HomeMy Public PortalAbout6221 TEMPLE CITY BLVD_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING COUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
CITY ' 19 ' s zIP BUILDING AND SAFETY DIVISION
NO.OF BLDGS. BUILDING j `
7
SIZE OF LOT NOW ON LOT ADDRESS /
�>,ar r�'
AC BLOCK LOT NOl LOCALITY JC
TEL NEAREST
NEAREST
O4oNE CROSS ST.
ASSESSOR
ADDR SS L����!/� Cit L MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE ' FIRE (I?OqESSED BY
CITY L[JE ZIP2r y-O� CONST Z
ARCHITECT OR TEL v^7
ENGINEER 4Z NO. a
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO. DWELL•UNITS BK PG
CONTRACTOR NOL US ZONE MAP
LIC. NO. c 0-3
ADDRESS NO, 3 SPECIAL
LIC. CONDITIONS
CITY �
CONSTRUCTION LENDER CLASS
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
NAME AND BRANCH BLDG.SETBACK FROM
FRONT OP.LINE OF (STREET)
ADDRESS CITY MOP.
} YARD = ;TOTAL SETBACK FROM TYPE OF EXISTING
SQ. FT. NO. OF NO. OF CHECK i FRONT PROP. LINE HIGHWAY WIDTH
SIZE STORIES Zr FAMILIES ONE
DES'CR N OF WORK NEW ❑ }
ADD BLDG.SE ACK FROM
SIDE PROP. INEOF (STREET) C
ALTER ❑ HIGHWAY } YA D`=TOTAL SETBACK FROM TYPE OF EXISTING L
EPAIR❑ ySrD_E`-P•RO.ELyLINE HIGHWAY WIDTH U.
a.
USE OF
EXISTING BLDG. DEMOL ❑ }
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) NO.
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
IN COASTjL4RMIT ZONE YES ❑ NO ❑
VALUATION, .��
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. IC
THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO a �jj /LIyQ a W1 0a
WORKMEN'S COMPENSATION INSURANCE.
SIGNATURE OF
PERMITTEE
a
ADDRESS
FINAL / BY
CITY �/ w `• e• ��L/,� NOL• ATE
MAKE CHECKS PAYABLE TO:
PC
CN FEE
HARVEY T. BRANDT, COUNTY ENGINEER
]
PLAN'CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.D. CASH
1 0 L41'rEg 26 2 .3 D 9.0 0 end
76AS38A CE0803 5/7A
DEPARTMENT OF BUILDING AND SAFETY AYYLIC:A 1'lU1V r UK YLKMI"1'
COUNTY OF LOS ANGELES TJ TT - �� `�T�T
wk J. FOX, CHIEF ENGINEER B�/ILDE \ V
NO. OF BLDG. ORD.NO. DISTRICT NO. PLAN CK. NO. PERMIT NO.
PLANS SETBACK LINE �] /�
FIRE APPROVED 37 S—V Z G3 y
ZONE BY DATE RECEIVED BY DATE OF APPL. DATE ISSUED
USE APPROVED C H
ZONE BY DATE T�
APPLICANT FILL IN HEAVILY OUTLINED POR'T'ION ONLY
E BUILDING
O E NAME ADDRESS
F W
WW- Z ADDRESS LOCALITY 7:E:'21'2! i t e /T y
2 Z NEAREST
Z W CITY CROSS ST. 1
a
LICENSE NO. NOI. E NAME 17 L E • P' ZTEM
W MAIL
EO NAME 3 ADDRESS 6 A(S� r
O T�O
U �p.� TEL. V
QE ADDRESS CITY 1 NO.
Z CITY 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
U APPLICATION AND STATE THAT THE ABOVE IS CORRECT
STATE TEL. AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
LICENSE NO. NO. AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
OF,J_S�'
Z LOT NO. /Y 0& QJC 'L. SIZE OF LOT4r)(ZQQ SIGNATURE OF
O OWNER
NO. OF BLDGS. p� a z4-.+
Q 6 BLOCK NOW ON LOT /yQ►V/� AUTHORIZED AG .
