HomeMy Public PortalAbout5817 CAMELLIA AVE_Certificate of Occupancy__ 75A&2-CERB2 11 n6
APPLICATION FOR OCCUPANCY INSPECTION
f COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION S,01 T
FADDRIEISS
FOR APPLICANT TO FILL IN BUILDING(Print or type only) ADDRESSNGL �CAM CL
NEAREST
CITY t Cc ZIP CROSS ST.
SEE 0F LOT NO.OF BLDG S. ASS
ESSOR
NOW ON LOT MAP BOOK AGE PARCEL
TYPEFIRE S Y
TRACT (v S BLOCK LOT NQS` rj 08 CO ZONJ
OWNERI O.
NO. NO. .z a
ADDRESSX15 ` L[ /�- 3 SPECIAL
CONDnlON3
CITYL c-- C `r- ZIP BLDG.SET BACK FROM
SIZE OF NO.OF / FRONT PROP.LINE OF (STREE
EXISTING BLDG. STORIES J TOTAL SET BACK FROM TYPE OF EXISTING
PRESENT USE OF BUILDING
HH3HWAY + YARD - FRONT PROP.LINE HIGHWAY WIDTH
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+ a
C' _ O
C
BLDG.SET BACK FROM V
NO.PARKING SIDE PROP.LINE OF (STREET) Z
SPACES PROVIDED O
HIGHWAY + YARD� TOTAL DET BACK FROM TYPE
SIDE PROP.LINE HIGHWAY
WDTHY WIDTH
REASON FOR INSPECTION REQUESTL� + d
N
CORNER CUTOFF YES NO Z
OCCUPANCY GROUP L OCCUPANT
P K AS VERIFIED LOAD
NV50 LF-4-'h C EXIT HARDWARE:
PROPOSED OCC. NO.OF E70TS NO SPEC-KNOWI- ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS PANIC DEVICES ❑
APPLICATION AND STATE THAT THE ABOVE IS COP,
RECT. PARKING .
SPACES ED
PROVID
SIGNATURE O
APPLICANT r-o —RN—AL
DATE �
ADDRESS C WIC/ S
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APPLICATION VALIDATION cx M.a CASH
4 1 4 rDNOV 23 2 2 0 3 0.0 0 n