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Home My Public Portal About5031 SERENO DR_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOB'PERMIT y COUNTY OF LOS ANGELES B U I L D N G 1 WM J. FOX. DHIEr ENGINEER i FO PLI T FOR OFFICE USE ONLY BUILDING DISTRICT NO. PLDATAN OK. NO. PERMITT[ 1BfUN0. ADDRESS OCRE .�[ LOCALITY VED 5 Or APPC]DA7Vm NEAREST �. y-�y- L UILD CROSS BT Q OWNER ADDREIBB B MAIL ADDRESS LOCALITY' TEL NEAREST CITY NO CROSS BY � ARCHITECT OR TEL ZONE �� :LAND TYPE GROUP ENGINEER NO BLDG ORD. N4 ADDRESS SETBACK LIN[ APPROVED CONTRACTOR NO BY DATE UB[ APPROVED ADDRESS =Ir[ i BY DATE LEGAL D[BDRICN I LOT NO ,BLOCK CORRECTIONS TRACT /* or B BIZ[ Or LOT X J23 I NOW ON LOOT Y r(ISTIMUBEorD BLDG d ►AMl d NC MS DESCRIPTION OF WORK - -- NEW ALTERATION ADDITION REPAIR �/ MOVING DEMOLISH O so ZEA /,0 /� or ROOM• STORIES WALLROOT COVERING ''« COVERING USE Or NEW — BUILDIN 41 A 1 �I APPROVALS 1 _�__1 I NATION A D STATE T THAT 1 HAVE RCD THIS INSPECTOR I ' DATE APPLICATION AND STAT[ THAT THE ABOVE IS CORRECT ►OUNDATICNI LOCATION. . AND AGREE TO COMPLY ITH ALL COUNTY ORDINANCES rORMB. MATERIALS AND STATE LAMS REG TING LDINS CONBTR OTION rRAM[• rIRE STOPS. SIGNATURE Or BRACING. BOLTS - OWNER LATH. IMTJ - AUTHORIZED A LATy1 IXTI ' P O • PLASTER. INT J rR PLASTER. VCT. • /,p INAL VALUATION r[[ 75A!39A CX$803 11 " APPLICATION FOR BUILDING.PERMIT Z , COUNTY OF LOS ANGELES ADDREN0 DEPARTMENT OF COUNTY ENGINEER woorte9B BURRING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST CAGGATTO GRIFFIN BU►T018U.1-0. G CROSS ST 'Acaso DISTRICT NO GROUP ,SEWER MAP FOR APPLICANT TO FILL IN y! TYPE K CON IST BUILDING rear l ADDRESS BTATISTICALC SSI FICATION CLA99 NO WELL UNIT - LOT NO BLOCK MAP q STATE NUMBER uLG' HWY YES O TRACT USEZONE SPECIAL � NO OF BLDGB CONDITIONS SIZEOF LOT NOW ON LOT ` r, 5 USE OF KXISTING ICK YARD HWY STREET NAME -WIDTH— FRONT IG i OWNER SETBACK MAIL P L- 5ory A w ADDRESS 5M Sereno Drive SIDE ITY Temple City TEL P L C ARCH ITECT OR TEL INSPECTION RECORD TEL ENGINEER NO 7 DD R -rs TE CONTACTO N4956 _ ADD _ DESCBEMON OF WORK Lam, NEW X ADD .w ALTER REPAIRNO OF DEMOLISH 10 OF JA- SO ZE OYY STORIES i FAMIILIE81 USE OF STRUCTURE [� Lz_ r 81,OL1 REO t APPROVALS A INSPE OR S SIGNATURE ADDR FOUNDATION N C FORMS MATERIALS s S3O0 PC s QQ FRAME FIRESTOPS FEH BRACING BOLTS VALUATION f� FURNACE LOCATION �g GAS VENT DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LATH INT PLICATION AND TE THAT THE ABOVE 18 CORRECT AND AGREE TO Y ITH ALL COU O ANCE AND STATE 8 RH LA ING IN ST ION LATH EXT SIGNA ED HOUSE NUMBER COR- PER 1 RECT AND POSTED ADDR FINAL G CLYDE DIRLAM PRIN IPALST URAL OINEER PLSI/Cw=VALIDATION CK Y o wX PEHleT VALIDATION u mo C m -'FM6 3 3 7m� NOV 5 2 3-A 1 5.00e m, LG6505M NOV10 1A 3 0.0 0 WORKERS COMPENSATION DECLARATION �S 9r_reby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING -PERMIT fISI 'tcrb, or a certificate of Worker'Compensation Insurance or a certified copy thereof (Sec 3800, Lab C ) - COUNTY OF l05 ANGELES BUILDING AND SAFETY ElPolicy No Company BUILDING Certified copy Is hereby furnished FOR APPLICANT TO FILL IN - ADDRESS Certified copy is filed with the county budding inspec- tion BUILDING G��j department ADDRESS 5031 ✓ERS�Q LOCALITY �7 NEAREST Date Applicant CRv C n�2 ZIP q 17 O CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT I X Z;J NOW ON&LO 2 MAP BOOK ASSESSOR PP,GE PARCEL COMPENSATION INSURANCE USE ZONE •(This section need not be completed if the permit is for one TRACT BLOCK LOT NO C/ hundred dollars ($100)or leu ) �• .w1 �1 / -r17 /(//� _ SFECLAL I certify that in the performance of the work for which this OWNER O Rf, MON NO29?d L/3 V\ CONDITIONS d permit is imed, I shall not employ any pecan n any manner ADDRESS F'L 31 !� tT�\O `�f7 DISTRICT GROUP TYPE FIRE D BY _ O so as to becomes lett to the Worker nsation Laws V `wIV it �O� _� CONST_ ZONE UO CITY r • - ZIP /Jr/� Dote Applicant "V STATISTICAL CLASSIFICATION APT NOTICE TO PPLICANT If after making ilia Certificate of ARCHITECT OR - TEL G Exemption, you should become subject to the Workers ENGINEER NO CLASS NO DWELL UNITS_ Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP us with comply with such provisions or this permit shot] be 2 deemed revoked CONTRACTOR TEj LL BK PG VALIDATION - LICENSED CONTRACTORS DECLARATION LIC I hereby offam that I am licensed under provisions of Chapter 9 ADDRESS NO VALUATION ' (commencing with Section 7000)of Dtvtswn 3 of the Business and U UC q / Professions Code and my license is in full force and effect CITY CLASS $ / , - 5IZ FT �j� ST OF t40 OF CHECK , License Number Ltc'Closs SIZE OCGL>' STORIES FAMILIES ONE 1 tDATE t Contractor pate DESCRIPTKKJ Crt WORT( -T- NEW ❑I am exempt under Sec f-(011 0 M 1 57 �-8 8P C for this reosan S ^' ALTER OREPAIR Date U E OF ISTING BLDG DEMOL ❑ Signature APPLICANT TEL OWNER-BUILDER DECLARATION , PRINT _ _ NO - t I hereby affirm that I am exempt from the Contractor's License ► Law for the following reason (Section 7031 5 Business and ADDRESS - Rofnssions Cods) REWM , s- BUILDING r - I,tas owner of the property or my employees with ADDRESS ` wages as their sate compensation will do the work and , the structure is not intended or offered for sale(Section LOCALITY 704, Business and Professions Code) MOVING TEL 11 1, as owner of the property,am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec- ADDRESS a tion 7044, Business and Professions Code) _ - REQUIREDTOTAL SETBACK FROM EXIST S 4 2 4 A • CONSTRUCTION LENDING AGENCY SET ISAO( YARD HWY PROP U WIDTH , - I herebyaffirm that there is a construction lending agency for FRONT - _ _ e e e e e 1 the performance of the work for which this permit is issued P L (Sec 3097 Civ C ) SIDE - _ I e 1.2 4,8 8 PL Lender s Name e e e 1 24.886 Lender s Address PC Fee S Permit Fee 0 9 it 1 8 6 InaonceFee 1 I certify that I have read this application and state that the - Q - '5 ` aboveon a correct i opine to comply with all County Invmogmion Fee ordinancesces and State laws relating s budding County to este Total Fee y aril hereby out n:e representanvea of this County to anter a upon the a mention property for inspection purposes SER INVERSE FOR EXPLANATORY LANGUAOE- $pnaturs of Applicant or Agent Do �I