WIDTH
ADDRESS NO.
CITY CLASS
CONSTRUCTION LENDER BLDG.SETBACK FROM
NAME AND BRANCH SIDE PROP.LINE Of (STREET) d
HIGHWAY + YARD — TOTAL SETBACXFROMT TYPE OF EXISTING 0
ADDRESS CITY SIDE PROP.LINE IHIGHWAY WIDTH
SQ.FT. NO.OF NO.OF CHECK + — zi
SIZE STORIES FAMILIES ONE k.
DESCRIPTION OF WORK NEW ❑ P C. Fee$ Permit Fee
ADD ❑ cx
❑ Issuance Fee 0
ALTER /d
REPAIR ❑ Total Fee p �! W
USE OF ~
DEMOL
EXISTING BLDG. ❑ Z
APPLICANT 1 -- TEL
(PRINT) r NO. r Q + • & • •
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J
BY(SIGNATURE) j ' t
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION"AND STATE
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES su
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE 2
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF V ; , I -'T�{
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATI TO WORKMEN'S COM Z
PENSATION INSURAf CE J
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SIGNATUREOF. -
PERMITTEE f
ADDRESS ' ' 'f
Z
TEL O
CITY NO Q
D
USE ZONE MAP
NO. j
SPECIAL
CONDITIONS
FINAL BY W
d
DATE