HomeMy Public PortalAbout5405 SANTA ANITA AVE_Certificate of Occupancy__ ti +
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r ' APPLICATION FOR 'OCCUPANCY INSPECTION
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING
(Print or type only) ADDRESS 'J
BUILDING `
ADDVEss LOCALITY
CITY aP NEAREST
GRIM ST.
NOW ON LOT'SZM OF LOT V NO.OF BLMAP BOOK IPAGE 1PARCEL
DISTRICT TYPE FIRE VffM6SkSED B
TRACT BLOCK LOT NO. ZON
•D
OWNER
No. 42
NO.
ADDRESS SPECIAL
P y-� CON FROM
(f BLEA C/ ONS
SET FROM
S NO.OF FRONT PROP.UNE OF (STREET)
EXISTING BLDG. STORIES TOTAL SET BACK FROM TYPE OF wan NG
HIGHWAY + YARD - FRONT PROP. LINE HIGHWAY WIDTH
PRESENT USE OF BUILDING F d
+ 0
U
BLDG.SET BACK FROM
NO.PARKING SIDE PROP.LINE OF (STREET) 0
SPACES PROVIDED TOTAL SET BACK FR TYPE OF Dc7*mw
HIGHWAY + YARD- SIDE PROP. LINE HIGHWAY WIDTH
_ W
REASON FOR INSPECTION REQUEST + �-
U)
CORNER CUTOFF YES NO Z
OCCUPANCY GROUP OCCUPANT
AS VERIFIED LOAD
EXIT HARDWARE:
PROPOSED MAX OCC. NO.OF EXTTS NO SPEC.KNOWL ❑
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS PANIC DEVICES ❑
APPLICATION AND STATE THAT THE ABOVE IS COR-
RECT. ' PARKING
SPACES REQ'D BYBY PROVIDED
SIGNATURE OF
APPLICANT FINAL
DATE
ADDRESS f3
YAtf* the .cope of thY bopection
the Buicbrog Official may approve
mkror correctSoro or eltelr o of
aP an wkdv atruchrre lir o frq work U
PERMIT REE
of a bWdInp, pkwnbkr7. merhankef
PHO�NNEE or elacticel rxture. ISSUANCE FEE
TOTAL FEE
APPLICATION VALIDATION CK. M.O. CASH
48 0c'l--'WV e6 22 4 3 0.00
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