HomeMy Public PortalAbout5850 CLOVERLY AVE_Certificate of Occupancy__ C
APPLICATIO FOR CCU Y INSPECTION
FOR APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILOING ��� v BUILDING AND SAFETY DIVISION
ADDRESS
ZIP �� ADDRDEISS d ��NG IV,
SIZE OF LOT NO OF BLOGS LOCALITY
.11J Jl O NOW ON LOT
��,��^- NEAREST
TRACT BLOCK LOT NO�V CROSS ST
%7L� J ASSESSOR
MP
OWNER ���/Q�� PC ate/ NOL (J,�� e3% DASTRIOCOT TYPE PFIRE ESSEp BY ARCEL
ADDRESS �A 3&k V-4 � �^dv CONSL„ ZONE
CITY ZIP USSEE'ZONE MAP
SIZE OF NO OF
NO �OZ�
EXISTING BLDG STORIES ( SPECIAL
CONDITIONS
PRESENT USE OF BUILDING 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 Q
REASON FOR INSPECTION REQUEST SIDE PROP LINE OF (STREET)
` = TOTAL SETBACK FROM TYPE OF XISTIN
HIGHWAY } YARD W
:7 SIDE PROP LINE _ HIGHWAY WIDTH
/—
y
+ = z
CORNER CUTOFF YES NO
PROPOSED MAX OCC OCCUPANCY GROUP
[:::L OCCUPANT
AS VERIFIED
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LOAD
APPLICATION AND STATE THAT THE ABOVE IS COR- EXIT HARDWARE
RECT
NO OF EXITS NO SPEC KNOWL ❑
❑
SIGNATURE OF PANIC DEVICES oma, _
APPLICANT
ADDRESSOPARKING REO'D PROVIDED
V67.5 ,fill ,8/ 'Q ,D !�(✓/'7 SPACES
ZIP /���
PHONE
AIAKF_ CHECKS PAYABLE TO
HARVEY T BRANDY COUNTY ENGINEER F114AL �, ��?�- BY
DATE '
APPLICATION VALIDATION CK M 0 CASH
1.5 3�IICT :15'4 0 u ` " .0 0 ®3�
76n662-cE992 12-73 �� "'
APPLICATION F OCC NCY INSPECTION
FOR APPLICANT TO FILL IN (Pant or type only) COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILD ING BUILDING AND SAFETY DIVISION
ADDRESS Y BUILDING _
CITY7Z t*i �& ��.T ZIP t 7P ADDRESS �O e-404-v
SIZE OF LOT NO OF BLDGS LOCALITY T�'
��X I 1 (i NOW ON LOT
NEAREST
TRACT / BLOCK L T NZ1 ! / CROSS ST , t
�!J f7 ASSESSOR q�
OWNER TEL MAP BOOK a6- PAGE �/��� PARCEL 17-10
NO DISTRICT TYPE FIRE P BY
ADDRESS � A CONST, ZONE
CITY ZIP USE ZONE MAP
SIZE OF NO OF
NO
EXISTING BLDG STORIES SPECIAL
CONDITIONS
PRESENT USE OF BUILDING BLDG SETBACK FROM ,
/ FRONT PROP LINE OF (STREET)
TOTAL SETBACK FROM TYPE OF EXISTIN
HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH
NO PARKING 'o
SPACES PROVIDED + _ 96
BLDG SETBACK FROM
REASON FOR INSPECTION REQUEST SIDE PROP LINE OF (STREET) Im
• HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING C
I(-K.-- SIDE PROP LINE HIGHWAY WIDTH
+ _
NO
CORNER CUTOFF YES NO z
PROPOSED MAX OCC OCCUPANCY GROUP
AS VERIFIED F OCCUPANT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LOAD
APPLICATION AND STATE THAT THE ABOVE IS COR- EXIT HARDWARE
RECT
NO OF EXITS NO SPEC KNOWL Cl
P ❑
SIGNATURE OFPANIC DEVICES
APPLICANT -
PARKING REQ'D PROVIDED
ADDRESS SPACES
ZIP
H E-�
AIAKL CHECKS PAYABLE TO f/�
HARVEY T BRANDY COUNTY ENGINEER FINAL BY
DATE '"
APPLIC ON VALIDATION OK M 0 CASH
76A662-CE992 12-73
C._'
MAR - 44U U ,00e�c