HomeMy Public PortalAbout6439 TEMPLE CITY BLVD_Building__ APPLICATION FOR- BUILDING PERMIT
FOR APPLICANT TO FILL IN (P,.m or TYPR Gniv)
FA=E'SS ,3 B(YD COUNTY OF LOS ANGELDEPARTMENT OF COUNTY ENGINEER
12 PLE C rY zip 9 / 7 � , BURRING AND SAFETY DIVISION
1 /NO OF SLOGS BUILDING
OF LOT /O X f6 NOW ON LOT 3 ADDRESS pl7 (T AID a BLOCK ✓ NEAREST
(��L�OT NO LOCALITY C
OWNER S'f NLB/ * L01TE Stt/J-4+OLA/A -Ir 7N CROSS ST
ASSSOR
ADDRESS 104iE Al LE C/ Y /414✓A MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE P SSED BY
CITY 76- PL,e C I r r zip 9l 7 P� CONST Z -
ARCHITECT OR TEL i D
ENGINEER NO
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO -DWELL UNITS BK PG
CONTRACTOR S �' L, TE'40L ONE MAP
LIC NO
ADDRESS NOL SPCIAL
CITY LIC CONDITIONS S
CLASS RO DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH BL G SETBACK FROM
ADDRESS CITY FR NTPROP LINEOF (STREET)
SQ FT NO-OF NO OF CHECK HIGH Y } YARD = TOTAL SETBACK FROM NG WAY EOF ICWIDTHG
FRONT PROP LINE
SIZE O STORIES / FAMILIES ONE
DESCRIPTION OF WORK EW ❑ O
BLDG SETBACK FR CJ
SDCOOM 3 DO SIDEPROP LINEOF (STREET) ¢
T J LTER = TOTA 5 TB TVP! OF EXISTING -
O
HIGHWAY } YARD
REPAIR SIDE PROP!VI Y WIDTH ly
CL
USE OF } = y
EXISTING BLDG S ENOL I
APPLICANT L SrE� TEL4ys 77/ CORNER CUTOFF YES NO ❑
IPRI NT) /1NO l O
BY (SIGNATURE) \' IN OPEN SPACE YES El NO ❑
V IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION IN
�K
1 HEREBY ACKNOW OGE THAT I HAVE READ THIS APPLICATION PAS .S
AND STAT[ THAT THE ABOVE I! CORRECT AND AGREE TO COMPLY A r n
WITH ALL ORDINANCES AND LAW! REGULATING BUILDING CON-
STAUCTION I CERTIFY THAT IN DOING THE WORK AUTHORISED
N[Rl BT I WILL NOt EMPLOY ANY PERSON IM VIOLATION Of TM[
LABOR CODE OF THE !T(,TE OF CALIFORNIA IN RELATING TD
WORKMEN'S COMPENSAT IOM INSUR C[�
SIGNATURE OF
PERMITTEE
ADDRESS TOLI C �F V
TF
NAL
CITYI
. SM fk4 CITY NOL .f-77/ DIATE /�6 - 7 BY `
,51A hE It
CHECKS PAlAHL6 /O P C Q PMT
FEE Y FEE
HARVEY T BRA NDT, COUNTY ENGINEER
PLAN CHECK VALIDATION CK H D CA AH No Pmm T VALIDA CK D CASH
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