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Home My Public Portal About5020 SERENO DR_Building__ APPLICATION FOR BUILDING PERMIT ' COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN , BUILDING ADDRESS I hereby affirm that I have a certificate of consent to sett insure 811111-DNG XDRESS ./ or a cerhfrate of Mrkers COnne peabon Insurance or a certified J50 !V ` copy thereof(Sec 3800 Lab C) Crit/ ZIP T LOCALITY Policy NO Company SIZE OF L NO OF BLOCS NOW ON LOT ❑ Certified copy is hereby furnished I NEAREST CROSS ST ❑ Cerhhed Copy is filed with the County buJdlrlg mWacton TRACT BLOCK LOT NO department USE ZONE MAP NO Date ApplicantASSESSOR MAP PAGE ^ PF*ZEL ell SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS, OVrtER TEL NO G: COMPENSATION INSURANCE WAR 61000 FT OF SCHOOL? YES NO PDOFiE DISTRICT GROUP TV CONST FIRE ZOtE PROCESSED BY (This section need not be completed d the permit s for one hundred , O dollars I$IGO)or lass) I certify that in the pa4c mance of the work for which this permit CITY ZIP pg is issued I shall not employ any person In any manner so as to �2 6< Uri �� l l � 3 become sublect to ft Workers COmpenseGpt Laws 1 ARCHITECT ENGINEER TEL NO _ STATISTICAL CLASSFICATION APT CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS NOME TO APPLICANT If after making this Ceref tate of REWIRED TOTAL SETBACK FROM EXIST 'Exemption you should become subtect to the Workers CONTRACTOR �7''' " TEL NO SET BACK YARD HWY PROP UNE wmN Comi ensetxm provsgrs of the Labor Code you must forthwith eF�—/�/t/ FRONT comply with such provsions or this permit shall be deemed revoked ADDRESS LIC NO P L _ LICENSED CONTRACTORS DECLARATION SIDE CITY LIC CLASS P L hereby ilium that em licensed o unde,cri 3 of the of Chapter 0 SEWER MAP -(commencing with Section 7000)d Drvisxxl 3 of the Buaneas and 50 F7 S� NO OF STORIES NO OF FAMLLJES ' Professions Code and my license s In full force and effect NEW BK RG ' d License Number LTC Class DESCRIPTION OF WORK ADD ❑ WLUATION O Contractor Date ALTER E] 8 $ 7�p ❑ I am exempt under Sec QAP REPAIR ❑ p� BSPC for this reason D, V DEMOL 13 —=,,C Date USE OF EXISTING BLDG URM ❑ - ' d $IgratUTO -APPLICANT(PFB✓I) TEL NO LOMA Porro♦ ' 1 • Z Cl I as owner of the property or my employees with wages as " IZ ACCT.: their sole compensation will do the work and the Stnmture s ADDRESS F 3 192.45 not intended or offered for sale (Section 7044 Business and FINAL DATE a 1 Professors Code) ITEM TIE rrancraT oR FUTIRE axew0 accieAaT w IXJ2 A rwzAnsous MATERM r 'I as owner of the property am exo1USNe contract with M A WI E CONTNMIID A HAIMogr91AMERLLL Ep TO oR GREATER TINN TIE FMAL BY 1 /�` ly n8 AAgIMiB SPELFED ai THE 1 DOLS NATERU YFOnNAT10N 61ACEi TOTAL 192.45 Business contractors toCotieconstruct the protect (Becton 7044 &sines end Professions Code) vas❑ NO❑ ' VAL TIE REQUIRE USE CF ,11E BIAq.Na 9Y TIE ArpuiurT OR FU 71 Sl.RllfA CHECK 192.45 ODCIFYM rEOLmE A PERMT FCR CORICT( TioN CA E PERATXM'FROM TIE T FOR 1 .00 CONSTRUCTION LENDING AGENCY DUNES urY Mv1Ai��xlEur asrracT IscraMo)SEE PERMIITIND aEcxusr EDIT CHARGE I hereby affirm that there Is a construction lending agency for v s❑ No❑ _ r the perfornsnce of the work for which this permit s issued(Sec 3097 CNC) �CKUST I I�WDERSnANDMYo.