HomeMy Public PortalAbout4816TEMPLE CITY BLVD_Certificate of Occupancy APPLICATION FOR OCCUPANCY INSPECTION
FOR APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING BUILDING AND SAFETY DIVISION
AOORESS
BUILDING
CITY p ZIP ADDRESS
SIZE OF LO •^ BR X• NO OF�BLDGS LOCAL TV
NOW ON LOT
N E4REST
TRACT BLOCK LOT NO CROSS ST
^ ASSESSOR
OWNERCV R. c', NOL MAP BOOK PAGE PARCEL
V DISTRICT TYPE ��//�+ FIRE PROCE SEO BY
ADDRESS 6 CONS FON t
CITY C ZIP USE(ZONE NO
�^
S1ZE OF PRoX. NO OF L
ZAV
EXISTING BLDG $TORIES / SPECIAL
CONDITIONS
PRESENT USE OF BUILDING C
L BLOC SETBACK FROM
FRONT PROP LINE OF (STREET)
TOTAL SETBACK FROM TYPE OF ISTIN
NO PARKING
HIGHWAY } YARD = FRONT PROP LINE HIGHWAY WIDTH
SPACES PROVIDED
} _
BLDG SETBACK FROM
REASON FOR INSPECTION REQUEST SIDE PROP LINE OF (STREET)
HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF XISTIN
510E PROP LINE IHIGHWAY WIDTH
CORNER CUTOFF YES NO
PROPOSED MAX OCC OCCUPANCY GROUP
AS VERIFIED OCCUPANT
1 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 ❑
SIGNATURE 0 - PANIC DEVICES ❑
APPLICANT
PARKING
ADDRESS SPACES REO D PROVIDED
17
ZIP 9""7,F0,
PHONE
/3 -a - a'
11AU CHECKS PAYABLE !0 '
HARVEY'T BRANDY COUNTY ENGINEER FINAL / BY
DATE L �-• IJ' ^J �
APPLICATION VALIDATION CK M D CASH
76A662-CE992 I64 Oi:gft iwrv, u
n3e A� .0 0 eDC
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