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Home My Public Portal About4967-4969 SERENO DR_Building__ WORKERS COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION FOR ILDING -PERMIT Ll insure or a Certificate of Workers Compenstion Insurance or _ a certified copy thereof (Sec 3800 Lab C ) - COUNTY OF LOS ANGEL L BUILDING AND SAFETY Policy PollNo Company Ce trf,ed copy m hereby furnts6ed FOR APPLICANT TO FILL IN BAu ILDIN Certified copy Is filed with the county budding mspec BUILDING I� tion department ADDRESS �/C LOCALITY A NEAREST Date Applicant CITY G ZIP v CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERSINO OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT-5-0 'WNOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed If the permit Is for one USE Z!A MA hundred dollars($100)or less ) ) TRACT BLOCK LOT NO I NO Y TEL -� p/7 SPECIAL ty I certify that in the performance of the work for which this OWNER C k LO CONDITIONS 0 permit is issued I shall not employ any person in any manner I ADDRESS Ccp c�� DISTRICT GROUP CYST FIRE D BY so as to become subject to the Workers Compensation Laws C S,5_ ` ,c / O CIm IN Fr7 (, �- rt' ZIP � 7 b Date Applicant STATISTICAL CLASSIFICATION API CONDO ARCHITECT OR TEL W NOTICE TO APPLICANT If after making this the Workers of ENGINEER �` NO CLASS NO DWELL UNITS Cl. Exemption you should become subje<I to the Workan N Compensation provisions of the Labor Code you must forth- ADDRESS - SEWER FG Z with comply with such provisions or this permit shall be EL VALIDATION deemed revoked CONTRACTOR � '61wp I BK _ r I - LICENSED CONTRACTORS DECLARATION LIC I hereby off irm that I am licensed under provisions of Chapter 9 ADDRESS r NO VALUATION aV t (commencing with Section 70DO)of Division 3 of the Business and LIC Professions Code and my license is in full force and effect CITY CLASS S 3.S TJ Vs SO FT NO OF nq OF CHECK License Number Llc Class SIZE STORIES FAMILIES ONE ❑ $' DESCRIPTION OF WORK NEW Contractor Dote ! ADD 0 - I am exempt from the licensing requirements as I am a lS licensed architect or o registered professional engineer r I ALTER FINAL acting in my professional capacity (Section 7051, REPAIR DATE Business and Professions Code) _ USE OF / � ` C] FINAL _ EXISTING BLDG - '^" �-� DEMOL Lic or Reg No Date T , OWNER-BUILDER DECLARATION (PRINT) C- NO q I hereby affirm that 1 am exempt from the Contractor s License ADDRESS 9.�5 S �. �' �t Law f he following reason (Section 7031 5, Business and Pro ions Code) BUILDING I as owner of the property, or my employees with ADDRESS 1 35.0A wages as their sole compensation will do the work and - - the structure Is not Intended or offered for sale(Section LOCALITY - # • • • • 1 7044, Business and Professions Code) MOVING TEL I as owner of the property'am exclusively contracting CONTRACTOR NO 2 • • 520 0 with licensed contractors to construct the project (Sec ADDRESS , r tion 7044 Business and Professions Code) - - • • -5200;-' REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD �y PROP UNE WIDTH I hereby affirm that there Is a construction lending agency for FRONT 0 9 28-81 the performance of the work for which this permit is issued Fit ' _I (Sec 3097 Civ C J SIDE - - PL _ Lender s Name _ 1 - $ P C Fee S I Permn Fe I ' Lander s Address 5 I certify that I have read this application and stale that the Issuance Fee _ above information is correct I agree to comply wnh o11 Count' tnvav,gaoon Fee ordinances and State laws relating to budding construction iotnl fe G andhereb thonze representatives of the County to enter ASJ upon t a re enti roper for ,nspect,00nn p ses SEE REVIL FOR EXPLANATORY LANGUAGE ^ S,gnarere of Applicant or Agent Date I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC {ORAS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0704040004 PHONE (626) 285-0488 EXT LEGAL ID NO OP CONST BUILDING ADDRESS ON FILE I SQ FT STORIES TYPE ' 4967 SERENO DR (STRUCTURE 1100 + VN TEMP CA 917003035 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET ENCINITA 5388-015-015 THOMAS PAGE 596 GRID H5 LOCALITY TEMPLE CITY, Cl (TENANT EXIST BLDG USE REBID USE ZONE R-2 ISSUED ON PROCESSED BY EXPIRES ON EXIST OCC GRP 04/04/07 JK 03/29/08 IOWNER TEL NO SLOGS NOW ON LOT VALUATIONIF_M FIT CODE IFEHR PATRICK F (626) 287-8234- 4,000 I 4967 SERENO DR TEMP 917803035 + FEES PAID DESCRIPTION OF WORK I TEAR OFF AND REROOF COMPOSITION SHINGLES PROW HOUSE I FEE DESCRIPTION QUANTITY UOM AMOUNT (APPLICANT TEL NO I SAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27 75 IAC STRONG MOTION REBID 4000 00 VAL 0 50 (SPECIAL, CONDITIONS I ID2 PERMIT W/0 EN-HC 4000 00 VAI - 115 80 ` TOTAL FEES 1 144 05 [CONTRACTOR TEL NO I y [APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER _ i I LIC NO IIDCA71ON AND SETBACKS (SOILS ENGINEER APPROVAL I ARCHITECT OR ENGINEER TEL NO FOUNDATION/TRENCH FORM9 I [ LIC NO SLAB/UNDER FLOOR i _ RAISED FLOOR PRAFIING I MAP NO SIi VER MAP BOOR PAGE FIRE ZONE CMP UNDERFLOOR INSULATION [ I144H265 3 - Oil _ V FLOOR SHEATHING ING OF FAMILIES DWELLING UNITS APT/COND STAT CLASS NO 21 I ROOF SHEATHING I I SCHOOL WITHIN HAZARDOUS SHEAP PANELS AIR QUALITY 1000 FEET MATERIALS NO NO NO FRAME. INSPECTION (REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS ISET BACK YARD HWY PROP LINE WIDTH IFRONT PL- INSUTATION/WEATHER STRIP( 9IDE PL- INTERIOR LATH/DRYWALL I I BRTERIOR LATH I (RATED FLOOR/CEIL ASSEM RATED WALL ASSEMBLIES I RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE I I I I I / REPORT ID DPR261 ROUTE TO BS0508