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Home My Public Portal About4937 SERENO DR_Building__ APPLICATION FOR'BUILDING PERMIT F LICANT TO FILL IN (Prrnl G, woe on iv) Bullf�I COUNTY OF LOS ANGELES ADDBuIfIssNc DEPARTMENT OF COUNTY ENGINEER CITY Temple City ZIPJZC�. BUILDING AND SAFETY DIVISION NO OF BLOBUILDING SIZE OF LOT NOW ON LOADDRESSTRACT S SAO ZiD l3 LOLOCALITY NEAREST OWNERL Conwa NCROSS STASSESSOR ADDRESS MAP BOON PAGE PARCEL DISTRICT GROUP TYPE FIRECITY L - ZIPlO� CONST' ZONE ARCHITECT OR TJ L�77ENGINEER NSTATISTICAL C.BLASSIFICATION PADDRESS CLASS NOS LDWELL UNITS BIR+ PG CONTRACTOR TUSE ZONE MAPNOADDRESS NPECIAL .CITY ^,. CONDITIONS11rcadia CgOAD DEPARTMENT APPROVAL REQUIRED YES❑ NOCONSTRUCTION LENDERNAME AND BRANCH BLDG SETBACK FROMFRONTPROP LINEOFADDRESS ITYHIGHWAY + YARD TOTALSETBACK FROM OP EXISTING SO F NO OF NO OF FRONT PROP LI HIGHWAY WIDTH SIZE STORIES FAMILIES yy DESCRIPTION OF WORK N EW O U IOLATI BLDG SETBACK FROM Ill Iionand SIDE PROP LINE OF )STREET) ALTER OTAL SETBACK FROM TYPE OF EXISTING extend am HIGHWAY } YAM —REPAIR SIDE PROP LIRE HIGHWAY WIDTH Wd USE OF - + EXISTING BLDGResidenceOL Z APPLICANT TECORNER G OFF YES ❑ NO ❑ (PRINT) NO BY (SIGNATURE) IN OPEN SP E YES ❑ NO ❑ ( IN COAST PERMIT ZONE YES ❑ NO ❑ ` VALUATION AY 1 OOOeOO �II XEREBY ACRXOWL[DG[ THAT I NAV[ RLAO TAT IDX ANDSTATE THAT THE ABOVE I8 CORRECT AND AOMPLY TWITH ALL OROINAYCES AND "WE R[OULATING C0X- �.) �� INfj--STRUCTION I CERTIFY THAT IN DOING THE WPI[EDHK LABORHEREY CODEIL 01 OTHE MSTATE PLOY AOF CALIFORNIAV IINOTTO Z �C �I ORAMEM8COMFIMBATION INfU11�1NC[ C��SIGNATURE ^`, �77$ �.dsP— Nab- -fea,s', PERMITTEE ADDRESSSS//CITY/J NODIATE DY ,51.1hE CHEChS PMT l PAYABLE IO FEE $FEE $ HARVEY T BRANDT COUNTY ENGINEER ��TQ 0-0 PLAN CHECK VALIDATION cN NO CASH PERMIT CK /M l00 cABH 3171�A06 as e 96.00 • Teweww ce•eof fqe - y I ?Z r. J WORKERS COMPENSATION DECLARATION L sure,or r that I haver certificate of consent to raself APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers'Compensation Insurance or a certified copy thereof (Sac 3800, Lob C ) COUNTY OF LOS ANGELES BUILDING AND SAFET Policy No Company `— Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the county bwldmg,lnspec - BUILDING non department ADDRESS Date Applicant CITY ZIP LOCALfTY1,161 CERTIFICATE OF EXEMPTION FROM WORKERS' SLOGS QST COMPENSATION INSURANCE SIZE OF LOT • NOW ON LOT CROSS ST (This section need not be completed if the permit is for one TRA & �-�/3 LOT n �-� ASS SOR pgGE PARCEL hundred dollars ($100)or lass ) !v L.EA1 L NE I certify that in the performance of the work for which this OWNER NO permit Is Issued I shall not employ any person In any manner ADDRESS -7i ISPECLAL LOTIONS so as to become subject to the Work 'Compensation Lows O L ,�-�' CITYL U Dale �ApphcantJttreARCHITECT OR �e ZIP TEL 0 NOTICE TO APPLICANT If, cher making this Certificate ENGINFER NO DISTRICT GROUP TYPE FIRE BY O Exemption you should become subject ,to the Work DOST ZONE T Compensation provisions of the Labor Code you must forth ADDRESS with comply with such provisions or this permit shall be6. TEL STATISTICAL CLASSIFICATION APT CONDO to deemed revoked CONTRACTOR ' NO it Z LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS_ I hereby affirm that 1 am licensed under provisions of Chapter 9 ADDRESS (L NO (commencing with Section 7000)of Division 3 of the Business andLIC SEWER MAP I Professiom Code and my license is in full force and affect CITY F I CUSS BK PG VALIDATION SO FT NO OF NO OF CHECK License Number LIc ClassSIZE STORIES FAMILIES ONE VALUATION Connector Dote $ DESCRIPTION OF WORK NEW ADD I am exempt under Sec ALTER Polls B 8P C for this reason REPAIR S Dole USE OF 1 EXISTING BLDG Signature APPLICANTFINALOWNER-BUILDER DECLARATION PRIM NOZ�l DATE "I hereby affirm that I am exempt from the Contractor a License Low for the