HomeMy Public PortalAbout5002 PERSIMMON AVE_Certificate of Occupancy__ , ..APPLICATION FOR OCCUPANCY INSPECTION
7OR APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING'G` • BUILDING AND SAFETY DIVISION
ADDRESS VG0� �d��1t�y yhy��Gery, AVF. ^^ C�'J /�/� '
UILDING
CITY i� Z I P �\�tl
rj ADDRESS cla / `• ,JC.�L.{fia.r!%�ln u,- �.
SIZE OF LOT / NO. OF BLDGS. 'S LOCALITY ��
�7-3 vp NOW ON LOT
NEAREST
TRACT1 BLOCK $. LOT NQO.(0l c ASSESSOR CROSS
OWNER �Q �O �u NOL�R MAP BOOK PAGE PARCEL
d� DISTRICT TYPE FIRE PROCESSED BY
ADDRESS 00 CON ZONE-� [
(/i'1/
vo�i lc CA OW 94,-J'
CITY/ `Qy-` ZIP fA\� USE ZONE NOP (,S/
SIZE OFNO. OF /
EXISTING BLDG. -(�� STORIES SPECIAL
CONDITIONS
PRESENT USE OF BUILDING BLDG. SETBACK FROM
e 42
r L-' FRONT PROP. LINE OF (STREET)
HIGFIWAY t YARD = TOTAL SETBACK FROM TYPE OF EXISTING
NO. PARKING FRONT PROP. LINE HIGHWAY WIDTH
SPACES PROVIDED O\ + _ �a
BLDG. SETBACK FROM c
REASON FOR INSPECTION REQUEST SIDE PROP. LINE OF (STREET) P
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF XISTING IL
IL
SIDE PROP. LINE HIGHWAY WIDTH
d
+
CORNER CUTOFF YES NO
PROPOSED MAX. OCC. OCCUPANCY GROUP �
AS VERIFIED
.-^-�J OCCUPANT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LOAD
APPLICATION AND STATE THAT THE ABOVE IS COR-
R ECT. EXIT HARDWARE:
NO SPEC. KNOWL. 0
NO. OF EXITS
SIGNATURE OF
PANIC DEVICES ❑
APPLICANT
PARKING -
ADDRESSSPACES ' REQ'D D PROVIDED D
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ZIP
PHONE HC��
MAKE CHECKS PAYABLE TO:
HARVEY T. BRANDT COUNTY ENGINEER FINAL �. BY
DATEC
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76A662-CE992 12-73 ✓