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Home My Public Portal About5082 SERENO DR_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKERS COMPENSATION DECLARATION FOR APPL1CAPITTO FILL IN BUILDING ADDRESS 1 hereby affirm that I have a oerBflcats of consent to sed I snre. S� AooR IS Al 5ARFA10 AR or a cKdroce a of Workers Compensation Insurance or a certfflwl x`1111 5psa 3sepn COPY thereof(Sec 9Bc0,Lab C) / C /1 r ILP -, Policy No Comps LG c L �• of OT I NO OF BLDG&NOW ON LOT C— C 11CerMW copy is hereby furnished kD NEAREST CROSS ST ❑ C8011111013 Copy Is filed with the county bulklmg Inspection O TRACT BLOCK LOT NO department I USEZONE NAP NO Data Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' FAA1 Ta Aho COMPENSATION INSURANCE WITHIN 10MFTOFSCHOOL9 res (Tho section reed not be completed d the permit Is for one hundred 0 Z E DISTRICT GROUP TYPE CONST FIRE ZONE BY I clWe($hat)or len) zIP / s 5A R.3 ... 3 I Issue that In Ma t employ performance of the work for which Mita a to Is lowed, I ahaa not empty am person io any manner en n f0 ARCHITECT OR QIGI TEL NG beDDme eDb)ed to the Workers'Compensation Laws STATISTICAL APT Dere Applicant CLASS ND STATISTICAL UNITS NOTICE TO APPLICANT If, after making this Cann icae of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers "CONTRACTOR . TEL SETBACK YARD HWY PROP LINE WIDTH C4mmust fordy*M 1rT-iI?1DC7,F Co" commply�wiMhwdl provisions or this permit shell bprovisions of the Lab"Coda, e deemed revolted l�t PL 111 o EZ .31 PL .30a LICENSED CONTRACTORS DECLARATIONSIDE 3301 uTY E IKPLM4SS I hereby affirm that I am licensed under provisions of Chapter S h 0 SEWER MAP (twmmencinp with Section TODD)of Division 9 of the Business and FT No aT No OF FAMw® NEW bI SK ro TOTAL 722 .30w Profenione Code.and my license Is in full force and affffect -Z p' License Number oflr3js? Lic Close (,] n DN OF WORK ADD ❑ y T1O�-' 9 (0 O U �,(� GEqC 722.3 Contractor Dale ALTER ❑ s (�(� .00Fr' ❑ I am exempt under Sac REPAIR ❑ — AIE- BaPC for thisraaaa, DEMOL ❑ LDMA PIC 0000 1 3/ 1/90 N;0-505 USE of DOSTs/0 BLDG _ URM ❑ 9227 1 A1110:++ 37ufe ! APFLICJWTltPm nIm LD"Penns I I 1 ❑ 1. as owner of the property. or my amploysee with wages as v — S✓D I their aDe compensation,wi l do the work and the structures r ACCT.i not Intended or oilm for sale (Section 7044, Business and Z V /''r. FauL DATE a g pinfassiona 9/ �7 M 72.62 1. " Owne Df the OR A 1EAPRI!000 DRn,n➢IaeUllla,DDDDDiMMTHNO,EAHAIAaD TER THAL (.p`��r 1 ITEMS• Cn A IaRRI!CCNMe 'e A HATARDdA YMrAMI.EWAL TO DR ORiAT6r THAN 11 / ❑ Lea owner tri the property em exclusively pro)o con(SWUM writ nEAwwnerscr®aKra HArArmanm MArenwaesoRYATgn Duan \ FpeAL SY� pR�� 1 Businlicensess and Profen o Code) the protect (Section Toed, ora❑ „D❑ Z I 'TOTAL 872 . 62 Bueirlsse and Pmreniorle Code) waL Tia Wrrrmm ueE v B!sAuoelo er ARLKN!r oR R„uBr eDxnaa I CHECK 672.62 CTI CONSTRUON LENDDKi AGENCY "MAK�T arOOw' (arwOoID) Tfaeoum 1 1 ^ Aol M ere reanmrKo aaaaner I hereby affirm that there Is a construction larding agency for M❑ No❑ V' n C .00 the performance of the work for which this penrld Is In, (sec ' / 11 r J , I ruse P!/D Tia IwAemm NArmuu eaomnATnorn ouu>E AND Tie et'wnrm J 1 l�I v� I 9057.CM C) � Fvuarnw QEoanar I,eoaerAro w naouwoorts uloeu TILE LOe ANDElE9 1 L: LandersName H� ":µDDm aReomwAmw"01RDe`�ra°Dia' Frmrr'�Ro�Mna / � 0000-0001 7/20/91, Lades Address I^�.J.