HomeMy Public PortalAbout4917 ENCINITA AVE_Certificate of Occupancy__ I �
APPLICATION OR 6PAI�CY INSPECTION
FOR APPLICANT TO FILL IN (Print ort COUNTY OF LOS ANGELES
type only) DEPARTMENT OF COUNTY ENGINEER
BUILDING -o BUILDING AND SAFETY DIVISION
ADDRESS
BUILDING
CITY ZIP ADDRESS ✓-�.
SIZE OF LOT \/ / NO OF BLDGS LOCALITY `
JC Ip O NOW ON LOT
AA NEAREST
BLOCK L ND- Z / CROSS ST
ASSESSOR
OWNER
TEL MAP BOOK PAGE PARCEL
DISTRICT TYPE FIRE p BY
•
ADDRESS � �_/`� l� CONST �. ZONE �,
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a
CITY ZIP USE ZONE MAP /
SIZE OF NO OF NO
EXISTING BLDG STORIES i ' SPECIAL
CONDITIONS -
PRESENT USE OF BUILDING
LDG SETBACK FROM ,
FRONT PROP LINE OF (STREET)
TOTAL SETBACK FROM TYPE OF EXISTING
NO PARKING HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH
SPACES PROVIDED + _
BLDG SETBACK FROM
REASON FOR INSPECTION REQUEST SIDE PROP LINE OF (STREET)
O
TYPE OF XITNG c-)
HIGHWAY + YARD = TOS DE PROP CLINETAL SETBAK FROM HIGHWAY WS TIH
0
+
CORNER CUTOFF YES NO Z
PROPOSED MAX OCC OCCUPANCY GROUP
AS VERIFIED OCCUPANT
I HEREBY ACKNOWLEDGE THAT I HAVE ROAD THIS LOAD
APPLICATION AND STATE THAT THE ABOVE IS COR-
RECT EXIT HARDWARE
NO OF EXITS NO SPEC KNOWL ❑
SIGNATURE OF
PANIC DEVICES ❑
APPLICANT
� PARKING
ADDRESS SPACES REQ'D PROVIDED
_ •� � (�ry S/T� ^ /BLDG /s •� w/K-`i2�, '
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FINAL ay
APPLICATION VALIDATION CK M 0 CASH
76A662-CE992 9/74 Q,� �' -g9� .{ U ® y 0. 0
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