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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 �/q , 1