HomeMy Public PortalAbout5353 LOMA AVE_Certificate of Occupancy__ APPLICATION
I L./f`TION F®If OCCUPANCY NC N, INSPECTION r�
FOR APPLICANT L N (Print typey� COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING �3 „/ BUILDING AND SAFETY DIVISION
DD
ARESS �Y J`L
BUILDING
CITY ,' ZIP O ADDRESS `..
SIZE OF LOT NO. OF BLDGS. LOCALITY
NOW ON LOT
NEAREST oz
TRACT BLOCK = LOT NO CROSS ST, v
ASSESSOR
' TEL MAP BOOK PAGE PARCEL
OWNER N�,S 0. y -DISTRICT TYPE _E FIRE PROCESSED'
ADDRESS 33 , ^�j CONST. ZONCITY ` ZIP91 2,e 1) USE'ZONE MA '
SI F N0. OF
N0.
EXISTI LDG STO oae SPECIAL
CONDITIONS
PRESENT USE 0 ILDING BLD6'SETBACK FROM
FRONT PROP LINE OF (STREET)
HIGHWAY t YARD = TOTAL SETBACK FROM TYPE OF ISTIN
NO PARKING FRONT PROP. LINE HIGHWAY WIDTH
SPACES PROVIDE
t =
BLDG SETBACK FROM
REASON FOR INSPECTION REQUEST SIDE PROP LINE OF- (STREET) >-
TOTAL SETBACK FROM TYPE OF XI TING C"'
HIGHWAY t YARD = SIDE PROP. LINE HIGHWAY WIDTH V
t
O
CORNER CUTOFF YES NO W�
Z
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.
R ECT.
NO SPEC I<NOWL ❑
N0. OF EXITS
SIGNATURE OF • •
PANIC DEVICES ❑
APPLICANT
PARKING
SPACES REQ'D D PROVIDED D
ADDRESS_ - '
,s-r/A.1 G 4) r- s�
ZIP 912
PHONE sJ�d G V Id 1-4-7 /VS
MAKE CHECKS PAYABLE TO ^
HARVEY T. BRANDY COUNTY ENGINEER DFINAL
ATE BY
APPLICATION VALIDATION CK 0. CASH
76A662-CE992 8/75 \ -