HomeMy Public PortalAbout5032 PERSIMMON AVE_Certificate of Occupancy__ 76c11AM
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-APPLICATION FOR OCCUPANCY INSPECTION
": COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER'
BUILDING AND SAFETY DIVISION
FOR (Print or type o FILL IN BUILDING
(Print or a only) ADDRESS
BUILDING IM�ON LOCALITY /& �
ADDRESS
NEAREST
CITY am A� i•Ti9 ZIP CROSS ST., ,ytQPs
NO.OF BLDGS. ASSESSOR
SIZE OF LOT (Pox ) 3o NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT TYPE FIRE PROCESS-ED BY
TRACT , b'`l BLOCK LOT NO. 6 - CO T. ONE r
OWNER tj-N��$ oP SAL NO. USEZ N NOP
ADDRESS
SPECIAL
Oro CONDITIONS "
CITY ��� �L� �l* ZIP BLDG.SET BACK FROM
SIZE OF OF FRONT PROP..LINE OF (STREET)
EXISTING BLDG. STORIES TOTAL SET BACK FROM TYPE OF EXISTING
HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH
PRESENT USE OF BUILDING
+ -
C
BLDG.SET BACK FROM
NO.PARKING OF
SIDE PROP.LINE OF (STREET)
SPACES PROVIDED
HIGHWAY + YARD= TOTAL SET BACK FROM TYPE OF _EXISTING
SIDE PROP.LINE HIGHWAY WIDTH F
REASON FOR INSPECTION REQUEST + -
M&i*L 801 L4)!/V61 *rj I) CORNER CUTOFF YES NO
? V>H�Ra OCCUPANCY UP OCCUPANT VERIFIED RA-C-4 aF 6-r-'\12
LOAD
EXIT HARDWARE:
PROPOSED MAX.OCC. NO.OF EXITS NO SPEC.KNOWL. ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS PANIC DEVICES ❑
APPLICATION AND STATE THAT THE ABOVE IS COR-
RECT. PARKING: ,
SPACES REQ'D PROVID711
SIGNATURE OF ` l
APPLICANT `�� 1�J� FINAL BY
DATE
ADDRESS -13-0 f 0,1;qg7Wi&& i3L.✓(D
Loly a0 V A Within the scope of this inspection
the Building-Official may approve
minor corrections or alterations of
ZIP an existing structure involving work
PERMIT FEE �Qe
of a building, plumbing, mechanical
PHONE J$737U or electrical nature. ISSUANCE FEE
TOTAL FEE
APPLICATION VALIDATION M.O. CASH
Y
7 1 .-21- 31 22 D.. 3 0.0 0 AW