� {� 1959 1 AM10:46 o I certify that I neve reed this application and atats Bet the above �1 tV V Ordounces anWrbrmatlon d State Nwecoffee l agree reading to building boncounty M PQ FEE �aa • �V rt S hwweby mz&*rlr0 DYe County to efdM upon ISSUANCE FEE , YR pu3. INYEBfIOATD«FEE TOTAL FE —E REVIEW FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORIFR'S COMPENSATION DECLARATION FOR APPLICANT TO FILL M BUILDING ADDRESS 1 hereby dflrm that I have a certiBcaa Of OMUWd to aff Insure. �)L or a cxtlBfate of Nbrkere Compensation lm mnc%or a carbffed copy tiereW(Bao 3990,Lab C 1 Cm - ZIP LOCALITY p Policy No CangmW 912E LOT OF SLOGS NOW ON LOT LE ❑ Certifled copy Is hereby furnished NEAREST CROSS ST ❑ CoMied copy Is pled with the cWrtty txaldlrlg Irmpectim TRACT BLOCK LOT NO daDerbnenit USE ZONE MAP ND Date—Applicant- A99ES90R MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF E)MMPTION FROM WORKER8' TEL No YES NO COMPENSATION INSURANCE '��'N"D vrtrNw,oeo Fr OF sdgoLT (7ha sacborl dead not he camPlead if the Parmff m for ane hundred ,j, V �O� �� r CrN�3T FmE ZONE siders(i100)or less) crTr ZIP - p�_�//T, 3 I cortity that m the Performance Of the work for which this permit dIAJ � m leered I deo not employ cry Person b arty men so es to rtECT OR ENOINFFA TEL NO Ned the Workers' Lana. STATISTICAL C//L��A'SSSI��FICATION APT CQ!!p0 Date Applrcem AGGRESS CLASS NO S DWELL UNITS X NOTI TO APPLICANT If or g this Cerblicate of REOIARED TOTAL SETBACK FROM EXIST Exemption you should beco o su act to the Workers �� SETBACK YARD HWr PROP LINE WIDTH Conlpersabw provbbns of the Labor Code you moat forMWM _ comply with such prow ns or thm permit dell be deemed revoked IK NO PROW ` PL LICENSED CONTRACTORS DECLARATION 9 LIC Z SIDE I hereby&M.. that I am licensed under provis"of Chapter 9 MAP , (carnrrarcng with Section 7000)of Dnnsw 3 of the Business ane SCf FT SIZE NO OF STORES NO OF FANILIR C Profadorts Cade end my I n full force she NEW [L} BK PG - 1 �y �y Lxxnsa Number a CWe "%!L D PTION OF WORK ADD ❑ vALAATI0N I!'faL 117 . ,3LJ ConbwtW Des n �,�. / c ? _ CEct ALTER ❑ $ ® �� :NE;K , { z ❑ Ismfu Sea C) REPAIR ❑ $ OWE •'-)- B BPClerecon DEMOL ❑ LpAAwcs Das USE °fm er'DG URM ❑ Blgnanae t!T( TEL LDMA P nn s - ❑ 1. es owner of the property, or ary ann0aysas with wages a �d ��+� 1 �•T' thw Bole eompermation will do the work and the structure m not Inmnded or offered for sale (Section 7044, Bus rens and o/sasrorm Cotla) wILLTNEAYFUGNTaII flrRweaNlDll10oaGaMNr A1MTMa0U$WTDWL - 2 RS _• ❑ t Soowre r of the property., am WCIUWV* CWbRafng With A raxnAs corrtAPOAi A NVMO0118 w eauL ro are aR$ATGI 1NAN yT�M_ 9CermBd contractors to construct the (Section 7044 the raAYOWTS BPIcm®aN Trf NArAmOl6 IWUWTgN Damn FMK By/ r/1 �r •j Imo' Business and ProfessCode) ors M❑ mo❑ Q !j_/ L u — O-H, 15 1 9-�7 wu ra vrrTN®Ass aF ra euaaso er ns!APRJUJ!!orf RnU1F arlRDaq _c- `_ FOA� omwwr uowmAvwar rorrmNarRlx:roNOWSEE wrroN mane rrceoum .FI_�p� - CONSTRUCTION LENDING AGENCY mar Aw ouAury•.•-•-^-_omTra.�lara06q eFr rosrrrrw arnnlsr -• r 1 hereby aflkm that there Is a constructionleMfng agency for MCI moo r-ft(�Ut I-the perkrmance of the work for winch this permit Is hued(Sec r N.YR a ra NATMIaaIA wT sGArOaVraN Duos Aro ra$040610 3087 CNC) FeamTso oteaOrsr l uraaewr W 16.0110®IBna wFA R4 Lae ANoats wrmrvcooa mtH2OusrwlxID 06uza,mnw ronzm,omlcrr+wvo f' ( { j Landers table N.2A�pa ORP Po1�oeLVMNa 61YRraW Tf YJialO fli�Ll �LI�I1{ L.1J��aq'��- Lender's Address a.Nfw x01 :47t�. 1 I'll' l.i1F: I certify that I have reed this app mfim and allots that 906 above Inlormebon Is cerrect I agree to campfy, with all comity, LPCFEE PERWTFEE ,3P9� ordirmcas and State laws relating to building OarmMotlon and • /hereby authorize rWraerrativa of this County m enter upon mss- FEE / - DroPerly(or 4mpechenP aaa K)N Fid TOTAL FEE