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HomeMy Public PortalAbout6353-6353 1/2 TEMPLE CITY BLVD_Building__ a xew rFLv I I,78> APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY _ FOR APPLICANT TO FILL IN ADIDRESS (p i UDHNG BUILDINGrr ' R ADDRESS leTEM LOCALITY NEAREST CITY lzwzz ZIP CROSSST /J p NO OF BLDGS ASSESSOR SIZE OF LOT CO NOW ON LOT D MAP BOOK PAGE PA EL TRACT BLOCK L NO 1p DISTRICT GROUP CID E DBV TEL OWNER I002LZ� NO Q C ,L.1 STA7�ASCAL 1.4 1J[A// .WELL UNITS T ON SEWER MAP ADDRESS O S',,((.y�X�__L I��`7 � O/LvK, i��D CITY Ar-j;,a(6- ZIP ARCH R ECi OR TEL VALUATION ENGINEERG 'EI Q NO 21 $ ADDRESS / BLDG SEIBM E'y� TEL // FPINE ISTREET) CONTRACTOR�j �V ANO LIC HIGHWAY + YARD T SiHW ETBACKFROM OF (STING PROP LINE AY WIDTH ADDRESS NO/�i LIC + _ CITY CLASS CONSTRUCTION LENDER BLDG SETBACK FROM � NAME AND BRANCH 14SIDE PROP LINE OF (STREET( HIGHWAY + YARD TOTAL SETBACK FROM I TYPEOF EXISTING IL ADDRESS CITY I SIDE PROP LINE 1HIGHWAY1 WIDTH Q SO FTNO OF Np Of CHECK + - V SIZE STORIESQ FAMILIES Q ONE Q USE ZONE MAP y DESCRIPTION OF WORK NEW - /^T NO i.-.! SPECIAL ADD vv\\ CONDITIONS ALTER FINAL BY l ` REPAIR DATE 4--10--?( USE TI / EXISTING BLDG DEMOL ��' / 1 /L Z APPLICANT / F ',\/l # -• • • 3 IPRINTI �/ ♦ / �J �D�"l 2 • -) 1 0 0 BY ISIGNATUREI yyl I HEREBY ACKNOWLEDGE i T I HA E READ THIS APR TION AND STATE J O O THAI THE ABOVE R CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCE u AND LAWS REGUATING BUILDING CONSTRUOIGN I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VKKATION OF 023-80 THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN SCOM �T �(/• p PENSATIINSURANCE /7 INSURAN SIGNATURE OFC ,/ ��j(G Gy PERMITTEE t!/ ✓✓O I� � � Z 7 Q.7 A ADDRESS — • N St l�7LS TEL ql o • • tT 0 # o • • • • 1 CITY5�6 GNO -- (A RJ N • —T <p Q • 8 0 7 2 5 PC Fee I • {.n d Permit Fee 'U CD CD N Cr. > • - P 07 2 5 E t1 n_l ) o w a Issuance Fee /�1 !� CH Total Fee 6JV 7,�Jss _I