HomeMy Public PortalAbout6250 ROSEMEAD BLVD_Building__ 02-!5v APPLICATION,FORBUI LDI NG PERMIT {
"IFORA'PPLICANT TO FILL IN (Print or type Only)
BUILDING • COUNTY OF LOS ANGELES J
ADDRESS �-1��. DEPARTMENT OF COUNTY ENGINEER
CITY C ZIP BUILDING ANDS DIVISION
NO.OF BLDGS. BUILDING
SIZE OF LOT NOW ON LOT ADDRESS
TRACT 71 BLOCK LO O. 3 LOCALI Y
TEL NEAREST
OWNE oAr- NO. Fj CROSS ST. .
ASSESSOR
ADDRES Z MAP BOOK PAGE PARCEL
GITY % (rjr ZIP �J DISTRICT V.-
OUP TYPE FIRE SSED BY
+C� ff� �j CONST. �/ ZO E
ARCHITECT OR TEL. �Og "/Ar
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWER
,,/�Q
ADDRESS CLASS NO.18. BK PG
CONTRACTOR 0. USE ZONE NOP -:2 ,c>
'LIC.
ADDRESS NO, rSPECIAL
� 2 CONDITIONS 7 � O
CITY LIC. J
CLASS ROAD DEPARTMENT APPROVAL`REQUIRED YES[] NO❑
CONSTRUCTION LENDER C
NAME AND BRANCHBLDG.SETBACK FROM
FRONT PROP.LINE OF (STREET) c
ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING C
SQ, FT. NO. OF NO. OF CHECK HIGHWAY + YARD - FRONT PROP. LINE HIGHWAY WIDTH C
SIZE STORIES FAMILIES ONE
_ u
DESCRIPTION OF WORK NEW + co
BLDG,SETBACK FROM
ADD
I"G ❑ SIDE PROP.LINE OF (STREET)
ALTER ❑ HIGHWAY + -YARD = TOTAL SETBACK FROM TYPE OF EXISTING
REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH.
USE OF
EXISTING BLDG. DEMOL El +
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) NO.
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
IN COASTAL ZONE YES ❑ NO ❑
VALUATION$ CATE GO RI CAL•EXEMPTI ON YES❑ NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE 15 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 THE TATE OF CALIFORNIA IN RELATING T -7—,%,9
2— A.��•�-��. l-"7 Ir_ ,1 �y�07
WORKMEN'S COMPEN ON INSURA �j {d /,� N
SIGNATURE OF �►•,� v
PERMITTEE
ADDRESrssT_
r
FINAL BY
CIT NO
L• /DATE [� s/ /' % ''`� / '/�j..f✓L=S1�`
MA KF_ CHECKS PAYABLE TO: P.C. $ FEE'$
HARVEY T. BRANDT. COUNTY ENGINEER G- '1
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION 2C I M.O, CASH
V:0 4-AMAR 1823-10 3.-.0:6.0•®
76AG38A CENS03 7/73 �.. -/',�,q� .1. a a;tm R 18 1 0 5 1•.0..0'A98