�a� �U1 RT� aEi WY 0000-0001 `10/24/95 Lender a Nano WMA �PPDMI,10o MD F�Mw WG ATS PEM1�EROIn i1E D IWZAnmaA9 29b4 1 AM 8:22 Lenders Address 0 oArcn w Aron I certify that I here read this information and state under penally / g Of penury that the above this application a Correct I agree r pIX1T)ly PC FEE PERMIT FEE .7 ` 0 veth a cm ty Ordmanxes and State laws relating to builthrg Cale IDn rid hereby authorize representatives OI the County ISSUANCE FEE � c to en ree d property for upectwn purposes �J INVESTIGATION FEE TOTAL FEE / SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATIONS FOR BUILDINGGPERMIT COUNTY OF LOS ANGELEAND SAFETY WORKER S COMPENSATION DECLARATION r FOR APPUCANT TO FILL IN I I IeLanlNa ADOREss I hereby affirm that I have a certdicate of concent to self insure � a� or a cerbh _cate of Workers Comperazi Insurance or a certified t ( r copy thereof(Sec 3800 Lab C) - - ` nP , \T '1 Policy No Company SIZE OF LOT NO OF BLIX39 NOW ON LOT ❑ Certified copy a hereby furnished SIZE CROSS ST L ❑ Certified copy is bled with the county budding mspeclon TRACT BLOCK LOT NO USE ZONE MAP NO depertrnent j� pAq(�;�{ - is�y "1.-;2 6 S-- Date- APPICant ASSESSOR MPP meq( V I Z b'LI SPECIAL CONOrr*NS CERTIFICATE OF EXEMPTION FROM WORKERS R 3 ' COMPENSATION INSURANCE WITHIN 1000 Fr of SCHOOL' yes NO (This section need not be completed if the permit is for one hundred ADDRESS 4C=LASS STRICT , GROUP TYPE CONST FIRE IDtE PROCESSED BY dollars($100)or less) - , I cerhly that in the performance of the work for which thu permit DT' LP / is Issued I shall not employ airy person in arty manner so as to O _e become subject to the Workers CampereatKm Laws TEL NO CLAAS/S��SIF��ICATION / APT CONDO Date Applicant _ h �.L DWELL UNITSNOTICE 70 APPLICANT If after making this 'Certificate of I� REQUIRED TOTAL SETBACK FROMEfaSTExemption you stoud become subject to the Vilorkers TOR NOSET BACK YARD HWY PROP UNE WIDTH Conpensatwn Proms Of the Labor Code you must fortMwth co ply wrth such pnmsons or this permit shell be deemed revoked ADDRESS Lic NOPLICENSED CONTRACTORS DECLARATION DE CITY - LIC CLASS L 7 hereby ng that I am Icensed underprovecre of Chapter 0 Profession with and 7000)of in full 3 0l and &emess and FT NO OF�[ORIES NO FAMWES NEW BK WWER P Po (jtl f.i } Professore Code end my loan%S In full farce end effect �� , License Number LIc Class ADD ❑ VALUATIONlei=•?L� Contractor Date ALTER ❑ $ 6!S'O 1 I fENS ❑ I am exempt under Sec REPAIR ❑ $ 101AL 14iC...dam B.SPC for this reason DEMOL ❑ CNECk 143.t= pM P/C HM �T Date USE OF EXISTINO BLDO URM ❑ [f1j1 GE Signature ) TEL NO LDk1A Perm• `tl z ❑ I as owner of the property or my employees with wages their sole compensation will do the work and the structureA S ESS ` TIVJOD (('/1�'/1 not Intended or offered for sale (Section 7044 Business and L Fl114L Q 1 !YID Professlprl9 Code) wtL THE AP%JCAHT os FUIUrE euC.CP1a oCC1l'MNT IMN0.E A INZARP'Us NATERMI v CCC_!!!�- ITCCJXNCj fffff''II 11111 I e9 OWnef W the Property 8m BJfflLL9Ne COrlffeCll with A MaRLPE rlAIE91AL EQUAL TO OR GREATER THAN THE, exclusively rIg AMaN19 SPE MA3NiW1l$NATERILLa KORWII01r GUDEt FlIIAI 8Y > �pTw1 +NI��62 licensed contractors to construct the pragcl (Section 7044 Ws❑ W _ _..•��, .,J . .'i t IR 182 Business and Professions Code) •• _ r.jT��/ wu THE w DED USE on THE B DUNG BY THE APPuuvr on FITTLP+E eldoeJG _ Cd1GCK 1827.62 OCCUMNL REGIHiE A PEmm FGR ppfrSmUCTDfI OR MgGF1UTl(kr FROM TIE 9gRH )+,r.I�� •00 CONSTRUCTION LENDING AGENCY poL> saururY ' '^�'<'"DISTRICT IsupNOl SEE PERI 140 a CXx Foil �' - 1 A.1"It1L� I hereby affirm that there is a construction landmg agency for W80 Nat ; i Il 1, ; �• 1 , ' N the pnce of the work for which this permit Is issued(Sec m erformaIrvA�REAn uATEBALsrsoRruTDNGuoE ArD THE stwouDPEaurrrva L• . I �; ,( j I f n Lend CIV m) irt�E 2 R]s�o cr�KIHSRE Y zo�aao�RG 2 UNDER]o l.�o c JD W140 MOQb ' s WOO-- '�(� Lender 9 Nitrile WTE 9 rEPoFTNp A!D F a OHPfIPIq A PEN F THE SLAGI,p UUV�W V 1 4411/96 823�0rL Lenders Address - 1 1 8•JV 0 I f peau that have mad the matioaton and state under penalty G n g with penury county the abae information St IS correct briee to caning PC FEE ^ PERMIT FEE a e •�� with ell county ordlrences I State lew9 relabrg lo lwll6rg L , 7 lent a Ui e r BBMetNes Of this COurdy ISSUANCE FEE x2730 m to rty far I pGfP08ay g PNES GAT ON FEE TCn[AL FEE 7 a a Apv SEE REVERSE FOR EXPLANATORY LANGUAGE