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Home My Public Portal About5080 SERENO DR_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORK$R'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby af8r that I here a cerlHfceM of consent to each Inwre, aua�ING E88 m a cerUflraa of Vlonkero'Compenaetion Inslrrorre,or a ceNiba AL 0 A25 D9 copy thereof(Sec 9800.Lab C) VV Cm zlv Icy No Company LOCALI — C SIZE OF LOT I NO OF SLOGS NOW ON LOT NEAREST CROSS 8f 1:1 Certified coq a hereby fumlded s / ❑ Certified Copy is filed with the county building Inspection TRACT BLOCK LOT NO USEZONE kw NO Dide Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' MrOAA �' COMPENSATION INSURANCE Lib - E N WITHIN t011a FT OF SCHOOL? rE,v ` (The section rleed net be COMPIOW d the permit a for one hundred :1 �B � '� DtSTRICy GROUP TYPE CONST F W E ZOr1E BY dollars($10D)or leas) o�Z` � t r I cerft that In the perlatronce of the work for which On pert oir e �v 7 - Ia Issued, I shall not employ arty person In any nNMer iso M to ARCKITECT OR ENGINEER TEL Np �•become errbOct to the Workers Compensation Laws STATISTICAL CLASSIFICATION APT CONDO Data—Applicant _ R � 1 NOTICE TO APPLICANT If afar making this Certificate of A EZ U a � DWELL UN IRED TOTAL eETeADIC FROM �ExlaT Exemption, you should become asubject to Ula Workers O s BET BACK YARD HWY PROP LINE WIDTH Compensallori you must forthwith V FRONT cc comply with such provisions or this perk afa0 be deemed revoked �c ADURE39 NO X11 AVEP L LICENSED CONTRACTORS DECLARATION CITY L LIC J PDE 2/�3� Sa I hereby affirm that I am licensed Under provisions M Chapter S h IO OF STORI��No OF FAMags SEWER ACCT.AT C (commencmg with Swum 7000)of Division 9 of the Business antl Rolee.iens cote,ant my tk7 is In null tome and NEW JR SK PG , 3307 693.6g 1_ PTION OF WORK ADD ❑ VALWITION _ License Number Ldc CIMe `�] ti Cootra(tor Date j ALTER ❑ _ — F _ TOTAL 1693. 6C1� ❑ l ern m exept under sec REPAIR ❑ "� _ CHECK 693.60 B&PC for this reason DEMOL ❑ Data USE OF EXISTING 81 —_ URM ❑ LDMA P/C 1 CHANGE .0( �f,YnY1VG ry�t I as owner APRICANT i LDMAIrSm1 " IOINJO—OW1 3/ 1/90 ❑ I M owner compensation fie property d my empk wW he wegM M ' W their solo edofferewrn do the work ant the Business a Is o 1 AMNO,?3 not ImNlaed a offered lir tale (Section 7004 BuelneM ant raAL Tti a Professions Code.) wK. OAR Rasa �NaDNT Na�ANAe„A„a �v-zs-9/ ; + 7 s31.4y ❑ 1 M owner of the property, am ax contracts with oa A lunA+e CCNTAINxq A 1MTAR(OV9 YATERLLL EQUAL ro aR Dewier TIMN protect (Section 7D44 E8�O mONT1ElrAlAlOpIisMATveM8a6ararATKxraUOEf ralALer I > f ' 1 ITEMS Incenses and Pr les to construct f the �✓Jf Bust neM and Proleaarons Code) � - ,' " YIILL TIS rNrt3am U�11F THE BUIIDPIa BY TTi APRJGVIT a1 RmAre ernLnara _ TOTAL 831. 49 COAST rIFDIlOiAFENaTfU DITURICT (NCRrmrc rTrsaNTlsawnr CONSTRUCTION LENDING AGENCY coder Aw aLluvrY NNrAorAa3rr IxBrRICr acADrml aff PvanTara ainumr � '- -'CHECK E31.49 roRauioaaua - I hereby mart that there U a caetrucbs p lending agency for rFn❑ rq❑ g 30 performance m me work for which role verb Is Issued(se( l% I- .';' CHANGE .Op 9087,dv C I Rage RE.n Tl¢HVAR((ue sTAIO W EQUM Troll time ANO Tri sa,(Ne m ) vDarrtw aEaa.mr I uaemruro w RewRomns un(er THE Ice ANanrs g Lender's Name NAls w>giro cagu laud Araunmo'uTlre �' i Len sAdareM 0000-0001 7/20/90 r I cartlly that I have read this appfimbon and era titer the above 1953 1 AM 10%45 IMormalm Is correct I agree to comply with all county PC FEE vERMrr FEE ordauun and State laws,reNarq to building construction and hereby authorize representattvee of this C runty to enter upon ISSUANCE FEE ^7 tebur en11011ed ro ny for Inspection purposes Y hehe ?