HomeMy Public PortalAbout5629 ROSEMEAD BLVD_Certificate of Occupancy__ 764962-CE9921U75 �" L
APPLMAT9®N FOR OCCUPANCY INSPECTION
t COUNTY OF LOS ANGELES
DEPARTIVIENT•OF_COUNTY ENGINEER
BUILDING AND SAFETY DIVISION .
FOR APPLICANT TO FILL IN BUILDING
•(Print or type only) ' ADDRESSa��
6p�
BUILDING
ADDRESS ' LOCALITY
T&t3iCITY ZIP NEAREST
m ib fe Otis CROSS ST.
SIZE OF LOT NO.OF BLDGS. ASSESSOR
NOW.ON LOT MAP BOOK PAGE PARCEL
DISTRICT TYPE FIRE PR ED BY
TRACT BLOCK LOT NO. 72— CONST. ZONE
TEL.
W.NER N0, USE ZONE MAP
.NO. � h
A PDRIESS SPECIAL
CONDITIONS
TY ZIP BLDG.SET BACK FROM
SIZE OF NO.OF FRONT PROP.LINE OF. (STREET)
EXISTING BLDG. STORIES HIGHWAY + YARD = TOTAL SET BACK FROM TYPE OF EXISTING
P ENT USE OF BUILDING
FRONT PROP.LINE HIGHWAY1 WIDTH
+ – C
` BLDG.SET BACK FROM C
VN -'P'ARKING SIDE PROP.LINE OF (STREET)
ACES PROVIDED
a, HIGHWAY + YARD= TOTAL SET BACK FROM TYPE OF EXISTING
SIDE PROP.LINE HIGHWAY WIDTH f
C
ASON FOR INSPECTION REQUEST + - L
,fiC
G
CORNER CUTOFF YES NO 'e
OCCUPANCY GROUP
f+
A5 VERIFIED• . J OCCUPANT
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 THkAqVE IS COR-
RECT. PARKING : REQ'D PROVIDED
SPACES
SIG ATURE OF �
LICANTFINAL
ESS t
DATE 7'2-'or�? BY
Within the scope of this-inspection
the Building Official may approve
tminor corrections or alterations of
ZIP an existing structure.involving work
PERMIT FEE
of a building, plumbing, mechanical
PHONE or electrical nature. ISSUANCE FEE
og TOTAL FEE
APPLICATION VALIDATION CK. M.O. CASH
5 �MAft: .15 4 .0 0 A058