HomeMy Public PortalAbout5520 TEMPLE CITY BLVD_Building__ APPLICATION FOR BUILDING PERMIT _
FOR APPLICANT TO FILL IN (Print or type only) '
BUILDESB#IN �-_ � COUNTY OF LOS ANGELES
ADDRD y? DEPARTMENT OF COUNTY ENGINEER
CITY zip 41,IF56 BUILDING AND SAFETY DIVISION
NO OF BLDG5 BUILDING
SIZE OF LOT • NOW ON LOT ADDRESS
TRA LOT NO-*p LOCALITY
TEL NEAREST
OWNER NO CROSSST 4
ASSESSOR 17
ADDRESS MAP BOOK PAGE PARCEL
-CITY 21P DISTRICT GROUP TYPE FIRE DBY
ARCHITECT OR TEL �� `�— O 8 T ZO!'IF
ENGINEER NO _
CLASSIFICATION J SEWER MAP
ADDRESS - TEL CLASS NO 1 / DWELL UNITS E BK G PG
CONTRACTOR NOZg
USEZONE MAP X-0
Y 0O -
LIC W
ADDRESS NO SPECIAL
LIC CONDITIONS
Ory CLASS ROAD DEPARTMENT APPROVAL REQUIRED -YES ❑ NO ❑
CONSTRUCT*N LENDER
NAME AND BRANCH BLDG SETBACK FROM
FRONT PROP UNEOF (STREET)
ADDRESS CITY -' TOTAL SETBACK FROM TYPE OF EXISTING
SO FT NO OF OF CHECK HIGHWAY + YARD FRONT PROP LINE HIGHWAY WIDTH
SIZE �' STORIES —ITFAMIL ONE _
DESCRIPTION OF WORK NEW + p e
BLDG SETBACK FROM ut
vv v, QECj ADD ❑ SIDE PROP LINE OF (STREET) rO
ALTER ❑ TOTAL SETBACI(FROM TYPE OF EXISTING
USE OF REPAIR ❑ Y.
HIGHWAY + YARD SIDE PROP LINE HIGHWAY WIDTH
_ Z
EXISTING BLDG DEMOL ❑ +
APPLICANT T' ?
�}�SfCORNERCUTOFF YES ❑ NO
(PRI NTI NO ?& Llcl
T IN OPEN SPACE YES ❑ NO ❑
BY ISIGNATUREI
IN COASTAL PERMIT ZONE YES � NO
VALUATIONS 00 5e
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORKER AND AGREE TO COMPLY WITH ALL ORDINANCES T C
/ S
AND LAWS REGIAATING BUILDING CONSTRICTION I CERTIFY THAT IN DOING THE
WORT(AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION 01 1
,
_
E LABOR CODE OF THE STATE OF CAUFORNWOM
IA IN RELATING TO gKMEN S C '^
PENSATI)IF INSURANCE. - _
TH
SIGNATUREOF - ��
PERMITTEE
E I LD=R. .�ta.c�.
ADDRESS- ��� /� VFNZ
CITY LJCJA.ZL TEL
NO DATE
- MAKE CHECKS PAYABLE TO PC M7
HARVEN
YT BRANDT.COUNTY ENGINEER FEE $� � LS FEE ��� ,�Ol
j
PLAN CHECK VALIDATION c c 11,10 CAJM PERMIT VALIDATION Cx RE o CASH
C R Sw,JAR CL3 2'1 EI 1 : F •°' I '
-0 8,9�JAN 13 .1 D 5 52 0 ens
es 7A 35ARR 1375
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