HomeMy Public PortalAbout6223 GOLDEN WEST AVE_Certificate of Occupancy__ a . �f /- \,APPLICATION FOR OCCUPANCY MSPECTION
y
FOR APPLICANT TO FILL IN (Pant or type only) COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING - / BUILDING AND SAFETY DIVISION
ADDRESS / ` ^ BUILDING �7
CITY / C` �' ZIP L ADORESS
SIZE OF LOT ` NO. OF BLDGS. •/ LOCALITY
7-0 NOW ON LOT
_ NEAREST �
TRACT = BLOCK LOT NO. CROSS ST.
ASSESSOR
OWNER L TEL. - MAP BOOK PAGE PARCEL
k�ENO. DISTRICT TYPE FIRE PROC ED BY
ADDRESS U /2 `�y/ CONST. - ZONE I-
1, (�!( = ria
CITY /` C 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)
,i ^ �' HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTIN w, f
NO. PARKIN& FRONT PROP. LINE HIGHWAY WIDTH
SPACES PROVIDED } _
O
U
BLDG. SETBACK FROM
REASON FOR INSPECTION REQUEST SIDE PROP LINE OF (STREET) p
=- TOTAL SETBACK FROM TYPE OF EXISTINGV
A HIGHWAY } YAN
C SIDE PROP. LINE HIGHWAY, WIDTH
c c.- } = z
CORNER CUTOFF YES NO
PROPOSED MAX. OCC, OCCUPANCY GROUP
AS VERIFIED 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 F-1
SIGNATURE0
PANIC DEVICES ❑
APPLICANT
t4
ADORES AREQ'D
SPAD PROVIDED
Sj� SPACES
S��• 9
ZIP
a PHO E TO `Je7VC t A-/C,
�e - r V 4/r.;H;Al__"O / s i o mr
MAKE CHECKS PAYABLE TO
HARVEY T. BRANDT, COUNTY ENGINEER DFINAL I ATE J BY \per'
4' APPLICATION VALIDATION K M O CASH
� s
✓i j 2;"3"�FEB ,15 2=2 B 1..8.E 0 ®�8
76A662-CE992 3/73 - -
_ /I