HomeMy Public PortalAbout5021 AGNES AVE_Certificate of Occupancy_3/23/1976_tile roof APPLICATION FOR OCCUPANCY INSPECTION
FOR APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUIDRESS 2 LD' ,U 11 G BUILDING AND SAFETY DIVISION
BUILDING
CITY e,�l,,fLe C Ty ZIP ADDRESS a
SIZE OF LOTNO OF BLDGS LOCALITY
}( NOW ON LOT
NEAREST J
TRACT 9-/g / BLOCK LOT NO CROSS ST ,�JQQ.Q�O✓
ASSESSOR
OWNER ���/ �AV l TEL
' MAP BOOK DISTRICT TYPE AAGE ARC EL
FIRE pR CESS BY
NO
ADDRESS ;�/ //D � //J / f O Q, CONST,. / ZONE
CITYhZIP / USE ZONE NO
SIZE OF NO OF
EXISTING BLDG STORIES SPECIAL
CONDITIONS
PRESENT USE OF BUILDING BLDG SETBACK FROM
/ / FRONT PROP LINE OF (STREET)
/ c S SCJ N C S c,JLE ,q,y`YTOTAL SETBACK FROM TYPE OF ISTIN
NO PARKING
HIGHWAY } YARD = FRONT PROP LINE HIGHWAY WIDTH
SPACES PROVIDED
T BLDG SETBACK FROM
REASON FOR INSPECTION REQUEST SIDE PROP LINE OF (STREET) >.
HIGHWAY -F YARD = TOTAL SETBACK FROM TYPE OF XISTIN CD SIDE PROP LINE HIGHWAY WIDTH U
L
CORNER CUTOFF YES NO W
O..
C/)
Z
PROPOSED MAX OCC OCCUPANCY GROUP _
AS VERIFIED OCCUPANT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LOAD
APPLICATION AND STATE THAT THE ABOVE IS COR
RECT EXIT HARDWARE
NO }OF EXITS NO SPEC KNOWL ElSIGNATURE OF
PANIC DEVICES ❑
APPLICANT
ADDRESS D (J'
� PARKING REQ D PROVIDED
cl SPACES
3 -,,�l/�7/ CQv SS�i o
ZIPCL'
� X03 �,v N� ,¢G�CSS, �? 919,�i-�'-o✓
��-- 3 PHONE
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MAKE CHECKS PAYABLF TO
�RVEY T BRANDY COUNTY ENGINEER FINALBY
DATE 3- J -76
ARPLICATION VALIDATIONcK 0 CASH
a z 27 2 DOC
8 4�r�AR
76A662 CE992 8/75
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