HomeMy Public PortalAbout5120 SERENO DR_Building__ t' APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Prmr or type only) I a
BUILDING COUNTY OF LOS ANGELES
ADDRESS �ERCA.3 o A� DEPARTMENT OF COUNTY ENGINEER
CITY CE GiT ZIP 9/T8o BUILDING AND SAFETY DIVISION
NO OF BLDGS BUILDING
SIZEOFLOT 3S' NOW ON LOT ADDRESS rSIZ
TRACT BLOCK LOT NO LOCALITY ` bE
OWNER=AliEL6GoL6FA12B TEL NEAREST
NOZ1?7"B'7 CROSSST
ADDRESS 51d370E i aleG Ab WESSORA MAP BOOK IPAGE I PARCEL
p DISTRICT I GROUP TYPE FIRE ESSED BY
{ITV C/LE C,E CyT ZIP /'Ip a CONST z
17
ARCHITECT OR TEL SC) Z CA777C-S
ENGINEER p (A„T AjE NO
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS TEL CLASS NO (J DWELL UNITS BK PG
CONTRACTOR NO USE ZONE MAP /
LIC NO -120
ADDRESS NO 2 Z SPECIAL
CITY
LI
C ASS
C CONDITIONS
CONSTR4CTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
NAME AND BRANCH BLDG SETBACK FROM
ADDRESS CITY FRONTPROP LINEOF (STREET)
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
SQ FT NO IE FA OF CHECK FRONT PROP LINE HIGHWAY WIDTH
SIZE A/ 16 FAMILIES ONE Y
DESCRIPTION OF WORK_ NEW ® + O
ADD C] BLDG SETBACK FROM
rU L6 $IDE PROP LINE OF (STREET) O
ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING
REPAIR
❑ HIGHWAY + YARD SIDE PROP LINE HIGHWAY WIDTH H
USE OF Z
EXISTING BLDG F AJG L L— F DEMOL ❑ +
APPLICANT�AR /6T ^ TEL ZB7 CORNER CUTOFF VES E] NO ❑
IPRINTI
IN OPEN SPACE YES ❑ NO ❑
BY ISIGNATUREI IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATIONS O 7-37f' !/iJ
I HEREBY ACKNOAnFDGIMAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMKY WITH ALL ORDINANCES
AND LAWS REGWTINK'BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT FMROY ANY PERSON IN VKXATKIN OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM
PEISATION INSURANCE
SIGNATURE OFI
PERMITTEE V'
ADDRESS
FINAL BY
TEL DATE
OTY NO
MAKE CHECKS PAYABLE TO PC $ FEE PMT $
14 VEYT BRANDT COUNTY ENGINEER FEE vO I Q79
`^
PLAN CHECK VALIDATION cK. w o CASH PERMIT VALIDATION (ZK� M o CASH
387fiJUL 523 ' R 167.40
585[ZSEP 2 1 D 279.00 •
ms ZAAG CEM3375 /JFK/
- I
r
WORKERS COMPENSATION DECLARATION 1 I / e ♦ Il
I hereby affirm That I have certificate of consent to 1 APPLICATION FOR BUILDING PERMIT
insure, or a certificate of Workers'
w
kers'Compenlion Insurance,
or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AN SAF
Policy No Company BUILDING
Certified copy is hereby furnished FOR APPLICANT TO FILL IN
ADDRFSS
Certified copy is filed with the county building inspec- BUILDING r
tion department ADDRESS SILO SL'lta No (�1/ I LOCALITY
Dote Applicant CITY ` T ZIP SV CRRO.SS ST
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT Z _ NOW ON Lor BLDGS ASSE PAGE PARCEL
COMPENSATION INSURANCE
,(This section need not be completed if the permit is for one TRACT BLOCK LOT NO USE ZONE NOP
24-9
hundred dollen($100)or less )
Al
I certify that in the performance of the work for which thisOWNER NOL 287 3 - CONDITIONS O•
PE
permit is issued I shall not employ any person in any r9anner JMTRICT GROUP TYPE FIRE D BY 0
so as to become subject to the Workers'Com nwtio awe ADDRESS O 09FI BROn W CONST ZONE
/l Data�`j.+11�1!_Applicant CAIRryCHLTECT O�R L T ZIP �L 7S() STATISTI IFKATION _ APi CONDO O
NOTICE O APPLICANT If, after making this Cent tate of ENGINEER c� U
Exemption you should become subject to the Workers' D G L, NO sow CLASS NO DWELL UNI75 Al.
Compensation provisions of the Labor Code, you must forth- ADDRESS Irt - SEWER MAP N
with comply with such,provisions or this permit shall be ! � Z
deemed revoked CONITIACIOR A4-1C.Od_ t 0 BK /A PG 7� - - VALIDATION
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS LtiICO 7'37 33 7 y UATION
(commencing with Section 7000)of Division 3 of the Business and LIC
Professions Code and my license is in full force and effect CITY CLASS �' ,
O 1 1 2 A
SQ NO OF NO OF CHECK
License Number tic Class SIZE STORIES 2. FAMILIES ONE O O O
Contractor Date DESCRIPTION OF K 0 NEW S ' �''•I. ° • 2 7)
ADD
I am exempt under Sec G - rOC>o ALTER C] FINALDATE y7 3 �� ° 2'8 6 08
B 8P C for this reason - REPAIR " - e ° 2(j �j�' 8
Date USE
FX STING BLDG MAX 0 FI AL � p 7 0 -8 4
Signature - APPLICANTTEL
OWNER-BUILDER DECLARATION PRINT vL NO '2.A '
I hereby affirm that I am exempt from the Contractor s Licensepop. 7
Law for the following reason (Section 7031 5, Business and V 0ADWA G8 7 - r • ° • ° —
Professions Code)
13 1, as owner of the y employe" BUILDING _ _ ° 2 1 4 20
property, or m em to ees with ADDRESS
wages ct thea sole comped or off rwilled f o the work and e ° L `4 2 ``
the structure is not intended or offered for sole(Semon LOCALITY -
70M Business and Professions Code) MOVING TEL 0 I, 1 T-8 4
1, as owner of the property am exclusively contracting CTOR NO
1 with licensed contractors to construct the project (Sec- ADDRESS
i non 7041 Business and Professions Code) 0 51,8 A
REQUIRED TOTAL SETBACK FROM EXIST
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY
I hereby affirm that there iso construction lending agency for ERONT PROP U WIDTH
the performance of the work for which this permit a Issued P L ► • 60000
i5ec 3097 Civ C ) SIDE
Lender's Name
c 5 0 0 0 G
P C Fee S L-
Lendei s Address r� • Permit Fee
I certify that 1 have read this application and shote that the, c5va7Y� Issuance Fee /0r_f-D
above infor.'- _E is comet' j oprse to comply sort.all County Investigation Fee �r V
ordMrices and Shote laws relating to building construction, Total Fee r 1t 0
and here authorize re natives of this County to anter ) (`
upon th a v mention property for inspection purposes
e
1 ¢- fEF RIVQfE FOR UIFIANATORY IANOUAG
Signature of Apple t a Agent pole ' ms