HomeMy Public PortalAbout9967 LA ROSA DR_Building__ APPLICATION FOR BUILDING PERMIT
FOR 'APPLICANT TO FILL IN (P.i F, PI IYP. on lY)
BUILDING /A. J BUILDING t'
ADDRESS 'o �• AODR ESS
CITY _ - IT ZIP- '
NO.OF BLDGS. LOCALITY
;SIZE OF LOT llak 77NOW ON LOT L NEAREST /
CROSS ST.'
TRACT BLOCK LOT NO ASSESSOR ' '
MAP BOOK PAGE PARCEL.
TEL-. DISTRICT GROUP YPE FIRE PRO SSED BY
OWNER NO. 3 - ONST. ZON 'T
ADDRESS _
STATISTICAL CLASSIFICATION-" SEWER MAP
CITY ZIP
CLASS NO,�LIC-DWELL.UNITS BK PG.
ARCHITECT OR TEL.
ENGINEER NO. US ZONE MAP
NO. . Ci
ADDRESS - - '�. SPECIAL
TEL. - CONDITIONS
CONTRACTOR NO ROAD DEPARTMENT APPROVAL REQUIRED YES❑ .NO'❑
LIC.
ADDRESS NO. BLDG.SETBACK FROM -
CITY LIC' FRONT PROP.LINE OF IST FEET)
CLASS
CONSTRUCTION LENDER +.. - HIGHWAY } YARD o TOTAL SETBACK FROM TYPE OF EXIIN
FRONT PROP. LINE HIGHWAY WISTDTHG
NAME AND BRANCH
ADDRESS CITY + 0
d
Sq. FT. NO. OF ( NO. OF CHECK BLDG.SETBACK FROM GOj
SIZE STORIES FAMILIES - ONE SIDEPROP. L INEOF —" ' ISTREETI,
[r
_
NEW HIGHWAY } YARD- = TOTAL SETBACK FROM TYPE OF E%ISiING O
DE C
PT,
OF WORK Ate- Z• SIDE PROP. LINE HIGHWAY WIDTH
CZ,
W
�d` • ADD ❑ .+ o �?_. z;I �-
b� JALTER ElEPAIR❑ CORNER CUTOFF YES ❑. NO ❑ - Z
USE OF
EXISTING BLDG. f EMOL ❑ IN OPEN SPACE- F. - -YES ❑ NO ❑.-
APPLICANr�]� TEL IN COASTAL ZONE YES E] NO ❑
T
(PRINT) p ND. 4'`
CATEGORICAL EXEMPTION YES❑ NO ❑.
BY ISIGNA TUR EI � ENVIRONMENTAL -
IMPACT ! EXEMPTION DECLARATION SIGNED (DATE)
VALUATION IM PACT' REPORT PROCESSED E "� (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-
STRUCTION, I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE TE OF CALIFORNIA IN PELAFft T -
WORKMEN'S COMPE TIO INSURANCE. -
OF INAL - BY
SIGNATURE
Q - - - • -
PERMITTEE DATE ✓!.��i �� /, � T -
ADORESS P.C. $ - PMT.Q
FEEFEE Y
TEL.
CITY - NO.
PLAN CHECK VALIDATION GK. M.O. C.SH PERMIT VALIDATION GK. M O. LSH
8 5 6irit'r'R u8 7, D. 9.0.0
.76A638B CE9003A 5/73