—014, –p6 INVESTIGATION FEE TOTAL FEE ? y J SFE REVERSE FOR EKPLANATORY LANOUAOE / APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WOR1Wn COMPENSATION DECLARATION FOR APPLICAIR TO FILL IN BUILDING ADDRESS I hereby affirm that I has a cerffcate of cons. to seH Insure, d • �L or a Certificate of 1A xters Compensation leurenas,or a Certified /CG copy*wRsof(Sao.3800,Lab C I Cm ZIPn' C IAdILy No CampauryLo�Tr r L.G 912E LOT OF SLOGS NOW ON LOT ❑ Cwdfbtl Copy a hereby furnished ir NEAREST CROSS ST ❑ Certlfbd Copy Is filed with the County building Ir,F,- oro TRACT BLOCK LOT No department USEZOTE MAP NO Date Applicant_ ASSESSOR AAP BOOK PAGE PARCEL SPECIE CONDrT)Orl4 CERTIFICATE OF EXEMPTION FROM WORIfERV TEL wim-wa taco Pr OF SCHOM? YESNo COMPENSATION INSURANCE ADDRESS I dohs awflort($100 need not be completed H the permit ta for on hundred I O� 7yPE donate(81oD)Of b!a) CITY ZIP 10M`*their In the pertormarnce of the work for which the permitnowntjiudW e issued I shall not emplay any person In any se as to FTECTORENGINEEA 'TEL NO bled the WbrlKete Lewd SL1TL4fICi1L CnIA.S�SIF1U710N APT CQNDO Data AppOcant ADDRESS CLASS NO ^DWELL IarfT3 X NOTI TO APPLICANT If m p this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption you should beco a su act to the Workers' TEL SETBACK YARD I r PROP LINE WIDTH ComPermaDon provisions,of the Labor Cods.you must brtlmm FRONT comply with such partelons or the permit""be deamad MVOk d V LIC NO FR +___ X =j L LICENSED CONTRACTORS DECLARATION D Z v -- _t'S I hereby affirm that I em IlCeieed under prowabre of Chapter 8 G — SITYHi MAP (commencing with Section 7000)of DMOM 3 of the Business;and FT SIZE NO OF STORES NO OF FAMIuw NEIN '_ !TEM. Professions Code and my I n hull face and F ".scarab Nhmlber a® L _ N OF WORK / ADD ❑ vAwATnw D.p� ► i C'••JL 117 . 30" QP / ALTER ❑ $ ®VV" � .HE �• REPAIR ❑ $ h,HiM6G •I I� ❑ IsmjthI3 UM- Sac BBPCreason DEMOL ❑ LOW FVC e USE OF EXISTING BLDG Date URM 11LI:IJ�"�1 3l2y!"_ South a TEL LOArA farm e ^ l ❑ I as owter of the property or my employees with wanes m �{� _ �C�'_ 1 •—_ their Cob ea�eurcatim will do the wok and the stnuctre a Ess F not Intended or offered for role (Section 7Oµ Business anti I} Code) ofesauOrm Code WLLMAP0.1GNfplRnllmeenaaeeODLUnN1T A1W11palaWOHWI `Z S� � r•_ • CONfANKI A IWAl00.e aQ1Al 1V dl d�REll TNN I e owlmer W the property em exchefvsy Contrectirhp with OR A IfenWEMAMOI1M8sernr>®d MNAwmae veoraurlCN auoai FOIAL BY licensed one contractors to couct the project Mactbn 7044, Business,end Professions Coda) res❑ Nis❑ ��"" (/ TCI- L 15 1 a 9 WILL M INTQID®Ua!Of M aUILDe1a BY TNl ARInGVlT OA nnilMe alaLflele /� 1 OCL111MHf IlIJAUMV PEHariORC DKmRK7t(SCAO Y SIMIG ONFlKINMeOUTN lr:F.h� [C i.`= CONSTRUCTION LENDING AGENCY coyer MR auAun MwtAoetmrt asuncr tsclotol sea PeaarTelo oa�amr I hereby affirm that there Is a construction lending agerwy,for m No❑ ❑ the psAomsnee of the wank for which the parmrt Is Issued(Sec I sends IVNo M hNINm01e MAT ea�oRMATgN mlml AND M BCAcrA 3087 Ch C) eelourTrlp ouwauar I uwoeTmTw W RaoUNMrerta roes M Roe AtKIHFe Lenders Nanrms COUNTVCOOL TnnlxCNSPfWR]e MEAROrhp as R BNZM 000,1—' lam 10/2,t/0- Landsh Address a.a,a.m Ail 0 1 Certify that I hsls read the application and state that the above $� Information Is COrrW I agree te Comply with all COuny PC FEE O PERMIT FEE .�P9� FZ ordinances aridStss laws reWng to Wilding construction ction a • Ja Aeby eulhatae MpMNnta#Mof thb Cam to enter upon Is9uANce FEE / le INVESTIGATION FEE TOM FEE s.