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Home My Public Portal About5041 SERENO DR_Building__ Ud' ' '- APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FORAPPLICANTTOFtL IN BL11LDINGADDRESS 1 hereby of llm that I have a certificate of consent to sen insure. BUILDING ADDRESS Cyd or a certificate of workers, Compensation Insurance,or a certified - �T�`��'F14 11 if&.9VC 15A 5041�j �[�/� D Copy thereof(Seo 3800.Lab D LP O '1' Jj Company D / l`617E OF LOT NO OF BLDGS NOW ON LOT ` ❑ Ca-WWII copy IS hereby f ffnlsl ed NEAREST ORM ST I�Cariffied 00" is filed With the County building kspection TRACT BLOCK LOT NO USEZW NO . department N PAPE /� q DeteApplicenl 'J{4at�L1--�� ASSESY ffK C/�lo -7 —•J gp / �C its CERTIFICATE OF EKEMPTION FROM WORKERS' x NTTF9N r(000/1 7—rEC NO NO COMPENSATION INSURANCE (This section need not be completed If the permit b for one hundred DmmcT P TYPE zonas dollars($100)Or lees) C �J rev i D I certuy that In the performance of the work for which Via perrat M v_ {J, N L , 3 � 3 Is lamed, I Mall not empty any person In my manner eo as,to ARCH OR ENGINEER TEL NO II�� tscome subject to the workers'Compensation Laws. M _ STATISTICAL CLASSIFICATION APT COM50, Date Applicant ADDRESS I CLAW NO eeDWELLuNrm 11 1 N077CE TO APPLICANT If, after making this Certificate of ' 03.0-5—Si,. A REWmm TOTAL SETBACK FROM DOST Exemption you should become subject to the workers' DONrRAcra1 e n I C TEL -�V -� SETBACK YARD HWY PROP LNE WIDTH Compensation providons of the Labor Code you must forthwM V tea. comply with surf)provisions or it=permit shall be deemed revoked E58 I eY . ILID NO FRONT pL LICENSED CONTRACTORS DECLARATION ' I LID Off / DE SIDE L I hereby affirm that I arr1 Ilcansetl antler provsiona of Chapter 8 13 SEWER MM •r (Commencing warn Section 7000)of Division 3 of the Business,ate 80 Fr SIZE NO OF STORES NO OP FAMILIES Moteeelors Code, as,to In full farce end erred NEW BK PG , 3307 779.bg A DESCN OF WORK MSS License Number ' 0 Lk Goes Ung of 1 ADD ❑ yAMBd O0 .,_ 1 ITEMS 05 ComractorN�alde�{�y�L ,7acee,. 1 I-�I-y ALTER ❑ TOTAL 779_ b7z ❑ Iernexempt under Sec REPAIR ❑ $ / 400. B BPC forthlareason _ DEMOL ❑ LDMA Pips (.�FSYl7E i1:f Dsae USE OF EXISTING BLDG URM ❑ i 1 Signature (PRINT! TEL NO LOMA Penne a, T, .,a,.� ❑ I ea ow sr of tiro 1912.--it0 -V1 Z I}Lull�-uuu 1 3/1_'x/90 property a my employees with Mega,es, their sole compensabon,will do the work end the structure is 1 ADDRESS - Iq F 94.,E _ F77111.1 `J not intended or offered for sale (Sechon 7041 Business and 1 FaalL DATE RTL+ Prolesabus Code) wauTRsiAAPnxswraa Rnur�ewLnmKuoccuwnrEQUAL wrau=.AswiaoanuaerwL L , I, as, owner of the property am exclusively eontracbng with A e rTEn aHaN ns, wLoas uArrmwnieore uan ou PduL Brl`` b f 1 1 Ikxnsed Contractors eo conswet the project (Secbon 7044j .,�❑ w❑ - + i i �+ '� -EHEC); Business and Professions Code) — -- I wu nE rrtvmeo USE of ra auLnen BY oa nmuma awLnlra CONSTRUCTION LENDING AGENCY QUAUrrYA•ewu. DiSTRICT uc,KLROMM SIM ATnH raor.ncearm I hereby affirm that there is a comVucba,lending agency for �❑ Iq❑ the performance of the work for which this permit 13 issued(Sec I were aeAo.rE nwARoas"TDIIALS"e TKAI cube AM ns,SCAorm 3087 CNC) � rnrnarrrenO alepalar I VaBiarA1D rIr rsCuselavrra uumn TIR Lee A1GHE8 IJ iC:I Landale Nenro muKecoeTma`•aeio sea sic oAvPnrerTL 1 ��1��:�' Lendele Address once.a..m.r I certify that I have read this epplicabon and side that the above / � mformadw is correct I agree to campy with all county PC FEE %/-. - PERMIT FEE /� ordinances;and Stade Iowa relating fo bulldog construction,and • .6!Q�J hereby au0iortze repreeent&dm of this County to enter upon lssuuvice the above-mentioned