HomeMy Public PortalAbout6411 TEMPLE CITY BLVD_Relocation__ 76A639 CF 879 8 62 Y
APPLICATION FOR KELOCA ON BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION _
.lOi'IN A LJAMBIE, COUNTY ENGINEER NEAREST _ \
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
FOR APPLICANT TO FILL IN GIST NO GROUP TYPE SEWER MAP SSED BY
Q GO BK PO
BUOILD NEG 7 00 Ezz
ADDR �� • o ✓BE WATER NOT REQUIRED ❑ RECEIVED
CERTIFICATE
LOCALITY NO O NIGHWA STATE MAJOR SECOND LOCAL
PRESENT
ADDRE$G L�{Al�V EMI PSC USE ZONE SPECIAL
CO NOITION9
LOCALITY
OWNER j BUILDING YARD HWY STREET NAME EXIST
MAIL ww a� SETBACK WIDTH
ADDRESS b IECOA00 S7_ FRONT
CITY /7SD TEL
IY , a _ P L
HIDE
MOVING TEL L
CONTRACTOR NO99 L
''�11 DURETY DATE NEC D
ADDRES9 W VD GOND S ^ILen 6Y }
BUILDING TjRIES
CASH DATE RECD d
CONTRACTOR NDEPosrt S FI Len w
ADDRESS APPROVALS DATE INSPECTORS SIGNATURE =
PRESENT OUNDATION LOCATION 0
USE OF FORMS MATERIALS -7
BUILDING GM1QRAME FIRE STOPS
PROPOSED BRACING BOLTS yI
USE OF
BUILDING0 � URNACE LOCATION ?
GAS VENTS DUCTS
SO FT 1 NO OFATH INT
SIZE ROOMS
WALL ROOFLATH EXT
COVERING b COVERINRoeK
LEGAL l6RLIY LHOUSE NUMBER COR- �l
DESCRIPTION LOT NO RECT AND POSTED '� //
TRACT FINAL
/ NO OF BLDISTRICT ENGINEER
SIZE OF LOT X/ NOW ON LSURETY BOND
USE OF RELEASED
EXISTING BLDG I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
IHEREBY STATE HE INFOR�oAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
CORRECT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
SIGNATURE DF BUILDING CONSTRUCTIO I CERTIFY THAT IN DOING THEAUTHORIZEDEREBYILNOT EMPLOY ANY PERSON IN VI LA
ADDRESS TION OF THE LABOR O OFTHE STATE OF Cw LIF NIA R AT
IND TO WORKMEN5NSATION INSU RwNVALUATION S P CSIGNATURE OFIFEEPERMITTEE ....�
FEE 3�.r�zS AODRESS_2L -!y r AE" AC
VALIDATIONCK. D H, JOHN F LEWIS PRINCIPALST�1.1URAL ENGINEER
//� PERMIT VALIDATION( �) mo wH
/�i4Rc�Li �2 �ocr 1 2 s o 35.0 0 sed
2 8 o�oci 9 60 !>
D !> 3 52 5 A!�6