HomeMy Public PortalAbout5038 SERENO DR_Building__ rawaaaw DRw aw rd � � .
APPLICATION FOR BUILDING PERMIT
DMSION OF BUILDING AND SAFETY BUILDINGS SF M
ADDRESJ L/1C
Do= of County Eughwer
Colmtp of Los Angelo[ LOCALITY
WPM J FOX COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUP T OF BUILDING CROSSUT
DISTRIG7 NQ GROUP SEWSEWERYAP
FOR APPLICANT TO FII.L IN �20- � CON l�C [J!C"
BUILDING J✓/ / STATE
ADDRESS SMAP
Y� °NWY
LOT NO ; N¢ IIH
CONDITIONS
/G /T'/TI"L/
TRACT
` NO OP BLDGo' BUILDING EXIST
SI2E OF
LOT NOW ON LOT SETBACK YARD HWY STREET NAM[ WIDTH
UEXISTING B¢or G tL/ELN�L PROr^' 20 S / �'✓q 6
P L
OWN¢It — SIDEP. -
MAIL
ADDRESSjr� 2'aT e f O TRACT DWELL f UNIT !S INDUSTRIAL
NO / �.'L-) DWELL 1 UNIT IS PIUSLIC BLDG
ARCHITECT OR TEL 2 DUFLBE f UNIT AVON . ALT ETC.
ENGINEER NO 3 APT —UNITS
B YIBCEL
ADDRESS
4 COMMERCIAL
TEL INSPECTION RECORD
CONTRACTOR NO
REBS (o IS M A
DFSCRIPTION OF WORK
NEW ADD ALTER REPAIR !f HMOLIBH _ 1 1
Bo IT NO OF NO OF
SIZE STORIES FAMILIES 1 l lrr
USE OF STRUCTUR
' � 1
SIGNATURE OP APPROVALS
A
A►FLICNT
ADDRESS DATE INSPECTOR S SIGNATURE
FOUNDATION LOCATION
s /y� P.C S FORMS. MATERIALS
5o F[¢ FRAME FIRE STOPS
VALUATION S� BRACING SOLTS
FE6 FURNACE LOCATION
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS °"VRNT DUCTS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WI ALL COUNTY ORDINANCES LATH INT
AND STATE LAWS REGU 1 6DING ONSTRUC-
TION LATH EXT
SIGNATURE OF HOUSE NUMBER CO
PERM] / RECT AND POSTED
ADDRESS V FINAL
WM J FOX.COUMT-/ENGIMZKd VALIDATION C N DIRLAM. CHIEF BLDG INSPECTOR
f�F�4 7 7 0�R APR 5 1 200
J
WORKERS'COMPENSATION D'CLARATION
4)I hereby affirm that I havecertificate of consent!a HlFM: APPLICATION FOR BUILDING PERMIT
insure or a certificate of Workers Compensation Irourance, �• •
or a certified copy thereof(Sec 3800, Lab C ) ti{
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No Company BUILDING
O
Cerufied copy is hereby furnished FOR APPLICANT TO FILL IN ADORE55
Certified copy is filed with the county bmkfing mspec- BUILDWG ,p
tion department ADDRESS IrOl \('5" 'O .041jed LOULm
NEAREST
Date Applicant CITY ZIP CROSS ST
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 7Q X I7/ NOW ON LOT MAP BOOK PAGE PARCEL
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one USE ZONE I MAP
hundred dollars ($IOD)or leu ) - TRACT BLOCK LOT NO NO
TEL / SPECIAL
I cenify•that in the performance of the work far which this OWNER 614A4;7-7 NO 'IJ-1-0704- CONDITIONS IL
permit is issued, I shall not employ any person in any mannerDISTRICT GROUP TYPE FIRE PROCESSED BY O
so as to become subject to the Workers'Compensation Laws ADDRESS 16*LS M .=1N1L A CONST Z U
Q i 09
CITU DV Af • ZIP 0 7 /G.. O
Dale ` Applicant ARCHITECT STATISTICAL CLASSIFICATION AFF CONDO V
OTICE O APPLICANT If, cher making Mh Certrfica a of ENGINEER NO CLASS NO DWELL UNITS_ W
Exemption, you should become subject to the Worker ti
Compensation provisions of the Labor Code, you must forth ADDRESS SEWER MAp 'A
with comply with such provaions or, this permit shall be _
deemed revokedCONTRACTOR NO BK FG VALIDATION
LICENSED CONTRACTORS DECLARATION LIC
I hereby affirm thot I am licensed under provisions of Chapter 9 ADDRESS NO VALUATION
(commencing with Section 7000)of Divaion 3 of the Business and LIC
Professions Code and my license Is In full force and effect CITY CLASS f 10,
SO FT NO OF NO OF CHECK ►
License Number Llc Class SIZE STORIES FAMILIES ( ONE
f
• Contractor Date DESCRIPTION OF WORK NEW ❑
I am exempt under Sec { - " y ADD ®
( / ALTER ❑ FINADATEL.•�
`• B 8P C for this reason � �D REPAIR ❑ '
USE OF
Dote 1 EXISTING BLDG pEMOL ❑ EyAL
APPLICANT TEL
Signature OWNER-BUILDER DECLARATION r PRINT G NO S —
I hereby off um that I am exempt from the Contractor's License 1 ADDRESS �:� J� X11107 ►Low far the following reason (Section 7031 5, Business and 11
Professions Code) IPRESENT
ILDLNG
I, m owner of the o Y employees ADDRESS
C prop", or m do to ees with ADDRESS
theses ct their sole compensation,will f o the work and LOCALITY
§ 4 4 2 1 A
the structure is not Intended or offered far sale(Section
70" Business and Professions Code) MOVING TEL n • •I• • •I�
I, as owner of the property, am exclusively contracting CONTRACTOR NO
with licensed contractors to construct the project (Sac- ADDRESS2 • 1 2 &88
tion 7044 Business and Professions Code)
CONSTRUCTION LENDING AGENCY { SE-F gApIX YARD HWY TOTAL P5�CK FROM WIDTH • • 2 C,8 8i
c�
I hereby affirm that there Is a construction lending agency for FRONT , Q 8 1,0 -8,3
the performance of the work for which this permit is Issued P L
tSec 3097, Civ C ) SIDE _
PL
4 Lenders Name
8
- lender t Address I PC Fe•f Permit Fee
I certify that I have read this application and state that the Issuance Fee
` above information is correct I agree to comply with all County Investigonon Fee `
a$ ordinances and Sate has relating to building construction, Total Fee
and hereby outhonze representatives of this County to enter
upon the above-mentioned property for inspectionpurposes
f0 RfVGSFOR FxPIANATOeY LANGUAGEp�wppli�cant nt 't
r ,
pate �s
11