HomeMy Public PortalAbout5232 CAMELLIA AVE_Building__ APPLIC4TION FOR BUILD N PERMIT
FOR APPLICANT TO FILL IN (Print or tYP:'onIV) C [TY _ �Yn�u � y
BUILDING C OF OS ANG
ADDRESS71 t�u i Al DEPARTMENT OF COUNTY ENGINEER
CITY ZIP BUILDING AND SAFETY DIVISION
N .OF BLDGS. BUILDING
SIZE OF LOT p NOW ON LOT ADDRESS
TRACT/5(073 BLOCK LOT NOCAM L
.,� LOCALITY El .
TE / NEAREST,
.OWNER N / CROSS ST.
ASSESSOR
ADDRESS MAP BOOK PAGE PARCE
DISTRICT JGROUP TYPE FIRE P OC D.BY
CITY ZIP ,J/�d CONST ZO
ARCHITECT OR TEL �J C•�o
ENGINEER NO.
STATISTICAL CL��►►ASCLASSIFICATIONWE/R(y�J(�.P -
ADDRESS Y41) CLASS NO. l DWELL.UNITS BK `� PG
plsd � .
CONTRACTOR I rl Q, LIS ZONE O. -
ADDRESS
LIC.
�
NO. / SPECIAL
CITY LIC. CONDITIONS
_ tfhC LAS'S ROAD DEPARTMENT APPROVAL REQUIRED YES[_ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG.SETBACK FROM
FRONT PROP.LINE OF (STREET)' S
ADDRESS CITY
SQ. FT. - NO. OF NO. OF CHECK HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING
SIZE STORIES FAMILIES ONE FRONT PROP. LINE HIGHWAY WIDTH
DESCRIPTION OF WORK - NEW
BLDG,SETBACK FROM
DD
SIDE PROP.LINE OF (STREET)
ITER HIGHWAY } YARU = TOTAL SETBACK FROM TYPE OF EXISTING
EPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH
USE OF ` t _
EXISTING BLDG, C JEMOL ❑
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
NO.
TUBE) PEN SPACE w YES ❑ NO ❑
t ! IN COASTAL ZONE. YES NO ❑
VALUATION i' CATEGORICAL EXEMPTION YES❑ NO ❑
IHEREBY ACKNOWLEDSE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO,COMFLY IMPACT EXEMPTION DECLARATION 3I6NED (DATE)
WITHALL ORDINANCES AND LAWS REGULATING IlUILDINS CON-
STRUCTION. I CERTIFY THAT IN DOINGTHE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL HOT E ER40N IN VIOLATION OF THE
LABOR CODE OF T STATE OF C RNIA IN RELATING TO
RK RATION IN URANCE.
PER TURE OF
ADDRESS
�5125A
T . FINAL
TEL ! w BY of 0 1
CITY NO. DATE S / -
220
MAKE CHECKS PAYABLE TO: FEE TFEV O
HARVEY T. BRANDT. COUNTY ENGINEER G
o
PLAN CHECK VAlJDATION C M.O. CASH PERMIT VALIDATION CK.0 fi 2c5- QAOH
76A 6D B,A CE0803 7/73
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