following reason (Section 7031 5, Business and ADDRESS FT Profenlons Code) - MINT - ' BUILDING Il (1 I, as owner of the property or my employees with ADDRESS I r wages cs thea sole compensation,will do the work and LOCALITY the structure is not Intended or offered fa sale(Section 70", Business and Professions Code) MOVING TEL I as owner of the property, am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec ' non 70", Business and Profasstons Coda) MOMMADDRESS # A" L SETBACK FROM MIST -CONSTRUCTION LENDING AGENCY =YARD PROP LINE WIDTH is &.10 a 8$6 1 hereby off Irm that there is a construction lending agency for FRONT t the performance of the work for which this permit Is Issued _ —El— (Sac (Sec 3047, Civ C ) SIDE vL , Lendees Nome Iq 363 PC Fee I - Pwmn FN 3 IDAIA Ref Y t f Lender's Address y I certify that I have read this application and state that the buance Fee 0' LDh1A P/C R 9- q a above information is correct 1 agree to comply with all County I igWmn Fav ordinances and State jaws relating to building construction, Toial Fee .1603 1 LDMA perm M R and hereby authorize representatives of this County to enter upon�e above-mentioned property for inspection purpos�e-si7 ,i ^ �O�Y / M W0$E FOR IXMNATORV L414GUA0E Signature of Applicant w Agent -{- D�bcale �+-I - rN` , LS WORKERS COMPENSATION DECLARATION _ , I heaffum that I have a certificate of consent to ,elf APPLICATION FOR BUILDING PERMIT insure or a certificate of Workers Compenstion Insurance or a certified copy thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING ADDRESS �Gn Certified copy is filed with the county building inspec BUILDING C hon department e' ADDRESS S LOCALITY ,PisrT _ C NEAREST Date 'Applicant CITYIT VZIP -{ CROSS ST r h I CERTIFICATE OF EXEMPTION FROM WORKERS N OF al. S ASSESSOR COMPENSATION INSURANCE SIZE OF LOT OW ON LOT - MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one p USE ZONE O, hundred dollars ($100)or less ) TRACT R 56 BLOCK — LOT NO SPECIAL >.OWNERTEL CONDITIONS d 1 certify that in the performance of the work for which this - DISTRICT GROUP TYPE FIRE PROCESSED BY V permit is issued 1 shall not employ any person in any manner so as to become subject to the Workers Compensation Laws ADDRESS f CONSI, " ZONE O Date Appl¢ant r CITY ZIP O STATISTICAL CLASSIFICATION Is J{/ 3 APT CONDO NOTICE TO APPLICANT If, after making this Certificate Of ARCHITECT OR TEL Exemption you should became subject to the Workers ENGINEER NO CLASS NO DWELL UNITS_ N Compensation provisions of the Labor Code you must forth ADDRESS - SEWER MAP Z with comply with such provisions or,this permit shall be deemed revoked CONTRACTOR TEL NO BKj& PG VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS - NO VALUATION P (commencing with Section 7000)of Division 3 of the Business and LIC Professions Code and my license is in full force and effecl CITY CLASS S 0*000 i SO FT NO OF NO OF CHECK license Number Lic Class SIZE STORIES FAMI IES ONE NEW ❑ $ Contractor Dote DESCRIPTION OF WORK ❑ l M ' I am exempt from- the licensing requirements as ADD I am o �7 bcensed architect or a registered professional engineer ALTER ❑ INAL acting in my professional copouty (Section 7051 R P,,yygg DATE Business and Professions Code) USE OFKy ' _ EXISTING BLDG MOL ❑ FINAL ...r Lia Or Reg NO _ Dote APPLICANT iEL BY - OWNER BUILDER DECLARATION • PRINT No �S _ I hereby affirm that I am exempt from the Contractor s License ADDRESS 4"f 5 O !