HomeMy Public PortalAbout5344 MCCULLOCH AVE_Building__ �,., •APPLICATION' FOR BUILDING PER .�
tFOR APPLICANT TO FILL-IN (Print or type only)
PODRESS
OS ANOMES
4 . �''�C.. C v �1 o ve• DEPARTMENT OF COUNTY ENGINEER
ASSESSOR
BUILDING AND AFETY DIVISION
Intl ,e` � ZIP cb,11 0
�) NO.OF SLOGS. BUILDING r
r i NOW ON LOT ADDRESS �� trr
BLOCK LOT NO. LOCALITY C I
TEL �, 1� NEAREST
�I,y11?(j g�t"/ NO. '441-43-05 GROSS ST. � 'r
44. Cull-061. I MAP BOOK PAGE PARCEL
j ` DISTRICT GROUP TYPE FIRE PR SSED BY
CITY��• fvt� 1e � ` ZIP . -R �i7• ',v f CONST ZO E
ARCHITECT OR TEL. (/I rr—
ENGINEER NO. /
STATISTICAL CLASSIFICATION. EWER MAP
ADDRESS
CLASS NO. DWELL,UNITS BK G
TEL.
CONTRACTOR NO USE ZONE[MMN
AakP
. LIC.. -ADDRESS Pkv {�I�Q�iC: NO• PECIALCITY LIC. ONDITIONS
r CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONSTRUCTION LENDER
NAME AND BRANCH . BLDG.SETBACK FROM F
FRONT PROP.LINE OF (STREET) C
ADDRESS-2(pa CITY _ TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY `�• YARD - C
SQ. FT t ) NO OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH [
SIZE �4 X��� STORIES FAMILIES ' ONE
DESCRIPTION OF WORK' I NEW 11 + 6
ADD BLDG,SETBACK FROM
SIDE PROP,LINE OF (STREET)
ALTER ❑ HIGHWAY' + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH
USE OF + _ .
EXISTING BLDG. �Q��t��� DEMOL ❑
APPLICANT'��`I `f TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) YV YJ1tioaI CI►7.N• N0. W41-Laos
BY (SIGNATURE)
IW OPEN SPACE YES ❑ NO ❑
'
A , IN COASTAL ZONE YES ❑' NO ❑
VALUATION$ _ 1 CATEGORICAL EXEMPTION YES❑ \NO ❑
I HEREBY ACK WLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED IDATE)
WITH -ALL ORDINANCES AND LAWS REGULATING BUILDING'CON-
STRUCTION. I CERTIFY THAT IN DOING 'THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY TWILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OFTHE ATE OF. CALIFORNIA IN RELATING TO / t�
WORKMEN'S COMPEN N/INSURANCE. !l� "lei I�/ � .5/�f� ��/ •� �%,I r�/ tLr.'�t_*'A-l•
SIGNATURE OF So_ ®f
PERMITTEE 7/r
ADDRESS t� v
•�® _ /'/�`` FINAL y BY
:TECITY '�y' NOL•TY�� DATE 1
® r
MA KF CHECKS -1AYABLE to: P.C. V. PMT
FEE I
HARVEY T. 'BRANDT, COUNTY-ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION K. M.O. CASH
q.4
7BA538A CE#a03 7/73 -�
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