HomeMy Public PortalAbout9468 BLACKLEY ST_Building__ APPLICATION FeOR
BUILDING PERMIT
BUILDING .
FOR APPLICANT TO FILL IN ADDRESS
BUILDING '
ADDRESS 7�0 8 �j _i G L F LOCALITY
NEAREST
CITY — ZIP J 4{d CROSS ST
NO OF BLDGS ASSESSOR
SIZE OF LOT f� �7- OW ON LOT MAP BOOK PAGE PARCEL
DISTRICT G$(Up TYPE J�T
TRACTBLOCK LOT NO � �.I CONS
TEL
OWNERIT K; NOZ �f6P�/S � STATISTICAL CLA IF AT10N SEWER
ADDRESS L C CLASS NO DWELL UNITS BK PG ,
CITY ZIP c4(7 � 1 U .Z NE �ND
P
ARCHITECT OR TEL CIAENGINEER dL(J �� NO NDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NOTEL
❑
CONTRACTOR CA111K! G Q NO BLD SETBACK FROM
LIC FROJT PROP LINE OF (STREET)
ADDRESS NO HIG AY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
LIC FRONT PROP LINE HIGHWAY WIDTH
CITY, CLASS
CONSTRUCTION LENDER + - a
NAME AND BRANCH - Z3(- BLDG SETS FROM U
SIDE PROP I (STREET)
ADDRESS CITY p
SQ FT NO OF NO OF CHECK HIGHWAY + YARD = FROM TYPE OF EXISTING U
SIZE .CJ STORIES FAMILIESONE DE PR P LI HWA� WIDTH
+ Z
z
DESCRIPTION OF WORK NEW 21
i �_ ADD ❑ CORNER CUTOFF YES ❑ NO ❑
ALTER ❑ IN OPEN SPACE YES ❑ NO ❑
REPAIR ❑ ❑� ❑
USE OF _ ❑ IN COASTAL PERMIT ZONE YES NO
EXISTING BL DEMdL
APPLICANT TEL X CO Y
(PRINT) -NO
415
BY(SIGNATURE) LAJ "I-f- '041/7,? "
I HEREBY A WLEDGE THAT I HAVE READ THIS A PLICATION AND STATE l 'f W r _$ A61102j
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION 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 COM; -
PENSATION INSURANCE -" - ^-• -• .. 'rte_
SIGNATURE OF t FINAL' d ' ^{ ' BY
PERMITTEE �,' DATE' ,���
ADDRESS r
TEL "i P,C Fee$ 1,1 ! 1,,,, Permit Fee Z'
CITY NO ,ta.t
Issuance Fee -
VALUATION
e T Total Fee
PLAN CHECK VALIDATIONi_ CK M o, }CASH _< ; ; PERMIT VALIDATION cK M o CASH
x Q0 -J4 ,,zo 1 D 4 2.0 Q ®Fd 4
is 76A638B CE d803B 6/76
r ^APPLICATION FOR
BUILDING PERM-ITBU ILDING -
FOR APPLICANT TO FILL IN, ADDRESS Q
BUILDING I ^
ADDRESS LOCALITY
1 NEAREST
CITY ZIP CROSS ST
'\ s NO OF BLDGS ASSESSOR
SIZE OF LOT rJ NOW ON LOT MAP BOOK ,PAGE PARCEL
/ // DISTRICT GROUP TYPE FIRE PR ESSED BY
TRACT 7 S BLOCK LOT NOS & O Q = CONST ZQ[lE
J TEL V �J
OWNER NO
(} STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS p evv
f CLASS NO DWELL UNITS BK PG
CITY ZIP' 2i „C/ �U1SE/Z/ppNE MAP d
ARCHIT OR TEL /G�
ENGINEER ' -NO SPECIAL
7a -CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
TEL
CONTRACTOR NO BLDG SETBACK FROM
LIC `FRONT PROP LINE OF ISTREETI ,
ADDRESS `'NO ' TOTAL SETBACK FROM TYPE OF 1 EXISTING
:HIGHWAY + YARD
LIC r,'.p k, FRONT PROP LINE HIGHWAY WIDTH
CITY y j w CLASS,
CONSTRUCTION LENDER + a
NAME AND BRANCH BLDG SETBACK FROM _
ADDRESS CITY SIDE PROP LINE OF (STREET) _ O
SQ FT NO OF NO OF CHECK HIGHWAY + YARD = T L SETBACK FROM' TYPE OF EXISTING U
SIZE STORIES FAMILIES ONE DE PROP LINE HIGHWAYWIDTH
DESCRIPTI N OF WORK NEW -
.� ADD ❑ CORNER CUTOFF YES ❑ NO ❑
_ ALTER ElIN OPEN SPACE YES ❑ NO ❑
REPAIR ❑
USEOF, BLDG DEMOL ❑ IN COASTAL PERM( NE YES ❑ NOEXISTIN ❑
APPLICANT i TEL
IPRINTI 115
NO .7
BY(SIGNATURE) -
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE `
THAT THE ABOVE ISCORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION ICERTIFY 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 L
WORKMEN S COM
PENSATION INSURANCE
SIGNATURE OF r FINAL BY D�LIQF�C�
PERMITTEE DATE (� }
, 94fC
ADDRESS t
TEL �,� PC Fee$ Permit Fee •/a
CITY - NO
QIssuance Fee
VALUATION $ 7&-0 -
r � a' oral Fee
PLAN CHECK VALIDATION CK M o CASH L PERMIT VALID T ACK - M o CASH
EP 12 1 D
®S-76A63813CE 88038 6/76