� C Law for the following reason,(Sechon 7031 5 Business and - Profess Code) BUILDING as owner'of the property or my employees with ADDRESS r wages as their sole compensation will do the work and the structure is not intended or offered for sole(Section LOCALITY - 7044 Busmess and Professions Code) MOVING TEL I as owner of the property am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec ADDRESS Tian 7044 Business and Professions Code) - CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK FROM E 4 fl 4 A SET BACK PROP LINE WIDTHIDTH - I hereby affirm that there is o construction lending agency for FRONT # i • . • • the performance of the work for which this permit is issued P L (Sec 3097 Cv C ) SIDE• r - - -- ' { PL • • 5200 Lender s Name ae - • • • 5200 $ Lender s Address P C Fee f Permit Fee 0 a.2 3 -8 1 >C I certify that I have read'this application and state that the luvance Fee above information is correct I agree to comply with all County - Inve•ogohon Fee p4 - ordinances and State jaws relating to building construction and hereby authorize representatives of this County to enter inial Fee Q upon the above mentioned property for inspection purposes (� �TLink AAJa�v 3-a 3—Q / SEE REVERSE FOR EXPLANATORY LANGUAGE Signoturo of Appl.cam or Agent CXDoi• mF WORKERS COMPENSATION DECLARATION hereby affirm that I have r certificate of consent self APPLICATION FOR BUILDING PERMIT Rsure, or*6 certificate of Workers Compensation Insurance, or a certified copy thereof (Sec 3800, Lab C) +__ • ' _ - r COUNTY OF LOS ANGELES` BUILDING AND SAFETY Policy No Company ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy Is filed with the county budding inspec- BUILDING ' tion department ADDRESS C CITY ZIP LOCALITY Date Applicant NO OF NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT FOW ON LOT CROSS ST COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT - BLOCK LOT NO MAP LOOK Cei I PAGE 0P PARCEL hundred dollars ($100) or less ) TEL USE ZOO MAP i 23 OWNER 'NO S I certify that in the performance of the work for which this �J SPECIAL i/ } permit is issued I shall not employ any person in any manner ADDRESS e. h /k' CONDITIONS n' t so as to become subject to the Workers Compensation Laws �y , O CITY ZIP K) i - U Date Applicant ARCHITECT OR TEL i DISTRIR GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT If, after making the Certificate of ENGINEER NO - ' CONST i. ZONE Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forth- ADDRESS _ - - .,v� --3 with comply with such provisions or this permit shall be TEL _ STATISTICAL CLASSIFICATION _ APT I CONDO Z deemed revoked CONTRACTOR NO LICENSED CONTRACTORS DECLARATION UC CLASS NO DWELL UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC and Professiom Code,and my licertse is In full force and effect CITY NO I FAMILIENO OF CLASS CHECK BK PG VALIDATION License Number Lic Class SIZE l STORIES S ONE - VALUATION Contractor Date DESCRIPTION OF WORK _- NEW -ADD ❑ _ l..'�/� ► t ❑I am exempt under Sec r e $ 'S R El ALTE B 8P C for this reason it r REPAIR $ Date USE OF i,ep ace inq R EXISTING BLDG l-1 DEMOL.❑ Signature _ APPLICANT TEL FINAL OWNER-BUILDER DECLARATION (PRINT) - ' - J a V t IJO g ,+ DATE I hereby affirm that I am exempt from the Contractor s License - 3� •Sei^erA , C Law for the following,reason (Section 7031 5, Busmesa ADDRESS and FINAL 1 Professions Code) SEM _ _ _ _ BY _ - y I, as owner of the property or my employees with BA�REu �j,�� A4�T.r wages as their sole compensation,will do the work and 3307 113.63 the structure is not intended or offered for sale(Section LOCALITY ► _ _ �- 1 IT015 1--� 7044, Business and Professions Code ) - MOYIPIG TEL - - - - L} 1 as owner of the property, am exclusively contracting CONTRACTOR NO r with licensed contractors to construct the project (Sea- ADDRESS _ TOTAL 113.63 tion 7044, Business and Professions Code ) 113,63 UIRED T AL SETBACK FROM 1 T ' CONSTRUCTION LENDING AGENCY SET M YARD ITWY E ��( j 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 ), _ _ 1 SIDEPIL - - Lender's Name 0000-0001 8/26/92 y p LDMA Ref 1 r - PC Fee{ Permit Fee ter/ 5207 1 Fyl 7i+1 Lender's Address a I certify that I have read this application and state that the is uance Fee LDMA P/C R 0 above information is correct I