HomeMy Public PortalAbout4840 TEMPLE CITY BLVD_Building__ APPLICATION FOR COUNTY OF LOS ANGELES �1
RTMENT OF COUNTY ENGINEER
VBUILDING PERMIT DBUILDNGAND SAFETY DIVISION !!
FOR APPLICANT TO FILL IN BUILDING /
ADDRESS
BUILDING t
ADDRESS / LOCALITY
/ NEAREST
CITY W ZIP CROSSST
( q ONO OF BLDGS ASSESSOR
SIZE OF LOT Y NOW ON LOT MAP BOOK PARCEL
DISTRICT Gfq��UP TYPE FIRE E55 Y
TRACE 7 BLOCK LOTNO
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OWNER NO 0{� u 'V '
STATISTICAL CLASSIFICATION EVAP
ADDRESS CLASS NO —.DWELL UNITS BK PG
CITY / ZIP - ZONE E O
ARCH( ECTO + - TEL
ENGINEER NO J $P IAL 146
• � CONDITIONS
ADDRESS + ` Y'
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
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TEL 4
CONTRACTOR NO BLDG SETBACK FROM
FRONT PROP LINE OF (STREET(
ADDRESS NO �Q T TOTAL SETBACK FROM TYPEOF EXISTING
LICA HIGHWAY + YARD FRONT PROP LINE HIGHWAY WIDTH
CITY C A5$
CONSTR ION L NDER + i
NAME AND BRANCH
BLDG SETBACK FROM U
ADDRESS CITY SIDE PROP LINE OF (STREET) O
SO FT NO OF NO OF CHECK HIGHWAY + VARD TOTAL SETBACK FROM TYPE OF EXISTING [j
SIZE STORIES FAMILIES ONE SIDE PROP LINE 1HIGHWAY1 WIDTH ✓✓�+�
DESCRIPTION OF WORK H `S r Z
iI G4 /f I / or ADD CORNER CUTOFF YES ❑ NO ❑
Q ALTER OPEN SPACE YES ❑ - .-NO'❑
USE OF REPAIR COASTAL PERMIT,ZONE YES'-0 NO ❑
EXISTING BLDGD //t`_�`�/C / DE�M/O'�L/O
APPLICANT T
/ Ff'1�r/ /E�//f�I�'j.NO
BY(SIGNATURE)
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT TETE ABOVE IS CORRECT AND AGREE TO 00M Y WITH ALL ORDINANCES
AND LAWS REGLAATING BUILDING CONSTRUCTgN CERTIFY THAT IN DOING THE _
WORK AUTHORIZED HEREBY I WILL NOT FMKOY ANY PERSON IN VIOLATION OF M
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN 5 COM
PENSATION INSURANCE • • +� 1
SIGNATURE OF FINAL ) By
PERMITTEE DATE �� (�!�� T R�
ADDRESS7 Al ,G—
CITY /� TEL P C Fee S Permit FeeNO
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Issuance Fee
VALUATION �Q _ -..
i Total Fee
PLAN,CFLECK,4AtlSADATI M P J PERMIT VALIDATION <np r o CAfH
POLICY HOLDER: / 2 3 4AUG 10 -1 U 6 1.0 0
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