Documenting Removal Or Loss Of Dwelling Units Form - San Francisco - Department Of Building Inspection

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City and County of San Francisco
Edwin M. Lee, Mayor
Department of Building Inspection
Tom C. Hui, S.E., C.B.O., Director
DOCUMENTING REMOVAL OR LOSS OF DWELLING UNITS
DATE SUBMITTED
1. PURPOSE:
This is a dwelling unit removal checklist for building permit applications connected to
buildings with 3 or more legal dwelling units (R-2 occupancy). Should any of the following occur in the
building, the permit may not be reviewed over-the-counter and shall be referred to the Planning
Department to be processed as a mandatory Discretionary Review (DR):
a. The work will result in the removal or loss of a dwelling unit: legal, illegal or of unknown status.
b. The work will result in the permanent displacement of any tenant from their dwelling unit: legal,
illegal or of unknown status.
2.
Complaint/Notice of Violation #
(connected to illegal dwelling unit)
3.
Permit Application #
4.
Property Address:
5.
Block/Lot: _____/____ Occupancy Group: ______ Construction type: _____ Stories:
6.
Sprinkler (check one): Full system
No sprinklers _____ Partial system _____
7.
Total number of existing dwelling Units (DU):
a. Number of legal DU: _____ b. Number of illegal DU: _____
8.
Number of DU proposed to be removed: Legal _____ Illegal _____
9.
Will any of the removed units displace existing tenant(s): Yes ____ No ____
a. If yes, number of tenants that will be displaced:
10. Are any of the illegal DU occupied: Yes
No
a. If yes, which illegal units are occupied:
b. #
#
#
#
#
#
I hereby declare that the information provided is accurate to the best of my knowledge.
Print name:
Title:
__________
Address:
____
Phone:
___________________________________________________
Signature:
Date:
____
Technical Services Division
1660 Mission Street – San Francisco CA 94103
Office (415) 558-6205 – FAX (415) 558-6401 –

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