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Home My Public Portal About5057 SERENO DR_Building__ DEPAESKINS OF COUNTS E NGnn= DMSION OF BUIIAING AND SAFETY®� B U l L®I N G BCOIINTY OF Loa COUNTY KNB 91 9 `I , APPLiCA7tON - --- IWATT J FOX.I COUNTY BNOINQQ1It.tid G. '� ATT D GRIFFIN, SUP T or Su1Lo1Na _ , � FOR APPIJPANT TO FILL IN ` t = FOR OFFICE USE ONLY BUILDING 131STRV NO , PUH CK on RGac ISO I PERMIT NO ADDRESS O �u� • � 7 I� LOCALI,fY. i EIVeD BY Te OF APDL DATEISSUQD NEARQBTryCROSS ST. _ • BUILDING A) OWN _J2 , U..jL I.L. .ADDRESS O y MAIL LOCALITY ADORES TEL NEAREST ,1,,, eRoeeeT ARCHITECT OR //''-/CITY I •TEL-J .1 a7 U .ZONE FIRE NPLANS 1 T�-' O OUP' ENGINEER K 1 • I C t.) :ted S . _ /J �.-�CL BLDG i o A^ BHrBACK LINE I I CO EL /�� USE / APPROVED ' � 'ZON BY DATS AODREBS� li 1 '}�. '• 1 'roO 01 HOUGH NUMBERING I LEGALI 1 Iw1- 'r . 1 'MAP NUMB n�nei� O AB810 �QD SY - - - �DESCRI ION LOTN SOCK a 1 1 CORRECTIONS TRACT k , NO OP BLD""xv -` ro, SIZE OP /� . INOW ON LOT � &W - - -- — EZ NO BLDG NO uOR ' - DP. ON OF WORN lo - NEW . ION 1, .1 'ADDITIOND Z REPAIR "DEMOLITION - "u. ' r EG Pr RO OF SIZE ROOMS STORIES 'ERT WALL ; ROOF COVERING COVER 6 -„I USE OF RQa APPROVALS INSPECTOR SSIGNATURB DATE FOUNDATION LOCATION FORME MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AR FRAME FIRESTOPS PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING BOLTS CORRECT IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION AND STATE LA REGULATI WILDING CONSTRUCTION GAB VENT DUCTS SIGNATURE LATH. INT FERMI LATH orr ADD PLASTER INT AUTHOR==AOT PLASTER EZT au FEE Gam- HOUSE NUMBER COR- / 0 VALUATION Lo �� RQCT AND POSTED PEE S �• FINAL 741A A 01111111 tea APPLICATIONTY COUNTY OF LOS ANGELES FOR BUILDINLG DING PERANDEMIT g WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers'Compensation Insurance,or a certified CITY 21P copy thereof(Sec.3800,Lab.C.) LOCALITY Policy No. Company SIZE OF LOT NO.OF BLGGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAI.CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS dollars($100)Or less.) DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY I certifythat in the performance of the work for which this permit CITY ZIP is issued. I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. become subject to the Workers Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLIGiNT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become Subject to the Workers CONTRACTOR TEL NO. SET BACK YARDHWY PROP LINE WIDTH Compensation provisions Of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS P L IL I hereby affirm that I am licensed underprovislons of Chapter 9 SEWER MAP 0 (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES 0 Professions Code,and my license is in full force and effect. — NEW ❑ BK PG LU License Number Lic.Class DESCRIPTION OF WORK ADD I!r VALUATION , J LL Contractor Date ALTER ❑ >- 0 ❑ I am exempt under Sec. REPAIR ❑ $ Cr Cr BAP.C. for this reason DEMOL ❑ CDMA PrC 0 Date: USE OF EXISTING BLDG. URM ❑ d Signature APPLICANT(PRINT) TEL NO. LOMA Perm♦ w Ql, as owner of the property, or my employees with wages as Z Rv��Q ~ their sole compensation, will do the work and the structure is ADDRESS F not intended or offered for sale (Section 7044, Business and FINAL DATE Professions Code.) WILL THE&PPUCANT OR FUTURE SUP-DING OCCUPANT HANpE A H IDOIIS MATERIAL = j ❑ I, as Owner of the property, am exclusively contracting with O A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER TWIN THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFOANOMON GUIDE? FINAL BY v licensed contractors to construct the project (Section 7044, AUTA rr� Business and Professions Code.) YES❑ NO QI MU THE NIENDED USE OF THE eUIDUNG BY THE APFUCANT OR FUTURE BUILDING OCCUPANT REOUIRE A PERMIT FOR CONSTRUCIgN OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY Co AR OUAUIY IMNAC£MENT DISTRICT IscAGMDI SEE PERMUTING CHECNUST FOR 2 IT GUIDELINES I hereby affirm that there is a construction lending agency for YES NO fOTfL 836 .23 /1. the performance of the work for which this permit is issued(Sec. IH EC READ THEH UNDERSTAND MY REQIALS UIREMENTS UNDER THE AND ANGELE COUNTY ITTINO GORE k 3097,CIV.CJ CHECKLITTLE 2.ST UNDERSTAND PTEIR 220 TI NS 220 HOD TH UNDER THE ROUGH 2 20 140 ANGELES COUNTY GODS Lender a Name MATERIAL-REPORTING AND ORSOBURYNG AA PERIMT FROM HE SCAOMD G HAZARDOUS 4��rr ` 0 Lender's Address flfii V p QNER W IGEN - o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct. I agree to comply P.C.FEE PERMIT FEE - Mkt-1,�(J '�; yi Sol with all county ordinances and State laws relating to building JJrJI �y 1 . construction, andJ1N eby authorize representatives of this County ISSUANCE FEE ato enter upon,"'bbove-mentioned property for inspection put " I" INVESTIGATION FEE TOTAL FEE m s SEE REVERSE FOR EXPLANATORY LANGUAGE IL . _.