HomeMy Public PortalAbout5113 DOREEN AVE_Certificate of Occupancy__ APPLICATION FOR OCCUPANCY INSPECTION
FOR APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING �C� � BUILDING AND SAFETY DIVISION
BUILDING
__CI TYe_ ZIP / Y!J/�Q ADDRESS
SIZE OF LNOW ON LOT
OT {—b�l f O. OF SLOGS. � LOCALITY j� `�f/y- ^ /
J
�L NEAREST
TRACT // ��- BLOCK LOT N CROSS ST, n _
/. ASSESSOR
OWNER V -/t� J✓ v TOL' MAP BOOK PAGE PARCEL
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DISTRICT TYPE FIRE PROCESSED BY
ADDRESS '� O' ' C NST. ZONE t
IVy�
CITY 6y. ZIP --) USE ZONE MAP
SIZE OF IF I NO.bF
EXISTING BLDG. STORIES U0,) SPECIAL
CONDITIONS
PRESENT USE OF-BUILDING BLDG. SETBACK FROM
�� 2 .FRONT PROP. LINE OF (STREET)
TOTAL SETBACK FROM TYPE OF XISTIN
NO. PARKING HIGHWAY } YARD = FRONT PROP. LINE HIGHWAY WIDTH
SPACES PROVIDED _ d
BLDG. SETBACK ROM
REASON FOR INSPECTION REQUEST S1DE PROP. LINE (STREET)
HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF XISTIN C
Q Y SIDE PROP. LINE IHIGHWAY WIDTH Q'�
} o (ri
I
CORNER CUTOFF YES NO Hg
PROPOSED MAX. OCC. OCCUPANCY GROUP
AS VERIFIED OCCUPANT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LOAD
APPLICATION AND STATE THAT THE ABOVE 15 COR-
RECT EXIT \RDWARENO. OF EXITSEC. KNOWL. El
SIGNATURE OF "�yy // yAJJ� NIC DEVICES El
APPLICANT // (�'%�-(�I
ADDRESS % /S w, � PARKING • REOD
SPACES � PROV ED �
�i (�'
21P `1r
PHONA44 ( ,
nlA� r cH'_"S 11AYA�tI�c TO:
HARVEY T. BRANDY COUNTY ENGINEER FINAL �J Y
DATE ��� � ( / t
APPL CATION VALIDATION CK. M.O. CASH
3 VLl
MAY 2322 D 1 8.00
76A662-CE992 12-73