HomeMy Public PortalAbout5329 ZADELL AVE_Building_2/11/1975_ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING ® BUILDING
ADDRESS fl a ADDRESS
CITY ZIP
NO.OFBLDGS., ® LOCALITY
SIZE OF LOT •fjj S ° NOW ON LOT NEAREST
CROSS ST. Q�hJL
ASSESSOR
TRACT��, �' BLOCK LOT NO �m� MAP BOOK. PAGE I PARCEL
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-� TEL..• DISTRICT GROUP TYPE FIRE ESS ED BY
OWNER a%• )ea VP�IN erg NO. "�' CONST. ZON
�•OCSp Z .
ADDRESS
STATISTICAL CLASSIFICATION EWER NIAP
CITY CA, ZIP r'
CLASS NO _DWELL,UNITS BK .d PG
ARCHITECT OR TEL. '
ENGINEER NO. USE ZONE MAPD J�
NO.
ADDRESS �� SPECIAL
E . CONDI TI ONS
CONTRACTOR 69wi6e, NOL ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
ADDRESS LIC.+91JC: NO. BLDG.SETBACK FROM
LIC, FRONT PROP.LINE OF (STREET)
CITY �, 'CLASS
HIGHWAY t YARD TOTAL SETBACK FROM TYPE OF EXISTING '
CONSTRUCTION LENDER
NAME AND BRANCH FRONT PROP. LINE HIGHWAY WIDTH
ADDRESS CITY t
SIZE T STORIES f FAMINO. OF NO. OLI F/ CHECK
SIDE GPROP.LINE OF.SETBACK M (STREET) v
r� NEW ❑ HIGHWAY t YARD = TOTAL SETBACK FROM TYPE OF EXISTING 0
DESCRIPTION OF WORK Lp 1J'I�fa."� SIDE PROP. LINE HIGHWAY WIDTH V
11� � L ADD ❑
TJO'Y',�1Cuie _.2 LTER ❑ t
j Z
/ � EPAIR� CORNER CUTOFF. YES ❑ NO ❑
SE OF
EXISTING.BLDG.&&`ue - EMOL ❑ IN OPEN SPACE YES ❑ NO ❑
APPLICANT TEL �j �f YES IN COASTAL ZONE NO
(PRINT) IJ ❑ .❑
CATEGORICAL EXEMPTION YES❑ 'NO ❑
BY (SIGNATURE) ��> P6 ENVIRONMENTAL
IMPACT EXEMPTION DECLARATION SIGNED (DATE)
VALUATION %OJT n IMPACT REPORT PROCESSED (DATE)
I HEREBY ACKNOWLEDGE 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-
5TRUCTION. I .CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY i WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF -CALIFORNIA IN RELATING TO
WORKMEN'S COMPENS N INSURANCE.
SIGNATURE OF FINAL BY
PERMITTEE DATE,"_ C
ADDRESS 09 At 120004% d ? i
P.C. Q �• PMT.Q
_ FEE. P FEE P
Y /� r7 �
TEL
CIT
NO. w
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. _M.O: CASH
? 6 4 k ;� 11 1 D 9.Q
7BA638B CE0803A 5/73 -