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Home My Public Portal About4917 SERENO DR_Building__ WORKERS' COMPENSATION DECLARATION _ I hereby affirm that I have certificate of consent self . APPLICATION _FOR BUILDING PERMIT Insure, or a certificate of Workers CompensationnInsurance, .- - _ or a certified copy thereof (Sec 3800 Lab C)//^^ COUNTY OF LOS ANGELES -I- - - -BUILDING AND SAFETY 9 Policy NCompany Tu A Q ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS /�•� t�D ❑ Certified copy is filed with the county building mspec- BUILDING - tion department '°� r l � Date Appllca OTy 4Z ZIP LOCAl11Y L.� - CERTIFICA OF EXEMPT( M WORKERS' SIZE OF LOT NOW ON LLOT- - NEAREST CROSS ST COMPENSATION INSURANCE'' ASSESSOR (This section need not be Completed If the perms Is for one TRACE BLOCK - - LOT NO MAP BOOK PAGE PARCEL hundred dollars ($100)or leu ) - OWNER 115E ZONE MAN 0P , 1 certify that in the performance of the work for which this ///��,/[� perms a issued, shall not employ any person m any manner ADDRE - �C. �/1 CONDITIONSSPECIAL - t - - - a so os to become subject to the Workers Compensation Laws ` 1 0 - c rr zip DatTI! ApplKa ARCH IEC!OR TEL NOTICE TNT If after k this Certihcare of - ENGINEER DISTRICT GROUP TYPECOMy IRE SSED BY O Exemption, you should become subject to the Workers O� n 7 �E Compensation provisions of the Labor Code, you must forth ADDRESS 1� with comply with such provisions or this permit shall be TEL STATISTICAL CLA--,AICATION APT CONDO Z deemed revoked CONTRACTO CLASS NO DWELL UNITS_ LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 ADDRE NO (commencing with Section 70DO)of Division 3 of the Business LIC SFWFR ' and Professions Code and my license a in full face and effect Cltt CLASS q VALIDATION /� SK SQ FT NO OF NO OF CHECK ,License Number„2��y4A�� Lic CWs�_ Slff STORIES FAMILIES ONE VALUATION Contract ��ateD MKRIPTION OF�WfORK NEW ❑ S ' l O `,� - / ❑ am exempt under Sec Y+ y1fatig Q. ALD ❑ 7 ► � 7 ALTER - - , B BP C for this reason U OF REPAIR f e _ EXISTING BLDG J i APPLICANT TEL S 44s -B D R Df�ION (PRINT) NO FINAL I hereby offer I exempt from the Contractor's License _ i Low for the following reason (Section 7031 5, Business and ADDRF� NN Professions Code) _ _ _ - _ _ _ \` ❑ 1 as owner of the property, or my employees with BUILDING BY ACCTxO ' wages as their sole compensation will do the work and ///7 - 3307 223.5[( the structure Is not Intended or offered for sale(Section LOCALITY _ ►�'► /` T 7044, Business and Professions Code ) - MOVING _ .. TEL _- 1 - 1 ITGI h7 ❑ I as owner of the property am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec- - ADDRESS _ _ TOTAL 28.5 tion 7044, Business and Professions Code ) MCK _ �e (RED YARD HWY _ AL SETBAOC FROM 1 T .t CONSTRUCTION LENDING AGENCY SET BA L E 7 - ' I hereby affirm that there Is o construction lending agency for FRONT OWE the Performance of the work for which this permit Is issued P1. (Sec 3097, Civ C ) SIDE y Lender's Name P L LDMA ��pprrTTppOOOD-�1 AM n PC Fee Permit Fee . Ref N ,�pLp 1 Aft 9iyp Lenders Address - Com' a I certify that have read this application and state that the issuance Fee J LDMA P/C N FIV above Information is correct I agree to comply with all County Inveanpation Fee GG ordinances and State Iowa ielating to building construction, Total Fee rsJ D LDMA Perm N'— < and hereby authorize representatives of this County to enter YP, upon thea ve-mentioned property for inspection purposes ' SEE MEREE FOR EXPLANATORY LANGUAGE - n of Applicant cr Agent Dole COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC FORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0909300012 PHONE (626) 285-0488 EXT LEGAL ID INO OF CONST I BUILDING ADDRESS J ON FILE I SQ PT STORIES TYPE 4917 SERENO DR I STRUCTURE V-B TEMP CA 917803035 1 JA99E950R INFORMATION NUI�ER I I NEAREST CROSS STREET 1 15388-014-008 I THOMAS PAGE 596 GRID J5 LOCALITY TEMPLE CITY Cl EXIST TENANT iEXIST OCCGRP09/3E RESID USE ZONE R-2 /09 N PROCESSED BY TOWNER TEL NO 113LDGS NOW ON IAT VALUATION (FINAL DA FI BY CODE BAZZI, MOHAMAD (626) 282-7991- 1 6 000 _ !.1)�AL. 14917 SERENO DR / (TEMP 917803035 FEES PAID I FTS IPTIO OF WORK KITCHEN AND BATHROOM REMODEL IFEE DESCRIPTION QUANTITY DOM AMOUNT (APPLICANT TEL NO I ISAKE AS OWNER - 1AA BLDG PERMIT ISSUANCE 27 75 I JAB STATE GREEN BLDG FEE 6000 00 VAL 1 00 ISPECIAL CONDITIONS AC STRONG MOTION RESID 6000 00 VAL 0 60 02 PERMIT W/ENERGY 6000 00 VAL 164 34 1 CTOTAL FEES 193 69 ONTAACTOR J TEL NO JAPPROVALS DATE INSPECTOR SIGNATURE 1SAME AS OWNER _ I I LIC NO ILACATION AND SETBACKS I 1 I I (SOILS ENUINEBR APPROVAL I I I (ARCHITECT OR ENGINEER TEL NO (FOUNDATION/TRENCH FORMS 1 LIC NO ISLAS/UNDER FLOOR I (RAISED FLOOR FRAMING (MAP NNO SEWER MAP BOOK PAGE FIRE ZONE CM0P0 IDNDERPIAOR INSOLATION JFLOOR SHEATHING NO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS NO 21 IROOF SHEATHING J I SCHOOL WITHIN HAZARDOUS ISHEAR PANELS JAIR QUALITY 1000 FEET MATERIALS J NO NO NO i FRAME INSPECTION I REQUIRED 1TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS ISET BACK YARD RWY PROP LINE WIDTH 1 11 I 1FRONT PL- SIDE PL- IINBDLATIDN/WEATHER STRIP( I IINTERIOR LATH/DRYWALL I (EXTERIOR LATH I I (RATED FLOOR/CEIL ASSEM J RATED WALL ASSEMBLIES IRATED SHAFTS/OPENINGS I - I IT-BAR CEILINGS 1-11 J 1LOT DRAINAGE (REPORT ID DPR261 ROUTE TO BS0508 I I I I I I COtYNTY OF•LOS ANGELES TELE CITY K 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 IAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0910130011 PHONE (626) 285-0488 EXT LEGAL ID _ NO OF CONST BUILDING ADDRESS ON FILE I SQ FT STORIES TYPE 4917 SERENO DR (STRUCTURE V-B TEMP CA 917803035 I 1ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET 5368-014-008 THOMAS PAGE 596 GRID J5 LOCALITY TEMPLE CITY, Cl (TENANT I EXIST BLDG USE REBID USE ZONE R-2 ISSUED ON PROCESSED BY I1EXIST OCC GRP 110/13/09 SR (OWNER TEL NO JBLDGS NOW ON LOT VALUATION IFINAL DAT FINAL BY CODE JBAZZ�4917LSERENO DR (626) 282-7991- I 400 I11 TEMP 917803035 I FEES PAID IDESCAI PT TON' OF FORK ( ICHANGE WINDOW TO EXTERIOR DOOR IN DINING ROOM PEE DESCRIPTION QUANTITY DOM AMOUNT' APPLICANT TEL NO ISAME AS OWNER - JAA BLDG PERMIT ISSUANCE 27 75 JAB STATE GREEN BLDG FEE 400 00 VAL 1 00 SPECIAL CONDITIONS IAC STRONG MOTION REBID 400 00 VAL 0 50 IB2 PERMIT W/ENERGY 400 00 VAL 48 02 (CONTRACTOR TEL e0 I TOTAL FEES 77 27 CONT AS OWNER I APPROVALS DATE INSPECTOR SIGNATURE SAMEI ILIC NO I I LovxloN AND sereAceLs I I ISOILS ENGINEER APPROVAL I 1ARCHI7ECT OR ENGINEER TEL NO IFOU NDATION/TRENCH FORMS I - I I LIC NO I SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO SEWER MAP BOOK PAGE FIRE ZONE CI ( HP UNDERFLOOR INSULATION I 144H265 3 001 I FLJOR SHEATHING INO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS I INO 21 I ROOF SHEATHING SCHOOL WITHIN HAZARDOUS I SHEAR PANELS AIR QUALITY 1000 FEET MATERIALS NO NO NO I FRAME INSPECTION I I 1 REQUIRED TOTAL SETBACK FROM EXIST FIRS SPRINKLER HANGERS SET BACK YARD RWY PROP LINE WIDTH FRONT PL- I INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM RATED WALL ASSEMBLIES IRATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID DPR261 ROUTE TO BS0508 I