HomeMy Public PortalAbout5329 ZADELL AVE_Building_4/30/1975_ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only) Jr
BUILDING p ADDRESS ��02 if✓(
BUILDING
ADDRESS7 /
CITY ZIP ,�'?r LOCALITY,• +? f✓/ '
NO.OF BLDGS. `
SIZE OF LOT 3a' f NOW ON LOT I NEAREST
CROSS ST.
TRACT/ BLOCK LOT NO+'V 2- ASSESSOR
MAP BOOK PAGE PARCEL
TEL. DISTRICT GROUP YPE FIRE P�ESSED BY
OWNER STQ/h/ NO. � - ONS ZONE /
ADDRESS S.� 9 ,b 1 L AAeS ^��
CITY /�®�E ZIP STATISTICAL CLASSIFICATION SEWER MAP
CLASS NO. 20 OWELL.UNITS 0j/BK/0 PG
ARCHITECT OR Jr TEL.
ENGINEER NO. U ZONE MAP
NO.
ADDRESS ./j SPECIAL
M 'iTEL. CONDITIONS
CONTRACTOR �7
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO 0-
ADDRESS J-3/jr J Afif�_LNO.
BLDG.SETBACK FROM
CITY 7,&/ ,Z_ ��� LIC..CSS FRONT PROP.LINE OF (STREET)..
LA (��� / TAL SETBACK FROM TYPE OF EXISTING
CONSTRUCTION LENDER HIGHWAY + YARD = HIGHWAY WIDTH
NAME AND BRANCH �/,�//�/��
FRONT PROP. LINE
ADDRESS CITY 1, + C�
SQ. FT. NO. OF NO. OF CHECK BLDG.SETBACK FROM �-
SIZE STORIES FAMILIES ONE SIDE PROP.LINE OF ISTREET) v
/ i _ TOTAL SETBACK FROM -TYPE OF EXISTING CC
DESCRIPTION OF WORK s �� NEW HIGHWAY + YARD - SIDE PROP. LINE HIGHWAY WIDTH C7
V
1,00"/ ISH �N ADD ❑ + _ d
y A ; r3't ALTER ❑
.Loco GvpG��TWL+•V'C2.n+ REPAIR❑ CORNER CUTOFF YES ❑ NOUSE OF
❑ Z
EXISTING BLDG. I EMOL ❑ IN OPEN SPACE YES ❑ NO. ❑
APPLICANT TEL.
(PRINT) NO. IN COASTAL ZONE YES ❑ NO ❑
BY (SIGNATURE) ENVIRONMENTAL CATEGORICAL EXEMPTION YES❑ NO ❑
IMPACT EXEMPTION DECLARATION SIGNED (DATE)
VALUATION v f IMPACY REPORT•PROCESSED (DATE)
I HEREBY ACKNOWLEOGE THAT i HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- _
STRUCTION. I CERTIFY THAT IN OI NG THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANYPPERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN'S COMPENS ION INSURANCE. .
SIGNATURE OF FINAL BY l)
PERMITTEE .. DATE .. �'��
ADDRESS P.C. ¢ PMT•C
FEE it FEE �P ,I 2-
TEL.�q$ /
CITY < NO. EE '
PLAN C ECS VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. . M.O. CASH
9 4 V'A .R :50 1 0 12.00 Ass
78AS38B CERS03A 5/73 - - -- _