HomeMy Public PortalAbout5138 PERSIMMON AVE_Certificate of Occupancy__ APPLICATION FOR CfCCUPAKCY INSPECTION ]
FOR APPLICANT,TO FILL IN (Print or type only) COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING BUILDING ANDSAFETY DIVISION
ADORES t (�
BUILDING /
CITY ZIP tADDRESS
NO. OF BLDGS. LOCALITY
SIZE OF LOT NOW ON LOT ` U
u
. NEAREST
TRACT BLOCK LOT N0. CROSS ST._
ASSESSOR
OWNER TEL. y� MAP BOOK PAGE PARCEL
NO. Q DISTRICT TYP FIRE BY
ADDRESS )' a,A -� C ST. E
n C �/��y6.
CITY �/�• /" bL ZIP USE ZONE MAP
SIZE OF (✓ ` N06. OFNO.
EXISTING BLDG. STORIES - I ISPECAL
CONDTIONS
PRESENT USE OF BUILDING BLDG. SETBACK FROM
FRONT PROP. LINE OF (STREET)
i HIGHWAY t YARD = TOTAL SETBACK FROM TYPE OF EXISTING
NO. PARKING FRONT PROP. LINE HIGHWAY WIDTH
SPACES PROVIO + _
BLDG, SETBACK FROM
REASON FOR INSPECTION REQUEST ? SIDE PROP. LINE OF (STREET)
= TOTAL SETBACK FROM TYPE OF XISTIN
HIGHWAY + YARD C
d ` SIDE PROP. LINE HIGHWAY WIDTH C
+ _
fW u
L
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-
RECT. EXIT HARDWARE:
NO. OF EXITS NO SPEC, KNOWL. El
SIGNATURE 0 PANIC DEVICES ❑
APPLICANT ff '/za /I
ADDRESS PARKING SPACES REQ'D PROVIDED
®/1 ZIP
PHONE
MAKE CHECKS/PAYABLE TO:
COUNTY ENGINEER FINAL?-.•2 -2 BY
DATE
APPLICATION VALIDATION CK. M.O. CASH
12 O'Llo REP 10 2 2 D 3 0..0 0 &sS
76A662-CE992 9/74
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