HomeMy Public PortalAbout6355 TEMPLE CITY BLVD_Building__ TDF ZSAO7IBA
EV 11/78)
APPLICATION FOR BUI DING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FTRACT
FOR APPLICANT TO FILL IN Q ADDRIESS
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NO OF BLDGS ASSESSOR
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STATISTICAL CLA$f/Q TIIQ�[J� SEWER MAP
ADDRESS I ' CLASS NO MF ELL UNITS BK PG
CITY P /e) - Z p �7
ENGINEER O S I �I Ol3lT,C' NO TEL 7 1 7 {..1 VALUATION $
ADDRESS A G BLDG SETBACK FROM
(� E h' ��/ FRONT PROP LINE OF IST REETI
CONTRACTOR'26M C Q I`(�ELNO �/ TOT BACK FROM OF ISTING
LIC
HIGHWAY + YARD F TPROP LINE HIGHWAY WIDTH
ADDRESS NO O
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CITY IC CLASS
CONSTRUCTION LEDER SIDE PROP LINE OF (STREET)
/_ BLDG SETBACK FROM
NAME AND BRANCH A. T A,
_ HIGHWAY + YARD = TOTAL SETBACK FROM TYREOF FX15TING
ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH O
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50 FT VMOF CHK
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INO OF
SIZE STORIES ESO - d
ONE Q
USE ZONE MAP
DESCRIPTION OF WORK WNEW NO
OSPKIAL
� ADDCONDITIONS
2-/ NlD ALTER DATE L4- /,g-0611 BY CE
l.(CYG. REPAIR L�—_`•—•�/,
USE OF DEMOL
EXISTING BLDG _ _
APPLICANT TEL e /�/J��, €2 7 5 4 A
IPRINTI O Y Z A t
BV ISIGNATUREI R "Re o 1 zicy— E1 - > + e e � 6.40
IHEKBY ACKNOWLEDGE THAT I HAVE READ THIS APRICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE
LABOR
ATON ICOODE OFTHE
STATE OF CALIFORNIA IN RELATING TO WORKMEN 5 COMPENS _ I023-80
SIGNATURE OF p
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PERMITTEE y
ADDRESS ' 2 r Ow0 ✓ # o • e
TEL "nV2 . 464 50
CIN NO <
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ee e e 464503
PC F
i Permit Fee ,C�C/ >
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