agree to comply with all County Investigation Fee ordinances and State laws relating to budding construction, Total Fee "Ile, 4 ` LOMA Perm N t and hereby outhonze representoiives of this Count/ to enter _ - pY} -upon t above-mentioned property for inspection purposes - SEE OVEM FOR EXPLANATORY LANGUAGE Siarxrturs of Applicant aw A& Dote v WORKERS COMPENSATION DECU1R.4710N iI hereby affirm than I have r ce'Cometdl{7ihs�h•�cisal( :;= PLICATION FOR BUILDING PERMIT 1ISI insure or a cerhficate'ol Workers'Compen n j�yul6nce" or a certified copy thereof(Sec 39DO, Lab C ) " � COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company BUILDING iiP - ❑ Certified copy is hereby furnished I FOR APPLICANT TO FILL IN .� - BUILDING ADDRESS ❑ Certified copy is filed with the county building spec- BUILDING hon deportment ADDRESSLYE* LOCALITY NEAREST— Date—Applicant t CITY ZIP CRO5557 CERTIFICATE OF E%EMPTION FROM WORKERS slzE OF LOT k / oLv oN Lo Oolc PAGE PARCEL COMPENSATION INSURANCE } (This section need not be completed if the permit is for one USE ZONE I MAP hundred dollars ($100)or leu ) TRACT BLOCK I LOT NO IND TEL SPECIAL >• I certify that in the performance of the work far which this OWNER 9 r CONDITIONS d permit iF rssued, I shall not employ any person in any manner - ISTR GROUP TYPE FIRE ED BY O so as to become subject to the Wake Compensation Laws ) ADDRESS (� CONST ZONE _ U Date4—? -A4- ` O 3 Apphcanf r i CITY ZIP TEL � STATISTICAL IF TION CONDO V NOTICE TO APPLICANT If after making this Certificate of Exemption, you should became subject to the Workers' ENGINEER NO CLASSNO DWELL UNIT$_ d Compensation provisions of the Labor Code you must forth- ADDRESS - SEWER P us with comply with such provisions or this permit shall be _ deemed revoked f CONTRACTOR TEL BK PG VALIDATION LICENSED CONTRACTORS DECLARATION LK: .I hereby offnm that 1 am licensed under provisions of Chapter 9 ADDRESS NO VALUAT N (commencing with Section 7000)of Division 3 of the Business and lI uC `�D Professions Code, and my license is in full force and effect CIT'I CUSS $ 047 C> poli. FT NO OF NO OF CHC-Oc .License Number Lic Chits SIZE STORIES FAMILIES ONE $ Contractor Date � DESCRIPTION OF WORK NEW ❑1 am exempt under Sec t / ADD ALTER E] FINAL - B SP C for this reason ^ - REPAIR DATE Dote OF tt EXISTING BLDG _ DEQ FINAL Signature •, APPLICANT TEL BT OWNER-BUILDER DECLARATION (PRINT)PRINTNO plop 1 hereby affirm that I am exempt from the Contractor s License Low for the following reason (Section 7031 5, Business andW. SE- -U - 1, io a a e e Profeuions Code) � , 1, as owner of the property, or my employees with i BUIL _ _ o e /� ? 7800 wages as their sole compensation will do the work and (i - - 7R005 the structure is not intended or offered for sole(Section y (�lE C 704.1 Business and Profeuioro MOVING Code) 1 MOVING TEL �J �Cl� ro 1, as owner of the property, am exclusively contracting !tCONTRACTOR NO with licensed contractors to construct the project (Sec- 'p ADDRESS - Sec- tion 706", Business and Professions Code) REQUIRED _ CONSTRUCTION LENDING AGENCY SET BAYARD NWy TOTAL LIN FROM EXIST i q I hereby affirm that there is a construction lending agency forI FRONT - - - the performance of the work for which this permit is issued P t;Sec 3097, Civ C ) _ SIDE ' L PL Lender's Name A� C� �``� �• 6 Lender's Address PC Fee$ Pe I Fee ,,� I certify that I have read this application and state that the ksuoae F. .J g/ S above information is correct I agree to comply with all County Investigation Fee �l �t '� i�'/ a - j91 ordinances and State laws relating to building construction, gQ i i .Jnr JI and here authorize Tocol Fee by represenfafivm of itis Count'to enter upon the above-mentioned property for Inspection purposes ^3' 1 $gnome oi f i Agent _ � L AE ItEVFJDE FOR EIfPULNATORY-LANGUAGE L .( ' //Lly Applicant or pore — - — - — -- es