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Home My Public Portal About4912 SERENO DR_Building__ vWORKERS COMPENSATIONrDECLARATION V a I hereby affirm that I have a certiflcote,of consent to,wlf ;BU TION FOR ILDING PERMIT ' r gppL1CA as insure or a certificate of WorkeCompensation Insurance _ _ , _ _ or a certified copy thereof (Sec 3800 Lab C ) "'` ' c COUNTY OF LOS ANGELES I BUILDING,AND S FETY Policy No Company BUILDING Certified copy is hereby furnished `,` `� FOR APPLICANT TO FILL IN gIXIIiE55 Ceit,fied copy is filed with the county budding mipec FMACT ��ILL-„III ,Ion'depanment '6,' 1 t rt; /T Date •`AppficoM "1 ZIP �7 V LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS - - NO OF BlDGS , hEARFSST T- r - COMPENSATION INSURANCE T NOW ON LOT O ` _ J ASSESSOR ' (This section need not be completed If the permit is for'one BLOCK LOT NO MAP BOOK PAGE PARCEL hundred dollar ($100)or leu ) I IJUSE ZONE MAP _ OWNER- CJS wCw�^S� 'NO OSOJ.7Z� NO Y I certify that in the performance of the work for which this //, I SPECIAL - {O permit is Issued, I shall not employ any person In any manner ___ ADDRESS �a_ �� - - �C,, CONDITIONS so as to became subject to the Workers'Compensation Laws _ V CITY C+i _ _ ZIP 17PU {G Date Applicant ' ARCHITECT OR TEL I DISTRICT GROUP IYPE _ FIRE BY NOTICE TO APPLICANT If after makmij this Certificate of NGINEER NO CONST Z E Exemption you should become subject to the Worker Compensation provisions of the Labw Code-you must forth ADDRESS • " with comply with such provisions w this permit shall be - - /� - TEL �! STATISTI C'L4551F TION , �T_ I= deemed revoked I t CONTRACT - NO -' LICENSED CONTRACTORS DECLARATION •, -- - 7 n - LIC 3%11 9 97.f %Ass NO OwFU"UNrrs— I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS .7.0 A SEWER MAP - (commencing with Section 7000)of DIVILan 3 of the Business and vis �l LIC- - L q - - - VALIDATION Professions Code, and my license Is in full force and effect CITY //,� �L� C% 9 �u - BK M PG / / SIS IZZE� CHECK TOR�' f FAMBOIES ONE LicenseNumber�Az•�LIc Classhi7r/�' � VAIU&JWN_ - - -- - - - DESCRIPTION OF WORK NEW $ .S COOr m O ' , r 1; Contractor" vo[.v Dote ADDA17 I am exempt under Sec n ALTER i •B&P C`for this reason _ S A-1 r r" REPAIR $ - - - -- Do,e EXISTING BLDG /iK4 r f OFMOL ` - - 2669-1 A " t Slgnwure - - ` - - - - - APPLICNJT TEL F _ _ '-- PRINT NO -DA #.e • • e_e-1 ' OWNER-BUILDER DECLARATION _. - _ ._ - - -- - - _ I hereby affirm that I am exempt from the Contractor s License ADDRESS FIN I • • 7 8 6o Law for the following reasons an (Section 7031 5, Business _ I ' Professions Code) " - Q -_ BUILDING e *,* 76 0 O" J I, as owner of the property or my employees with ADDRESS wages as their sole compensation will do the work andLOG4l1TY { 3, 1 8'a 8 7 'the structure is not intended w offered for sole(Section - - 7044 Business and Profession%Code) -1 '" MOVING "' _ -- TEL' ❑ --._ _ - _ _. - I, as owner of the progeny am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec- ADDRESS I `-- •'i' tion 7044, Business and Professions Code) SETBACK F�_ M. --` CONSTRUCTION LENDING AGENCY - -SET I CKRED- YARD- -HWY - APROP LIPS WtOTH I hereby affirm that there is a construction lending agency for FROM - _ _ _ _ .- +.`•.- -- -- ----- -- -the performance of the work for which this permit Is Issued - PL -- - ' (Sec 3097 Civ C ) SIS - 8 PL Lender's Name ` LDA41 Ref ✓• i i PC Fee S Lender's Address 4 I certify that I have read this application and state that the -- - -- - Issuance Fes - - -IRNA P/C Y- `< above Information is correct I agree to comply with all County Investipouon Fee - - - 7 0 _ 1 ordinances and State laws relating to budding construction - Total Fee -LONA Pe.m�Y and hereby authorize pWieentatives of this County to enter I upon the oned pro for Inspection purposes SEE MEM FOR EXpL^NATORY LANGUAGE Iynaiure of Appl, tit- - `•?'