HomeMy Public PortalAbout5140 SERENO DR_Building__ DIP" ` °F ` BUILDING
1
DMSION OF BIIII.DING AND SAFETY
COUNTY OF LOS ANGEM
WILLIAM J FOX, Coutm ENGINEER APPLICATION
CABSATT D GRIFFIN, BUF'T OF BUnmMa '
FOR A PLICAM TO FUy >N FOR OFFICE USE ONLY
euILDINO '1 DIBTRI PI.AM C11 OR R[c NO PERMIT NDrA
ADDRESB -�I- U
LOCALITY MR BY DATE OF APPL ATB ISSUED
C
NEAREST C r
ADDRREBOILMISS
OWNER
MAIL �^
ADOR `S 1 0 6� LOCALITY a
NEAREST /
C TY TEL D CROSS ST
No-ARCHITECTOR FIRS NO OF OR
ENGINES ZONE PLANS
DDR SBLDG
ET"A LINE
CONTRACTOR TEL + USE APPROVm
ZONE Afy BY DATE
ADDRESS / 0 J'a HOUSE NUMBERING
LEGAL MAP NUMB O ASSIGNED (Ji
DEHCR PTIO K
CORREC[IONS
TRACT
_ NO OF BLOW
SIZE OF LOT Npw ON LOT
USE OF NO OF
EXI NO BLDG
DESC 1MON OF WORE D -
A_
NEW AL ADD D
Z
REPAIR DEMOLITION
BO FT
SIZE NOOYe STDRIEB
EXT WALL _ ROO
COVERING COVmi NG
UOQ OF UCTUREI _
APPROV
INSPECT 'SSIGNATURB DATE
FOUNDATION LOCATION
FORMS. MATERIALS
1 HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME FIRE STOPS
PLICATION AND STATE THAT THE INFORMATION GIVEN 18 BRACING. BOLTS
CORRECT
1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION
AND STATE LAWS REGULATING BUBAIN6 CONSTRUCTION GAB VBTlT DUCTS
SIGNATURE OF LATH. INT
PERM o- ,
S I 0 LATH EXT
ADD
PueTER. INT
AUTHORIZW AOT
PLASTER EXT
S P C •
m�
FEE HOUSE NUMBER COR.
�� RECT AND PORTED
VALUATION B FINAL
7"611" 011011 1�f1
f
APPL�C TION FOR BUILDING PERMIT
+ COUNTY OF LOS ANGELES _ BUILDING AND SAFETY _
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING AM 0 �/�� '
I hereby affirm that I have a certificate of consent to sett inure BUILDING AD 7S Y(�IV o
or a cerhfaYor
ate of kCompensation Insurance or a ceridstl
ers 2V Y/ 0 ,nY '
copy thereof(Sec 3800 Lab C) CITY ZIP LOCALITY
Policy No Company SIZE OF LOT NO OF BLDG$ NOW ON LOT
El Certified Copy o hereby furnished - I NEAREST CROSS ST
❑ Certified ra Copy filed with the County building inspectionTACT'�L('/'I BLOCK LOT NO
d �}
depaartment 7 { { 8 USE ZONE MPP NO y
Date Applicant I ASSESSOR MAP PAGE PARCEL
� SPECIAL CONDITIONS
CERTIFICATE OF EXEMPT10N FROM COMPENSATION INSURANCE
OWNER C'Y"►'l Z ) I TFL NO
IIS 9-169 w-rHN 1000 FT OF SCHOOL? YES NO -
(The sectan'need not be completed if the permit s for one hundred A�RESS
b 5 V 2 / 'I DISTRICT GROUP TYPE CONST FIRE NNE C/✓VF'�)'_5'EOp�./B}Y�-.
Idollars
cerhf ($100)thatior less) P�� r
cerhfy that m the tPerformanceemploy
of the work any
which the permit rl O < %'17t 7 C/ C,e nP4 71 D 0� ^ ,
s issued I shell not empby any person In arty manner so as to
become subject to the Nbrkers Compenaatan Laws ARCHITECT OR ENGINEER TEL NO
SIATIS TION APT CONGO
Date P.pploNO ent ADDRESS CLASS DWELL UNITS
MOTILE TO APPLICANT If after making the Certrfaate of REOURED TOTAL SETBACK FROM EXIST I
Exemption YOU Should became subject to the workers CONTRACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH
C rrpensaton provlsans of the Labor Cade you must forthwith
comely with such praveans or the permit shell be deamed revoked ADDRESSLIC NO FRONTPL
•r
LICENSED CONTRACTORS DECLARATIONSIDE ,
CITY - LIC CLASS P L
I hereby affirm that I am licensed underpovslons of Chapter 9
1pommleromg with Section 7000)of DNeon 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMIUES SEWER MAP
Professors Code and my Ilcerse is in full face and effect NEW ❑ BK PG , a
License Number Lo Clads DESCRIPTION OF WORK d v Q7 / ADD (:1VALU/IfION
Contractor Date SrVC6ALTER ❑
$ J Q 0
❑ I an,exempt under Sec REPAIR ❑ $
cc
BSPC for cc the reason DEMOL ❑ LDMA P/C I . '
Date USE OF EXISTING BLDG URM ❑ EL
Signatureco
APPLICANT IPRIVT) _ _ TEL NO LDA Perm I 1 •, Z
❑ I as aver of the property d my employees with wages as =
than sole compensation will do the work and the structures ADDRESS F ACCT.: t
not intended or fa Sale (Secbon 7044 Business and FINAL CAE 4 11V.�
a
Wf1 TIE APRJGJR CA FIfILiE®ILOND OtaFIWr HAIpLE A HAZNA ER MATEPoAl • cre
❑ I as owner of the property am exclusrveN contracting ug 44 off A r TST FEDDON T A HAI/JOple IWTEfMI NFOR ro off°REATER TIWI THE 1 iTCI Lo
licensed conbeclore t0 C0119trUp1 the project ($BC11M 7044 ���aPECFlED ON THE HAZJPJJ(%19 AIATEFNwe NFDFNATION GUpE+ FINAL BY
Business and Professions Code) . YES❑ • 'Ip❑
TOTAL- 116 .99
Nil TIE MENDED U OF TIE BIADLNa air TE APRJCAIIi OR FUME E 601 116.99
OCCUMNL REOIIIE A PElM'i FOR C TRCr( il0lr OR MO%RMTTNGC THE t FOR
CONSTRUCTION LENDING AGENCY rACTr rwucaEEE++n o,srwcn Ixroum SEE�RLnrrnNo clEacus*Foa �C.r����
I hereby affirm that there s a constructor, lending agency for res❑ �❑ _ r A.f1AWE
the performance of the work for which the permit is ssuad(Sec _ I
m 3097 Civ C) I CCXu i UNDER�swo r.�Ka IRErons� R raLas w�FLFS GDONTvc"coci
N Lenders Name ruTE REarimnzric,wD 'aezatir�ia AT rRpoLltNiN�ec�ix
µ° N�0U4 r�Trf1 ee
Lenders Address _ -MI 12/14/95
�.m o:. 379 1 AM 8:57
I certify that I have read the application and state under penalty
of perjury, that the above Information a correct I agree to cornloy PC FEE PERMIT FEE
$ mth all county ordinances and State laws relating to building
Cat9trUCt and hereby aulhonze representativesCoISSU
of the County ISSUANCE FEE y V
to L�n the above- r my or Inspection purposes V-0
9�17 /2'/y—90-6 INVESTIGATION FEE TOTAL FEE
SEE REVERSE FOR EXPLANATORY LANGUAGE