HomeMy Public PortalAbout5439 CLOVERLY AVE_Certificate of Occupancy__ APPLICATION F R O CUPA CY INSPECTION
FOR AVOYCANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDINGr 3 P-1BUILDING,AND SAFETY DIVISION
ADDRESS
BUILDING
CITY ./ ' mig� ZIP Cf J 6 ADDRESS
SIZE OF LOTNO OF BLOGS LOCALITY
O NOW ON LOT
NEAREST
TRACT 'S�IQ K7 OLOCK LOT NO 0 Q CROSS ST
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TEL p MAP BOOK PAGE _ PARCEL
OWNER " NO "ID�O DISTRICT TYPE FIRE ED BY
ADDRESS >'° I I v �� CONS ZO
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NO
SIZE OF NO OF SPECIAL
EXISTING BLDG STORIES / QV CONDITIONS
PRESENT USE OF BUILD G BLDG SETBACK FROM
FRONT PROP LINE OF (STREET)
HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING
NO PARKING FRONT PROP LINE HIGHWAY WIDTH
SPACES PROVIDED } _
BLDG SETBACK FROM
REASON FOR INSPECTION REQUEST SIDE PROP LINE OF (STREET) r
TOTAL SETBACK FROM TYPE OF EXISTINGO.
HIGI HWAY } YARD = �
SIDE PROP LINE HIGHWAY WIDTH C-D
1 } = O
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CORNER CUTOFF YES NO
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Gie n a 64 �
PROPOSED MAX OCC OCCUPANCY GROUP
AS VERIFIED OCCUPANT
LOAD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS COR- r EXIT HARDWARE
RECT
NO OF EXITS NO SPEC KNOWL El
SIGNATURE0 PANIC DEVICES ❑
APPLICANT 0 ca_
/ PARKING REQ'D PROVIDED
ADDRESS SPACES
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Z I Pqog o erob15— 945Wmrs
PHONE
-76-7 bo
MAKE CHECKS PAYABLE TO
[HARVEY T. BRANDY COUNTY ENGINEER FINAL BY
DATE --� �'�•
APPLICATION VALIDATION CK M 0 CASH
0t1-taAv 2422 D
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76A662-CE992 6/7$ -