HomeMy Public PortalAbout5041 SANTA ANITA AVE_Certificate of Occupancy__ APPLICATION FOR OCC'UPANCY INSPECTION.C-�'? {�
BUIL NG ANDSAFE IVI$IO.N
F R APPLICANT TO FILL IN BUILDING
(Print or type only) ADDRESS
FC,TY.%t,,,P,,,
DLRESS Q f 5 ry11 0� LOCALITY
NEAREST
C ZIP '?/7910 CROSS ST,
NO. OF BLDGS, ASSESSOR
SIZE OF LOT �x �/Yf / p MAP BOOK PAGE PARCEL
4 NOW ON LOT DISTRICT JTYfE FIRE OC ED BY
TRACT CK M3 LOT NO./ O
CONS ZONE
L
TE .
OWNER /� V u,y'� NO. �/Oj° ZONE . MAP l
Ca
ADDRESS.!rbW /Q�/� v , SPECIAL
CONDITIONS
CITY6 C.r A ZIP 0 BLDG. SETBACK FROM
SIZE OF NO FRONT-PROP. LINE OF (STREET)
EXISTING BLDG OR ES' HIGHWAY t YARD = TOTAL,SETBACK FROM TYPE OF EXISTING
FRONT PROP. LINE HIGHWAY WIDTH
PRESENT USE OF BUI ING
BLDG. SETBACK FROM'
NO. PARKINGSIDE PROP:LINE OF (STREET) p
SPACES PROVI
HIGHWAY + YARD. - TOTAL SETBACK FROM TYPE OF XISTIN �
SIDE PROP. LINE HIGHWAY WIDTH- p
_ C
+
REASON FOR INSPECTION REQUEST u
o
.CORNER CUTOFF YES NO u
�/ OCCUPANCY GROUP-lbw . ��] OCCUPANT
E
/-r dP h AS VERIFIED IT
r LOAD
• EXIT HARDWARE:
PROPOSED MAX. OCC. NO SPEC, KNOWL. ❑
• - NO.=OP•EXITS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS P' IC DEVICES ❑
APPLICATION AND STATE THAT THE ABOVE IS COR-
RECT. PARKING•
SPACES' REQ'D OVIDE`.
FINAL
SIGNATURE OF DATE i
APPLICANT
ADDRESS Within these p f this inspec-
tion the Buil' g Official may
approve minor corrections or
alterations of an existing struc-
ture involving.work of a build- Permit.F
ZIP ing, plumbing, mechanical or
electrical nature. Issuance Fee
' PHONE
Total Fee —31 0
APPLICATION VALIDATION"--�-o• CASH
76A662C-CF992B 11/.75 5 9 OL DEC 9 Q, D 3 0.0 .0
D \AfL