HomeMy Public PortalAbout4972 SERENO DR_Miscellaneous__ il
• " COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT
DEPARTMENT OF PUBLIC {ARKS 9701 LAS TUNAS MP 0508 0307220003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT
LEGAL ID NO OF MMr— NEW BUILDING ADDRESS
ON FILE SQ FT STORIES TYPE OCCUP GROUP 4972 SERENO DR
STRUCTURE 1 VN U1 TEMP CA 917803036
ASSESSOR INFUMTION NUMBER'5388-012-014 THE�STPCAGE ROS559966REEGRID- NSINTLOCALITY TEMPLE CITY
IXIST OCC GRP USE ZONE
TENANT ISSUED ON PROCESSED ST: EXMM bF_
SLOGS NOW ON LOT VALUATION: 07/23/03 JK 01/19/04
0
OWNER: TEL. NO FINAL DATE FINAL BY 7WE
4� SERENOEDR;JAMES G RAY,RUTH E (626) 285-2141-
TEMP 917803036 6E5LAIFILUN up WORK
CONVERT GARAGE BACK TO INTENDED USE
OLCUP LOAD IXIST
APPLICANT TEL. NO
SAME AS OWNER OCCIA LOAD NEW
PARKING SPACES REQUIRED SPECIAL CONDITIONS
PARKING SPACES,PROVIDED _
EXIT HARDWARE Cr ,
CONTRACTOR TEL- NOi% F \ \ LIMITED TIME USE
SAME AS OWNER - NBR OF'IXITSJ� `�A
LIC NO //, V/ A/.L�� FROM TO
FEES PAID\\.
r ,
FEES DESCRIPTION t �_QWNTITY LION' �� AMOUNT:
ARCHITECT OR ENCrgnT-- TEL NO1 r 71TRAILER USE
OA PERMIT1ISSUANCE r-1 \�_ i'�'\ 27.75
LIC NO 01 R/M OCC/USE INSPECT — 145.95PERMIT
TOTAL FEES Iii' 111��173.70
1'NO OF FAMILIES: DWELLING UNITS. APT/CONO STAT
IIu CLASS' _� � 'i u�L
NOSCHOOL WITHIN
HAZARDOUS
AIR QLALITY 1000 FEET MATERIALS
NO NO NOREQUIRED MAL ShIBACK FROM EXIST
SET BACK YARD HWY: PROP LINE WIDTH
FRONT PL_ y
SIDE PL- �� `?8r VICE phi
���
REPORT ID: DPR267 ROUTE TO: SS0508
J�a n
WORKERS COMPENSATION a Cert DECLARATION CE76M444
875- MISCELLANEOUS APPLICATION {1
CE 876(1 i 841 _ LI
I hereby affirm that 1 have a s Compensation
of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION
insure, or a certificate of Workers Compensation Insurance,or
a Certified copy thereof(Sec 3800,Lab C)
Policy No Company FOR APPLICANT TO FILL IN AUILOD.1. 'j�97�
Certified copy is hereby furnished BU ILDINa 2 , 1 � E�� `rte Locw urr
ADDS¢9Y 1 f� Y
Certified copy n filed with the wunty budding inspectwn LOCALITY RAREST
department _W E NROSS ST
Date Applicant NRAReST DISTRICT No ur rr PR r ceeemD BY
CROSS HT C&,;
CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL O �7
COMPENSATION INSURANCE DESCRIPTION I LOT No BLocK A mNwA
NOP (uwCl[) STATE MAJOR SECOND LOCAL
(no section need not be completed If the Work involved
OF GLOBS VO1VEd TRACT NOW ON LOT USE ZONA SPECIAL CONDITIONS
by the permit is for one hundred dollars (2100) or less)
///��i
SIZE Or LOT USI Or
I Certify that in the Perforce of the work for which this ¢x1S
manTING BLDG
permit u issued, I shall not employ any person in my manner OWNER .7Jt KI IF o
so as to become subject to the Workers Compensation Laws MAIL n \ OCCUPANCY GROUP �� o
Dale Applicant
ADDRESS �� N • St(Ze_f,.)o ok w
U
NOTICE TO APPLICANT If, after making this Certificate of CITY TCS L!—:, CA rT+oL 2,9'5' Vcf I OCCUPANT LOAD a
Exemption, you should become subject to the Workers
Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE
with Comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ NO Spec Knowl ❑
deemed revoked
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION IBS Panic Devices
I hereby affirm that 1 am licensed under provisions of Chapter
9 (Commencing with Section 7000) of Division 3 of the Bust Swr SAFETY PERMIT E] (LIST ITEMS BELOW( NO Or EXITS
ness and Professions Code, and my license is in full force and LA-t,f rJ
effect PARKING REGD D PROVIDED D
r SPACER
License Number LIMITED TIME USE Lnc Class r �N�
Contractor Date Lk3 t rH 0 kT 6 bt-eIT— P.T. DAT.
0 1 am exempt from the licensing requirements as I am a �I INer¢croR S
licensed architect or a registered professional engineer SIZE or No or slGwwruwQ
acting in my professional Capacity (Section 7051, Bus- EXISTING BLDG ETowl¢S
mess and Professions Code) FINAL APPROVAL
Lic or Reg No Dale PRESENT tie¢ or BUILDING i7 Il
7-
167
HOML OWNER-BUILDER DECLARATION o oP Ex unluG Buumwae w
ON LOT AND USE 1 Op III ���
1 hereby affirm that I am exempt from the Contractor's '1 o 0 /�+ T 227 . 70
License Law for the following reason (Section 7031 5, Bustne and Professions Code) NO PARKING SPACES PROVIDED
�L T27.70IY1Ay1/'[- �Il11
1, as owner of the property, will do the work and the 171'BTVG
structure u not intended or offered for sale (SectionProfessions7044,Business and Professions Cade)
CONSTRUCTION LENDING AGENCY PwoP D USE or BUILDING ODIDG—M 2/11/K'
I hereby affirm that there is a construction lending agency 2154 1 AM10:51
for the performance of the cork for which this permit is
issued(Sec 3097,Cw C)
Lender's Name
PROPOSED MAX OCC
Lender's Address
PERMIT FEE
1 certify that 1 have read this application and state that the
above information is Correct I agree to Comply with all County ISSUANCE FEE
rndinances and State laws relating to budding construction,
and OQby alittharize representatives of this County to enter TOTAL FE a Q
upo abo e-mentionAperty for in pu oses
SEE REVERSE FOR EXPLANATORY LANGUAGE
Siiiiature of Permittee at