HomeMy Public PortalAbout5822TEMPLE CITY BLVD_Certificate of Occupancy (2) 76A66271 n5 Y
APPLICATION FOR OCCUPANCY INSPECTION
COUNTY OF•LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING
(Print or type nly) ADDRESS �� 7, �� �_��►��,
FDDRES
LOCALITY
S �/ [� ZIP NEAREST
CROSS ST.
OF LOT NO.OF BLDGS. ASSESSORIII
NOW ON LOT MAP BOOK PAGE PARCEL
vp DISTRICT TYPE FIRE PROCESS
TRACT BLOCK LOT N0.Sdd CONST. ZONE
5r.
.5,001 1� 3
WNE P,
TEL. USE ZONE MAP /7
NO. c OO 7
DDR AG G' SPECIAL
c� CONDITIONS
CITY a ZIP / BLDG.SET BACK FROM
SIZE OF N0.OF FRONT PROP.LINE OF (STREET)
EXISTING BLDG. STORIES HIGHWAY + YARD =
TOTAL SET BACK FROM TYPE OF EXISTING
P ESENT USE OF BUILDING FRONT PROP.LINE HIGHWAY WIDTH /
+ _ r
C
BLDG.SET BACK FROM
N0.PARKIN SIDE PROP.LINE OF (STREET)
SPACES P ID
TOTAL SET BACK FROM TYPE OF EXISTING
HIGHWAY + YARD= SIDE PROP.LINE HIGHWAY WIDTH f
ON FOR INSPECTION REQUEST '� + = C
CORNER CUTOFF YES NO e
OCCUPANCY GROUP OCCUPANT
AS VERIFIED LOAD
EXIT HAD ARE:
PROPOSED MAX.OCC. NO.OF EXITS NO SPE .KNOWL.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS PANIC DEVICES ElAPPLICATION AND STATE THAT THE ABOVE IS COR- "
RECT. PARKING
SPACES RE&D PROVIDED
SIGNATURE OF BY
PLICANT FINAL i ��!
ADDRESS � DATE
AL
Within the scope of this inspection
the Building Official may approve OOF
minor corrections or alterations of
ZIP ¢ an existing structure involving work
PERMIT FEE
of a building, plumbing, mechanical
PHONE or electrical nature. ISSUANCE FEE
TOTAL FEE
5
APPLICATION VALIDATION— Co. ?* M.O. CASH
•tel 0 R .f V
-O o p b
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