HomeMy Public PortalAbout9855 VAL ST_Certificate of Occupancy__ APPLICATI O OCCUPRANCY INSPECTION
FOR APPLICANT TO FILL IN (Print orCOUNTY OF LOS ANGELES
type only) DEPARTMENT OF COUNTY ENGINEER
BUIL-NG r/ �+� BUILDING AND SAFETY DIVISION
ADDRESS
UILDING
13
ZIP 09 1,71e AD RESS
i
� N0. OF BLDGS. LOCALITY
SIZE OF LOT �X NOW ON L01'
NEAREST
TRACT/j / Q BLOCK y� LOT N0. a CROSS ST.
fv G 'ASSESSOR
AGE
OWNER�4��X�TT� MP'z EL. DASTRIOCT OK TYPE PFIRE OCES ED PARCEL
ADDRESS004443_ �` �� ✓�/) CONST./ ZO
CITY c`// ZIP5?-'7-lel
/ el ZONE MAP —^
SIZE OF N0. OF /j NO. � 6
Q -3
EXISTING BLDG. STORIES dy SPECIAL
CONDITIONS
PRESENT USE OF BUILDING BLD SETBACK FROM
FROfIT PROP. LINE OF (STREET)
HIG AY + YARD - TOTAL SETBACK FROM TYPE OF EXISTING
NO. PARKING FRONT PROP. LINE HIGHWAY WIDTH
SPACES PROVIDE
BLDG. SETBACK FROM
REASON FOR INSPECTION REQUEST SIDE PROP. LINE of (STREET) a
c
HIGHWAY + YARD' - TOTAL SETS FROM TYPE OF XISTIN C
SIDE PROP. LI HIGHWAY WIDTH
� C
(�f + 4
CL
or CORNER CUTOFF YES NO Z
PROPOSED MAX. OCC. OCCUPANCY GROUP .�-
AS VERIFIED JJ_ OCCUPANT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LOAD
APPLICATION AND STATE THAT THE ABOVE IS COR-'
R ECT. EXIT HARDWARE:
N0. OF EXITS NO SPEC. KNOWL. ❑
SIGNATURE 0
PANIC DEVICES ❑
APPLICANT
ADDRESS tj PARKING REQ'D PROVIDED O
SPACES
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PHONE
MAKE CHECKS PAYABLE TO:
HARVEY T. BRANDY COUNTY ENGINEER FINAL
DATE
APPLICATION VALIDATIO I4, M.Q. CASH
2 3 Ov"t"SEP'2:0.2:2 0 3 0.0 0 ,&98
76A662-CE992 9/74 M