HomeMy Public PortalAbout6273 ROSEMEAD BLVD_Certificate of Occupancy__ APPLICATION FOOD-CSC UPANCY INSPECTION
FOR APPLICANT TO FILL IN (Print or type only) COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING ,rBUILDING AND SAFETY DIVISION
ADDRESS (D
BUILDING
CITY '-- ZIP ADDRESSf.- l i
N0. OF BLDGS. LOCALITY
SIZE OF LOT / io,3
NOW ON LOT
lam` NEAREST
,. TRACT ✓f BLOCK LOT N0. CROSS ST.
(/ ASSESSOR
OWNER TEL. MAP BOOK PAGE PARCEL
NO. DISTRICT TYPE FIRE E D BY
ADDRESS CONST.' ZONE
CITY ZIP
USE ZONE MAP .
SIZE OF N0. OF N0.
EXISTING BLDG. STORIES
a
�.-2,_ SPECIAL
CONDITIONS
PRESENT USE OF BUILDING
BLDG. SETBACK FROM
FRONT PROP. LINE OF (STREET) -
^- HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING
FRONT PROP. LINE HIGHWAY WIDTH
• N0. PARKING O
SPAC PROVIDED }
BLDG. SETBACK FROM
REASON FOR SPECTION REQUEST SIDE PROP. LINE OF (STREETI
&5�0 0I,�. TYPE OF rXITING 0
HIGHWAY } YARD = TOTAL S DES ROPETBACLINEK FROM HIGHWAY WIDTH 96
cS N
} = Z
't a
CORNER CUTOFF YES NO
PROPOSED MAX. OCC. OCCUPANCY GROUP
AS VERIFIED D!E�
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. ❑
SIGNATURE OF
PANIC DEVICES ❑
APPLICANT
' ADDRESS PARKING REQ'D PROVIDED
Cla2�d
f f Lam- ]DATE
SPACES
- 4 L4--
'7 ZIP •
LLC/� Z"7f�ONE .
MAKE CHECKS PAYABLE 7-0:
HARVEY T. BRANDY COUNTY ENFINAL BY
—�
APPLICATION VALIDATION CK. M.O. CASH
2 6 ' SAY 20 4 v U
76A662-CE992 12-73 -
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