HomeMy Public PortalAbout6411 TEMPLE CITY BLVD_Building__ APPLICATION FOR BUILDING PERMIT
FOR PLICANT TO FILL IN (P,,.t Rr IYPS Rn1Y)
BUI LOINIG �� ��. a� �,� COUNTY OF LOS ANGELES
A RESS DEPARTMENT OF COUNTY ENGINEER
CITY ptP/.E zip BUILDING AND SAFETY DMSION
�/�� NO OF SLOGS BUILDING
SIZE OF LO/TJ/�(O�� NOW ON LOT �(/ AD ESS
TRACT �/ Y BLOCK L T NO r .,(LLJFO.CALITY 42
OWNER _ff�� No EST
^ O d�OSRSST
ASSESSOR
ADDRE ST • MAP BOOK PAGE PARCEL
'/ /�T DISTRIC GROUP TYPE FIRE PROCESSED BY
CITY /} ` �/Y/C ZIP //, V CONST Zp
ARCHITECT OR TEL
ENGINEER NO
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO DWELL UNITS PG
CONTRACTOR TEL USE ZONE MAP /.
LIC n �g NO V
ADDRESS NO /.[ SPECIAL
CITY LIC ( `• CONDITIONS
CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO
CONSTRUCTION LENDER
NAME AND BRANCH BLDG SETBACK FROM
ADDRESS CITY FRONT PROP LINED (STREET)
SO FT7/�( NO OF NO OF CHECK HIGHWAY } VARO = TOTAL SETBACK FROM NIP WAv E OF wIIpTTMG O
JbV FRONT PROP LINE V
512E STORIES / FAMILIES ONE
❑
DESCRIPTION OF WORN NEW }
ADD BLDG SETBACK FROM a
SIDEPROP LINEOF (STREET) Z
S �^ LTER HIGHWAY } YARD _ TOTAL SETBACK FROM TYPE OF EXISTING
EPAIR❑ SIDE PROP LINE HIGHWAY WIDTH
USE OF }
EXISTING BLDG DEMOL ❑
APPLICANT JAZED CORNER CUTOFF YES ❑ NO
(PRINT) Q3�BY (SIGNATURE) IN OPEN SPACE YES ❑ NOIN COASTAL ZONE YES ❑ NOVALUATIONS , CATEGORICAL fAlMPTION YES❑ NO ❑
1nEREDY ACFNDWLfOOC TXAT XAYE REAIPLICATIOM ENVIRONMENTAL
AND STATE THAT THC ADOYE IDCORRCCT ANE TO COMPLYIMPACT EXEMPTION DfCLARATION SIGNED IDATC)
WITn ALL OPD(MAMC[S AMD LAWS RECULAV ILD(M6 LONDT RUCTION I CERTIi MAT IM OOIM0THAUTHORIZED IMPACT REPORT PROCESSED (DAT!)
nEREDY WILL NOT OY AMY PERSON ITION 01 T [LA60R CODEDF ES ♦TEOCALIIORATIN 0WORKMEN D COMP N INSURANCESIGNATUPERMITTEEADDRESSy FINCITY A Q DATE /�/ r111AI ( HI [ IRS P11 1 H/ PC PFEE FEE $/�
HARVEY T BRANDY COUNTINEER
PLAN CHECK VALIDATION CK M o CASH PERMIT� VALIDATIO cK M o CASH
9 8 UDEC 2 1 u 1 2.0 0 •
76A658A CE PDO! 12/72 - -