HomeMy Public PortalAbout5598-5600 MCCULLOCH AVE_Building_5/13/1975_ � �• - Com'
APPLICATI N FOR B LDING PERMIT .�tJ71
FOR APPLICANT TO FILL IN (Print or type Only) 1 I
BUILDING �� y,, / f BUILDING L.1
ADDRESS?�U L�" M,/ + L/f-L (,166 ADDRESS J� .�;.� , 1
CITY Jyf !/ ZIP O L�
LOCALITY r�r �/-�
r NO.OF BLDGS.
� NEAREST
SIZE OF LOT Qx1! SNOW ON LOT /�� CROSS ST. I�
� �c;23ASSESSOR r
TRA T LOT NO MAP BOOK PAGE PARCEL
TELs`, DISTRICT GROUP TYPE FIRE PROCESSED BY
OWNER 4' ,v l „NO.�7 j �] CONST. ZONE
/� J L
ADDRESS /(� Ll Y
/f` _ T / STATISTICAL CLASSIFICATION SEWER MAP
CITY j�fn ^fir / ZIP ! sy CLASS NO. _DWELL.UNIT j� BK PG
NGINEER ��1I 0G
ARCHITECTe�R or, tN
, OL ��I /UJ USE ZONE NOP tJ�
E
ADDRESS440 / --1 SPECIAL
TEL. 1 CONDITIONS
CONTRACTOR NO
LIC. ROAD DEPARTMENT APPROVAL REQUIRED YES E] NO
ADDRESS NO. BLDG.SETBACK FROM
CITY LIC. FRONT PROP.LINE OF TREET)
CLASS
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
CONSTRUCTION LENDER
NAME AND BRANCH FRONT PROP. LINE HIGHWAY WIDTH
r /
ADDRESS CITY + `S %„7 moi•# VQ }
SQ. FTS � NO. OF y NO. OF CHECK BLDG,SETBACK FROM CD
SIZE?aSTORIES FAMILIES ONE SIDE PROP.LINE OF (STREET) v
—;77Op /j C3fiC _ TOTAL SETBACK FROM TYPE'OF EXISTING m
ES'CRIPTION OF W R NEW HIGHWAY + YARD CD
SIDE PROP. LINE HIGHWAY WIDTH
ADD ❑ _ v
+ — Lu
ALTER ❑ CIO
G.
EPAIR❑
CORNER CUTOFF YES ❑ NO ❑ Z
- � -
USE OF
EXIEXISTITI
NG BLDG,' EMOL El OPEN SPACE. YES El NO ❑
AP(PRIN)N . ,0A &;7. IN COASTAL ZONE YES ❑ NO ❑
1 CATEGORICAL EXEMPTION YES❑ NO ❑
BY (SIGNATURE) ENVIRONMENTAL -
• IMPACT EXEMPTION DECLARATION SIGNED (DATE)
VALUATION �/ (pV V! 19O IMPACT REPORT PROCESSED (DATE)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY �+v, �• ` '� 4••��_l � �1� q� y �
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCT.ION. 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 TION INSURANCE.
SIGNATURE OF FINAL �7 BY
PERMITTEE DATEege
ADDRESS P.C. $ PMT.
a FEE V e FEE
TEL.
CITY NO.
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. JM.O. CASH
9 4 2 3 D 13 1.4
12 8 P MAY - 13 1 D_ 2 1 9.0 0 a�b
78,453813 CE9803A 5/73 •� T ..