HomeMy Public PortalAbout5619 CAMBURY AVE_Certificate of Occupancy__ APPLICATION FOR OCCUPANCY INSPECTION L�
FOR APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING BUILDING AND SAFETY DIVISION
ADORES C
oeol
BUILDING i
CITY `l, eX G ZIP I L� 91,
ADDRESS �/ / - ,t. . (f��" .
NO. OF SLOGS. LOCALITY
SIZE OF LOT
�S NOW ON LOT
/ NEAREST
TRACT J /J(� BLOCK - LOT N0. CROSS ST.
ASSESSOR
OWNER 7 N NOL MAP BOOK PAGE PARCEL
DISTRICT TYPEFIRE - P BY
KI
ADORES S,
/ CONST. ZONA
J'` w
CITY _� '1� , ZIP USE ZONE NMA OP
SIZE OF NO. OF
EXISTING BLDG. STORIES ��/ SPECIAL
CONDITIONS
PRESENT USE OF BUILDING BLO it SETBACK FROM
FR IIT PROP. LINE OF (STREET)
TOTAL SETBACK FROM TYPE OF EXISTIN
H GHWAV + YARD = FRONT PROP. LINE HIGHWAY WIDTH
NO. PARKING
SPACES PROVIDED
O
U
BLDG, SETBACK FROM �
REASON FOR INSPECTION REQUEST SIDE. PROP. LINE OF (STREET) p
HIGHWAY + YARD = TOTAL SETB CK LINE HIGiE AY WIDTH y
/ "S f N
+ = z
// CORNER CUTOFF YES NO
CA S
C_Z�o6 PROPO EO MAX. OCC. OCCUPANCY GROUP
CJ AS VERIFIED OCCUPANT ,
LOAD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS COR- ( EXIT HARDWARE:
R ECT,
N0. OF EXITS � NO SPEC. KNOWL. ❑
SIGNATURE OF PANIC DEVICES ❑
APPLICANT
PARKINGREQ'0 PROVIDED
ADDRESS , 3r � � SPACES •
ZIP j
)
PHONE )
SIA/:/i C"ECFS PAYABLE TO:
HARVEY "
ARVEY T. BRANDT. COUNTY ENGINEER FIIJAL �1
APPLI ATION VALIDATION CK. M.O. CASH
7 .1 6PFEB 15 2.2 1 8.0 0
76A662-CE992 3/73 I •' '