� - _. _ _ _' -- __ _ - " ' - _ - - -_ - - - 1 • COUNTY OF LOS ANGELES TEMPLE CITY q 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1212040091 PHONE (626) 285-0488 EXT LEGAL ID NO OF CONSTNEW BUILDING ADDRESS ON FILE SQ FT STORIES TYPE OCCUP GROUP 4912 SERENO DR STRUCTURE 1512 2 V-B R3 (ASSESSOR INFORMATION NUMBER I TEMP CA 917803031 1GARAGE 719 1 V-B U THOMAS CROSS STREET ENCINITA 5388-013-015 OTHER HOMA,B PAGE 596 GRID JS IACALITY TEMPLE CITY CAI (TENANT EXIST BLDG USE USE ZONE ISSUED ON PROCESSED BY EXIST OCC GRP 04/09/14 SR OWNER TEL NO IBLDGS NOW ON LOT VALUATION (FINAL DAM FIIiAL BY CODE XWAN, JOHN (626) 233-1944- I 236,300 9[/ / G/1/,•r!^/ 14912 SERENO DR - ITEMP 917803034 FEES PAID ESCRIPTIO OF WORK I 1ADD NEW 2ND FLOOR 3 BEDROOMS, 2 BADEMOLIS, OVER NEW ATTACHEDI (APPLICANT IEEE DESCRIPTION QUANTITY DOM AMOUNT 3 CAR GARAGE FAMILY RM b BATHRM DEMOLISH (E) 1-CAR GARAGE T&L NO (SAME AS OWNER - IBI PLANCHECK W/ENERGY 236300 00 VAL 2 050 50 IAA BLDG PERMIT ISSUANCE 27 80 ISPECIAL CONDITIONS AB STATE GREEN BLDG FEE 236300 00 VAL 10 00 AC STRONG MOTION REBID 236300 00 VAL 23 60 _ B2 PERMIT W/ENERGY 236300 00 VAL 2,412 30 (CONTRACTOR TEL NO D9 PC EXTENSION FEE 512 63 DOL 512 63 APP:OVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - OB CERTIF OF OCCUPANCY 101 40 LIC NO TOTAL FEES 5 138 23 VACATION AND SETBA, I_ I SOILS ENGINEfiR APPROVAL kf ARCHITECT OR ENGINEER TEL NO POU:IDATION/TRENCH FORMS rJ ^ ^n CHEN, DAN (909) 598-8858- I I r/YI \N O 120548 VEJAR ROAD LIC NO ISLAB/UNDER FLOOR �yJ WALNUT CP 91789 • i✓ �� (RAISED FLOOR FRAMING I (MAP NO SEWER MAP BOOK PAGE FZRE ZONE CMPI IUNDFRFLOOR INSULATION 3 00 _I (1ST LEVEL FLOOR SHEATH NO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS 0 NO 21 12ND LEVEL FLOOR SHEATH M SCHOOL WITHIN ATERII ROOF SHEATHING (AIR QUALITY 1000 FEET MATERIALS c � Vw NO NO NO (FIRE DEPT FRAMEI14SIECTI IBLDG DEPT FRAME INSPE I IBHEAR PANELS I IINSULATION/WEATHER STRI INI2RIOR LATH/DRYWALL I (EXTERIOR LATH SLOT DRAINAGE I SMOKE DETECTION DEVICES I FIRE DEPARTMENT APPROVAL I• ADDITIONAL DATA ON FILE r IREPORT ID DPR261 ROUTE TO BS0508 I I I I I I I C • COUNTY OF LOS ANGELES TEMPLE CITY K 0508 BUILDING PERMIT -� DEPARTKENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1407030067 PHONE (626) 285-0488 EXT (LEGAL ID NO OF CONSTNEW BUILDING ADDRESS ON FILE SQ FT STORIES TYPE OCCUP GROUP 4912 SERENO DR STRUCTURE 24 2 V-B R3 TEMP CA 917803034 ASSESSOR INFORMATION NUM03EA GARAGE NEAREST CROSS STREET ENCINITA 15388-013-015 OTHER THOMAS PAGE 596 GAID JS LOCALITY TEMPLE CITY CAI TENANT EXIST BLDG USE USE ZONE TISSUED ON PROCESSED BY T EXIST OCC GRP 07/03/14 SR OWNER TEL NO IGLOOS NOW ON LOT VALUATION FINAL DATE FIjj�AALL• lly CODE IKWAN JOHN (626) 233-1944- 3,558 Ir/�[f 1( / 14912 SERENO DR ��,(�`'y/ - T ITEMP 917803034 FEES PAID 65 IPTI OF M7RR ADD 24 SF CLOSETS TO EXISTING PERMIT (TO EXISTING NEW BED (PEE DESCRIPTION QUANTITY DOM AMOUNT ROOMS) (APPLICANT TEL NO SALE AS OWNER IAA BLDG PERMIT ISSUANCE 27 80 I IAB STATE GREEN BLDG FEE 3558 00 VAL 1 00 ISPECIAL CONDITIONS AC STRONG MOTION REBID 3558 00 VAL 0 50 IB1 PLANCHECK W/ENERGY 3558 00 VAL 108 20 CONTRACTOR TEL NO IB2 PERMIT W/ENERGY 3558 00 VAL 127 40 SAME AS OWNER TOTAL FEES 264 90 APPROVALS DATE INSPECTOR SIGNATURE I I LIC NO I IIOCATION AND SETBACKS (SOILS ENGINEER APPROVAL I (ARCHITECT OR ENGINEER TEL NO - (FOUNDATION/TRENCH FORMS ICHEN, DAN (909) 598-885B- 20548 VEJAR ROAD LIC NO SLAB/UNDER FLOOR WALNUT CA 91789 • (RAISED FLOOR FRAMING MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP UNDERFLOOR INSULATION 3 00 NO OF FAMILIES DWELLING UNITS APT/GOND-STAT CLASS 11ST LEVEL FLOOR SHEATH 0 NO 21 2ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS IROOF SHEATHING LAIR QUALITY 1000 FEET MATERIALS NO NO NO FIRE DEPT FRAME INSPECTI • BLDG DEPT FRAME INSPECT SHEAR PANELS INSULATION/WEATHER STRIP (INTERIOR LATH/DRYWALL - EXTERIOR LATH LOT DRAINAGE T ISMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL( I• ADDITIONAL DATA ON FILE I I I I ` REPORT ID DPR261 ROUTE TO BS0508 I I I