HomeMy Public PortalAbout5460 TEMPLE CITY BLVD_Building__ APPLICATION FOR
BUILDING PERMIT
BUILDING
FOR APPLICANT TO FILL IN ADDRESS C41cx :c iLNG ,
AUDDRE55 —' LOCALITY
AM
NEAREST
CITY y ZIPNO OF CROSS ST
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SIZEOFLOT y�1 Q NOW ONLOTr MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE P ED BY
TRACT BLOCK LOT NO v p ? CONST L / E
TEL V d V
OWNER �� NO���
4 STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS �` _ CLASS NO DWELL UNITS b BK/aPr2
CITY ZIP LRE ZONE MAP
ARCHITECT0 TEL on NO
ENGINEER '� 1 N Y„ /c... / SPECIAL
CONDITIONS
ADDRESS Z_ . T L ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO❑
EL 1
CONTRACTOR NOZx \ BLDG SETBACK FROM
q FRONT PROP LINE OF (STREET)
ADDRESS NO '.L�I TOTAL SETBACKFROM TYPE OF E%(STING
HIGHWAY + YARD FRONT PROP LINE HIGHWAY WIDTH
CITY l `C'L`ASS G—� S
CONSTRUCTION LENDER + i
NAME AND BRANCH 7 CI
BLDG SETBACK FROM V
ADDRESS CITY /�� SIDE PROP LINE OF (STREET) �0j
SIIZZE� STORIOES FAMIF NO OIIES "C% QryEK HIGHWAY + YARD TPKL SETBACK SIDE PROP LINE
HIGHWAY EXISTING
6
❑ + Z
DESC I TION OF WORK NEW
^�"7 ADD CORNERCUTOFF YES ❑ NO ❑
ALTER INOPEN SPACE YES ❑ NO ❑
REPAIR
USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑
EXISTING BLDG L, DEMOL
APPLICANT TEL C
I WRINTI f"LQ NO -r 1 O �T e�
BY(SIGNATU
C/
THA
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS WITH
AND STATE
LACES
AND THE ABOVE IS CG BUIL AND AGREE 1TI COMPLY CERTIFY
T ALL ORDINANCES L
AND LAWS ORIIHAbNG BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL EMPLOYVIOLATIONOY ANY PERSON IN VIOLATION OF
THE LABOR CODEOF THE STATE OF CALIFORNIAIF IN RELATING TO BCOM
FFNSAl1ON INSURANCE y� ND
SIGNATU �PERMITTERE OF �L]J �` DAffL /J f_ BY
ADDRESS
TEL PC Fee E Permit Fee
CITY NO
Issuance Fee
VALUATION$ oL,IJO
Total Fee
PLAN CHECK VALIDATI c mo CASH PERMIT VALID,17Q cL ;0 C"H
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APPLICATION FOR BUILDING PERMIT
"OR APPLICANT TO FILL IN (P,,.t or tvPR only)
BUILDING .r!C T - COUNTY OF LOS ANGELES
ADDR DEPARTMENT OF COUNTY ENGINEER
CITY ZIP ING AND SAFETY DIVISI
O OF BL BUILDING
SIZE OF LOT NCM' ON L ADDRESS
TRACT BLOCK LO LOCALITY
"J TEL NEAREST
OWNER �� / r NO CROSS ST
ASSESSOR _
ADDRESS Remy MAP BOOK PAGE - CEL
DISTRICT GROUP T FIRE ESSED By
CITY ZIP CONS
ARCHITECT OR TEL
ENGINEER NO
STATISTICAL IFICATION SEW MAP
ADDRESS CLASS NO DWELL UNITS B P
CONTRACTOR Ap NEL E ONE MAP
A DORESS .CF Sr LIC
NO NO
S SPECIAL
I LIC CONDITIONS
CITY CLASS
ROAD DEPARTMENT APPROVAL REQUIRED ES❑ NO
CONS RUCTION LENDER
NAME AND BRANCH BLDG SETBACKFROM
FRONT PROP LINE
OF (STREET)
ADDRESS CITY
HIGHWAY } YARD TOTAL 5 TBACK PROM TYPE OF EXISTING
SI FT�` NO OF NO OF CHECK FRONT ROP LINE HI HWAV WIDTH
SIZE (�IdO STORIES I FAMILIES I ONE >
} - Itno
C
DESCRIPTION OF WORK NEW o
OD mBLDG ' Ct
SIDE PROPROP LI LINEEOF OF -(STREET) �
ALTER
HIGHWAY _
} YARD -
TOTAL SETBACK FROM TYPE OF EXISTING
/
REPAIR SIDE PROP LINE HIGHWAY WIDTHUSOF
y�
_ D
EXISTING BLDG ��Q.� �'/� EMOL } Z
APPLICANT TEL.y�LOt(� CORNER CUTOFF YES NO C]
RINT) NiBdoGG O
BY (516NA TUR EI IN OPEN SPACE Y NO
Cl
IN COASTAL PERMIT ZONE ES NO C]
VALUATION$
1 HEREBY ACKNOWLE04E THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON
ST RUC TIONCERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY 1 WILL NOT EMPL Y ANY PERSON IN VIOLATI OF THE
LABOR CODE OF THE E OF CALIFORNIA IN TING TO
WORKMEN 3 COMPEHSAT INSURANCE
SIGNATURE OP
PERMITTEE _ _ �
ADDRESSZOE LS
` /r4 FINAL BY
CITY Npl�G6,J / DATE
11AIAT 4t
AE CHECAS Y.ISAHLE 70 FEE $ FEE W �� 1
HARVEY"T BRANDT. COUNTY ENOINEER
PLAN CHECK VALIDATION CK M o CASH PERM VALIDATION cN o CASH "
36NY 1 1
On 21.75A9'
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