HomeMy Public PortalAbout6166-6168 ROSEMEAD BLVD_Building__ APPLICATION FOR BUILDING PERMIT
FOR AOJUCANT TO FILL IN (Print ortype only)
BUILDINGCOUNTY OF LOS ANGELES
ADDRESS i 6 6 / 6 DSr:1--ej ,0 �� DEPARTMENT OF COUNTY ENGINEER
CITY _T',,",p ZIP BUILDING AND SAFETY DIVISION
t O.OF BLDGS. BUILDING
SIZE OF LOT O 7(/ 7,3 NOW ON LOT Q ADDRESS /,
TRACT BLOCK I OT NO. s d LOCALITY Q.
n TEL. NEAREST
OWNER I` NO. ASSESSOR
CROSS ST.
ADDRESS ��0� 3� (/ ��jp �O/�O(L J MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE ROCE D BY
-CITY ZIP �QGCJ� n CONSV ZONE„
ARCHITE OR TEL. J V CJ
ENGINEER NO. STATISTICAL CLASSIFICATION ) SEWER MAP
TEL.
ADDRESS CLASS NO.Q '� DWELL.UNITS "�� I BK 6' ?PG
CONTRACTOR NO. USE ZONE MAP
LIC. / c) U
SPE
ADDRESS NO. �•/(-� SPECIAL
LIC. CONDITIONS
CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCHF/-- BLDG.SETBACK FROM
FRONT PROP.LINE OF (STREET)
ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING
SQ.FT. ,_ NO.OF NO.OF CHECK HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH
SIZE a'_S 3 STORIES FAMILIES C ONE J }
DESCRIPTION OF WORK eG✓ NEW � + �� �S� O CL
ADD ❑ BLDG.SETBACK FROM
Alazm es 'v 49A t-19 6.FS SIDE PROP.LINE OF (STREET) O
ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING G
SIDE PROP.LINE HIGHWAY WIDTH
USE OF REPAIR E] Z
EXISTING BLDG. ��� [� DEMOL ❑ +
APPLICANT TEL b � CORNER CUTOFF YES ❑ NO
NO. ❑
(PRINT) /c- ( ...
K IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATURE)
y IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION 4)
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS A LICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE ST LIFORNIA IN RELATING T ORKMEN'S COM-
PENSATION INSURA
RE OF !�'/rf�� ��� 1�c�.E' C
FERMITTgr
ADDRESS 3 L���� P -
FINA
CITY v"'! •' � P/L' TEL LO DA EL ^ B
FMAKE CHECKS PAYABLE TO: FEE $ !/ FEET $ OJi
HARVEY T. BRANDY,C LINTY ENGINEERP'C J 93 Q L r _"7 3 ,.sz
PLAN CHECK VALI TIO CK. Y.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
i
2 34 r--1AY 2 D 235thy 2 1 u 51 2.5V ♦
3 4.6 5
QR: j�6A638A CE#803 3-75
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