HomeMy Public PortalAbout6244 ROSEMEAD BLVD_Building__ APPLICATION -FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only) )
BUI t_DI NG n COUNTY OF LOS ANGELES
ADDRESS LI' t C.},(�'H19 ,i� DEPARTMENT OF COUNTY ENGINEER
CITYj /� la zIP r3 BUILDING AND FETY DIVISION
Rol
NO.OF BLDGS. sry BUILDING
SIZE OF LO ,5 OMA 1 l NOW ON LOT ADDRESS
TVTAC BLOCK LOT NO ,'$ LOCALITY
TEL NEAREST
OWNER (f f" ® NO. J CROSS ST. a
/�*� ] j�+, ASSESSOR
ADDRESS W C / �/Pt/r�+(/�/�SVI1i� `p' MAP BOOK PAGE PARCEL
IITYPECITY (y,� ` ZIP `lt as DISTRICT GROUP CONS FORE SED BY
ARCHITECT OR y� TEL, tt [ .v�
ENGINEER i/ q, NO.
�d. "• rU0 STATISTICAL CLASSIFICATION
�� �//�'' p?'7 /`EWER AP
ADDRESS � (� �� H' Cl!y: y w J?110.0 CLASS NO.�aDWELL,UUNITS (^ BK
CONTRACTOR c i."• ry
TEL ��! USE ZONEFNO.
!' ja(f f�fiNO. —2,ADDRESS PECIAL
CITY LIC. ONDI TIONS
��� CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG.SETBACK FROM
FRONT PROP.LINED ISTREETI C
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 q STORIES ' FAMILIES ONE
L
DESCRIPTION OF WORK a V, 1fz s'fggi NEW 0 c
�/�{,1( / ADD BLDG.SETBACK FROM
�f/4; CK K.%b� 1 L L�• �y SIDE PROP,LINE OF ISTREETI
: ALTER ❑ _ TOTAL SETBACK FROM TYPE OF EXISTING
,� !•C s HIGHWAY + YARD HIGHWAY WIDTH
—REPAIR❑ SIDE PROP. LINE
USE DEMOL E] +
EXISTING BLDG.
APPLICANT TEL( CORNER CUTOFF YES ❑ NO ❑
(PRINT) "1rr )b 1 6GL NO.
IN OPEN SPACE YES ❑ NO ❑
BY (SIGNATURE) yL Y,
y, �
J a = IN COASTAL ZONE YES ❑ NO ❑
VALUATION$ ( 0//� ()o b ri 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 ALLORDINANCES AND LAWS REGULATING BUILDING CON- I
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPA T REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE -
Vl
LABOR CODE OF T STATE OF CALIFORNIA IN RELATING TO y
WORKMEN'S COMA I N INSURANCE..)
SIGNATURE
J/ERMITTEE OF
- ) r
DRESS-11S719 li�l�C -� �/b r/ l l If
FINAL
CITY�� a NOL ` / DATE J BY
MAKE (ALECKS PAYABLE TO: F E FEE 1'
HARVEY T. BRANDT. COUNTY ENGINEER 2� / 01
PLAN CHECK VALIDATION CK 0 CASH o CJ PERMIT VALIDATION CK M O CASH
C:4 D
76A638A CE7eB03 7/73 Lr.