HomeMy Public PortalAbout4853 CLOVERLY AVE_Certificate of Occupancy__ APPLICAT N FO OCCUP WCY INSPECTION
FOR APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDINGADORE BUILDING
^ qy BUILDING AND SAFETY'DIVISION
SS� BUILDING
CITY nQ�-s. ZIP qVW&O ADORES
NO SIZE OF LOT � „ Ql� NOWOONBOTS t LOCALITY
v NEAREST
TRACT V^ I.dS''y BLOCK LOT NO 77
CROSS S
ASSESSOR"
OWNER TEL MAP BOOK PAGE PARCEL
pL'LW\l NO DISTRICT TYPE FIRE LOCESSE BY1
ADDRESS L'QJ6'� e�AV� �y �� /`O CONST �, ZONE _
CITY" CAL4%r ZIP g1CjG� USE ZONE MAP''/VJ�
E OF G.►i NO OF O \ 1 NO
EX TING BLDG STORIES PECIAL
CONDITIONS
PRIES USE OF BUILDING
BLDG SETBACK FROM
FRONT PROP LINE OF (STREET)
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTIN
NO PARKI /
FRONT PROP LINE HIGHWAY WIDTH
N �
SPAC PROVIGDED + _
O
BLDG SETBACK FROM u
REASON FOR INSPECTION REQUEST SIDE PROP LINE OF (STREET) C.
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF XISTIN V
7C7`� SIDE PROP LINE HIGHWAY WIDTH
+ ul
= W
i
CORNER CUTOFF YES NO
PROPOSED MAX OCC OCCUPANCY GROUP
AS VERIFIED OCCUPANT
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LOAD
APPLICATION AND STATE THAT THE ABOVE IS COR-
RECT EXIT HARDWARE
NO OF EXITS NO SPEC KNOWL El
2 ❑
SIGNATURE OF PANIC DEVICES� �
APPLICANT
ADDRESSCt l-yPARKING REQ'D o PROVIDED
/�, �� � J SPACES
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AIAKL CHECKS PAYABLE TO
HARVEY T -BRANDY COUNTY ENGINEER FINAL BY
DATE 3�- S
• PPLICATION VALIDATION CK D CASH -
A662-CE992 12-73 69 -r-"JUL 243 2 2 0 1 8.0 0 ®bb