property for in yy jQ �A]-- - , 11-�1-41 INVESTIOATEDN FEE TOTAL FEE 3 Q' or a r SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS COMPENSATION DECLARATION 1,hereby a affirm that havecertificate of consent to self .APPLICATION FOR BUILDING PERMIT insure, or o certificate of Workers' CompensaI tion nsurance - - or a certified copy thereof (Sec 3800, Lab C ) I COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No 4QA-Wl3 Compan;sitI& CWA& BUILDING - //l ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS GL�2 Certified copy is filed with the county building inspec- W DING tion department ADDRESS Date&'�3ApphcaM /�'I aTv ZIP LOCALITY ` CERTIFICATE OF FROM WORKERS' SIZE OF LOT I i NOW�ON&LOTS NEAREST SSST COMPENSATION INSURANCE I _ ASSESSOR 1 p r (This section need not be completed if the permit is for one TRACT BLOCK LOT NO d MAP BOOT( d I ! - PAGE PARCEL ':�'1 7 hundred dollars ($100)or less ) I V + LePI USE ZONE MAP OWNER NO ZONE I certify that in the performance of the work for which this — SPECIAL d permit is issued, I shall not employ any person in any manner ADDRESS ♦ - - �- 0 so as to become subject to the Workers Compensation Laws CONDITIONS O - - - CITY ` ZIP - U ' Dote Applicant ARCHITECTiw�l TEL DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT If, after making this Certificate of - ENGINEER - - -- NO - Z r i Exemption, you should become subject to the Workersp � C! ,Compensation provisions of the Labor Code, you must forth- ADDRESS - •�/ --3 f with comply with such provisions or this permit shall be TEL $- STATISTICAL CLASSIFICATION APi CONDO Z deemed revoked CONTRACTOR MO geD LICENSED CONTRACTORS DECLARATION UC CDASS NO DWELL UNITS I hereby affirm that 1 am licensed under provisions of Chapter 9 - ADDRE� Irj%L NO SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC and Professions Code,and my license is in full force and effect CITY C1.4SS BK PG VALIDATION ��//��//��.. L� SO FT NO OF NO OF CHEaC License Number 60gq� 1 1 'Lic Class V SIZE STORIES Z FAMILIES ONE ,.� VALUATION Contractor^� ♦♦�1� Date f0 '�-R�L DESaI1PTION OF WORK NEW $ �r O �- ❑1 am exempt under Sec App ,❑ :J ► - � ALTER ❑ B 8P C for this reason REPAIR ❑ $ DateUSE CF EXISTING LDG DEMOL ❑ SignAPPLICANT_ TEL t FINAL (PRINT) NO �AA NER-BUILDER DECLARATION DATE - '-iq, I hereby affirm that I am exempt from the Contractor s License - - - Law for the following reason (Section 7031 5, Business and ADDRESS FINAL Professions Code) _ PRESENT - By - - a '' -_ El 1, as owner of the property BUILDING or my employees with ADDS - -- - wages as their sole compensation,wdl do the work and ; 'S - _-LOCALITY ; the structure isnot intended or offered for sale(Section MOVING FEl y i L.,- 704 Business and Professions Code ) ❑ I, as owner of the property,am exclusively contracting COMR,s.C<CIR NO -- with licensed controctora to construct the project (Sec- hon 7044, Business and Professions Code ) ADDRESS CONSTRUCTION LENDING AGENCY )RED SET BA. YARD HWYTOTAL SETBACK FROM- EXIST PROP ., U I hereby affirm that there isa construction lending agency for FRONT _ - the Performance of the work for which this permit is issued PL - r (Sec 3097 Civ C ) SIDE g P L Lender's Name ^ PC Fees Permir Fa LDMA Ref Y 2 Lendeie Address V , t o 1 certify that I have read this application and state that the Inuanro Fee LDMA P/C Y above information is correct I agree to comply with all County Inveatgonon Fee c ordinances and State laws relating to building construction Total Fee LDMA Perm R < and hereby authorize representatives of this County to enter - - pY¢ upon the above-mentioned property inspection purposes _SEE REVERSE FOR EXPLANATORY LANGUAGE - rwNr. of Applicant or Agent Data