G �
J m TRACT, ff T 8 Ali�� R ND�p J R. CORRECTIONS
D USE OF BLDGS.
NOW ON LnT
DESCRIPTION OF WORK
USE OF
BUILDING
O
- C
n
a
Iia
NEW TYPE I GROUP
NO. OF N. OF
ALTERATION ROOMS FAMILIES
ADDITION SIZE 4b� (i
REPAIR STORIES s
MOVING WALL COVERING
DEMOLISH ROOF COVERING
P.C.S lf'a o FINAL APPROVAL
FEE
am 6 I INSPECTOR'S
_VALUATION /,ill O IEE -2! DATE NAME
iF bl-VIS10i OF BUILDING AND SAFETY BUILDING
Department of oEBgineer 9 �9
' Department
County of Los
Angeles
WM. J. Fox, COUNTY ENGINEER• APPLICATION
FOR APPLICANT TO FILLIN , FOR OFFICE USE ONLY
BUILDINGp c� E 4 DISTRICT NO. PLAN CK.OR REG.NO, ,( tPE MIT NO.
ADDRESS �c J2/'� &D� �'Q/?7 A—if '��`
LOCALITY Q� L �t� EOEIVED BY DATE OF APPL. DATE ISSUED
NEAREST q,. J
v,dRrS e �-3 �
CROSS B'T/ D i Y �I /�I v P BUILDING
OWNER V A7 14 G ADDRESS G 211 !(/o �0—r,/,� .e ,, //- /I— r
MAIL _ • v LOCALITY
ADDREBB A Z c I �-, /'r9 /�� (f�1.1 ;, ,1 , NEAREBT /
,/�y��77 p� } DROSB BT. Gar- rs r r'/
CITY II ll L �l hk"N q FIRE moor TYPE GROUP
ARCHITECT OR nTEL ° ,
ZONE PLANE
ENGINEER NO. BLDG. O ORD.
O'
f SETBACK LINE / d G
ADDRESS V UBE °�APPROVED
�✓ of—
TEL ZONE` BY DATE
CONTRACTOR r NO. HOUSE NUMBERING
ADDRESS MAP NUMBER—in-49 0 33 NO. ASSIGNED BY
LEGAL ff
DESCRIPTION LOT NO. �j v BLOCK LDS t CTION�jS
LF I
TRACT v
NO. BLDGEL I NU
SIZE DF LOT/ox, D II NOW DN LOT t LE
uscorNEL
EXISTING BLDG.(/!J�✓• /Jl4J} I F wC eB
DESCRIPTION OF WORK
x/rrs/✓6 r s°r7�kr F�s�r'�a vr''rIc'D m
NEW ALTERATION ADDITION I 4 Se�LIJ••�/ ;�r..-•� L� / D l[1 �/ � F/ Z
REPAIR �/ DEMOLITION /).,e y /?,� C
SIZE / ROOMS STORIES //
EXT.WALL ROOF
COVERING COVERING �%I.� A /I/ -
U8E OF STRUCTURE
l o "3 7-d 11W i A-7'
RO ��DOlO U ANYAl INBEOTOGNATURE DATE_
FOUNDATION:LOCATION
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP-�
FORMS, MATERIALS
PLICATION AND STATE THAT THE INFORMATION GIVEN 18 FRAMEI FIRE BTOPB■ kC cll�l IJ
/
CORRECT. BRACING,BOLT8 Y c 6 !fib
1AGREE TO COMPLY WITH ALL COUNTY ORDINANCES• FURNACE: LOCATION. ,/
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT.DUCTS /Y�LI ia;rlACf-N,7T//✓ S a
BIBNATURE OR �� �� � ��� LATH■ INT � `1 ����;�= llti �'3 1
PERMITTER s�
ADDRESS vri 7 /I/•w I ll�n/Vt� (g � /°�'(/�- LATH■ WIT. cS�
AUTHORIZED AWT—
PLASTERYINT.
�r�
PLASTER■ EXT.
® FEE 13.9,r% HOUSE NUMBER OCR-
VALUATION REOT AND PORTED 10�
VALUATION FEE ,�F • FINAL
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