HomeMy Public PortalAbout10792 BLACKLEY ST_Certificate of Occupancy__ APPLICATION 'FOR CUPANC INSPECTION,...' .
FOR APPLICANT TO FILL IN (Pint or'type only) COUNTY OF LOS ANGELES-'•,
DEPARTMENT OF COUNTY ENGINEER
BUILDING .� ,.y r BUILDING AND SAFETY DIVISION '
ADDRESS BUILDING _
CITY ,v - - IP ADDRESS
SIZE OF LOT NO. OF BLDGS. LOCALITY _
A NOW ON LOT r ,
NEAREST 7t
.TRACT /3�/� � BLOCK LOT NO.-5— CROSS ST.
ASSESSOR
TEL.- MAP•BOOK PAGE PARCEL
OWNER �, NO." DISTRICT TYPE FIRE PROCES ED BY
ADDRESS
CONST////J�JJ''''
r 't(� � +
,CITY - ZIP,
USE'ZONE MAP r�
'SIZE OF N0. OF '
EXISTING BL G. STORIES SPECIAL
CONDITIONS
PRESENT'USE 0 UILDING - BLDG. SETBACK FROM %
FRONT PROP. LINE OF (STREET) '
' - TOTAL SETBACK FROM TYPE OF EXISTIN
HIGHWAY t YARD = FRONT PROP. LINE HIGHWAY WIDTH
NO. PARKING _
SPACES PROEO - _
+
' - BLDG. SETBACK FROM �' '�C�C� V
REASON FOR INSPECTION RE SIDE PROP. LINE OF �F'L (STREET)
.HIGHWAY t YARD = TOTAL SETBACK FROM TYPE OF XISTIN Q
SIDE PROP, LINE HIGHWAY WIDTH
+ �(1 = a
CORNER-CUTOFF YES NO H
• - Z
PROPOSED MAX. OCC. OCCUPANCY GROUP �y�
AS VERIFIED ' / OCCUPANT
I HEREBY-ACKNOWLEDGE THAT I HAVE READ THIS .J� LOAD
APPLICATION AND STATE,THAT THE ABOVE IS-COR- EXIT HARDWARE:
R ECT. - - -'
N0, OF EXITS NO SPEC. KNOWL. El
SIGNATURE OF PANIC DEVICES ❑-'
APPLICANT `�L�'-� -�'TnGs•y ' .
e PARKING
ADDRESS SPACES REQ'D� PROVIDED
Cji3� �'` �' -'. � -
-s
ZIP.
7
jJ y /,J :PHONE
AIA KE CHECKS PAYABLE TO''
HARVEY T. BRANDT COUNTY ENGINEER eY
DATE ® " 2�1���' �//'J Jlrrl�.i$^�✓
APPLICATION VALIDATIO CK. M.O. CASH•
1 8 7�il tj 19 2=2 1) 1 8.0 CU
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76A662-CE992 12-73 - w