HomeMy Public PortalAbout5116 C & D SERENO DR_Building__ APPLICATION FOR
BUILDING PERMIT
FOR APPLICANT TO FILL IN All'.Ess J
BUILDING - -
ADDRESS 6r C � LOCALITY
OTV NEAREST C
�`g 4r C ZIP 7 O CROSSST `J
NO OF BLDGS ASSESSOR
SIZE OF LOT NOW ON LOT MAPBOOK PAGE PARCEL
rDISTRICT GROUP TYPE FIRE ESSED IY
TRACT - BLOCK LOT NO d CON �LWL�Q
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OWNER '*RRiE t,pF+91�BNo2873957
STATISTICAL CLASSIFICATION / SEWER MAP
ADDRESS O 7 U CLASS NO 4n 7_ DWELL UNITS BK PG
OTV �G7A1 LLr ZIP p 115E ZONE P AFL U I
ARCHITECT OR TEL 2 SPECIAL`
ENGINEER NO CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
TEL _
CONTRACTOR NO BLDG SETBACKFROM
LIC FRONT PROP LINE OF (STREET)
ADDRESS NO TOTAL SETBACK FROM TYPE OF EXISTING
LIC HIGHWAY + YARD FRONT PROP UNE HIGHWAY WIDTH
CITY CLASS -
CONSTRIICTION LENDER + i
NAME AND BRANCH - O
BLDG SETBACK FROM V
AD DR CITY SIDEPROP LINEOF ISTREETI O
50 FT NO OF NO OF CHKK HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING [j
SIZE TORIES FAMI LI ESL ONE SIDE PROP LINE HIGH WAV WIDTH a
ti
+ Z
DESCRIP ION OF WORK NEW
L E ADD ❑ CORNERCUTOFF VES ❑ NO ❑
ALTER IN OPEN SPACE YES ❑ NO ❑
REPAIR
EXISTSE TIING BLDG S/AJ6-1,!e :,74," DEMOL IN COASTAL PERMIT ZONE YES ❑ NO ❑
APPIPRINTT e LL 7 87 0 7� OYT3LE valx7f
BV(SIGN Prs-rLTT-T/,o -s
/I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUAND SLATE
THAT THE ABOVE IS CORRECT AND AGUE
LLKREE TO COMPLY ALL ORDINANCES
ANE) REGATING BUILDING CONSTRUCTION I CE THAT IN DOING THE
WORT(AUTHORIZED HEREBY I WILL NOT EAWLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM
PENSATION INSURANCE
SIGNATURE OF ` � FINAL BY
PERMITTEE ///lll DATE
1 �
TEL P C Fee S d Z. S Permit Fee
CITY NO
Q Issuance Fee
VALUATION$ --' �O
TDTaI Fee '441F
PLAN CHECK VALIDATION CLL Mo CASH PEQAUT VALIDATION r o C"H
-386i`JUL 5239 102.15
588�SEP 223 D 106.43e' e 589�SEP 2 1 D 347.63 !08
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