HomeMy Public PortalAbout5220-5222 SERENO DR_Building__ Y ENGINEER
MOFEIMOU AND SAFETY BUILDING 1
COUNTY OF LOS ANamis
WILLIAM J FOX, CouHTY ENGINEER APPLICATION
CASSATT D GRIFFIN. SUP T or BUILDINa
FOE APPLICANT TO I IN FOR OFFICE USE ONLY
ADDRESS J f-ZO �J� �' 6 DISTRICT NO PUN C�w RSC No PERMIT NO
Q / - /-� S 7 8 Z11 2-.
LOCALITY I'�M CA- L%[ R 1 D OF A PL D TE IBS !D
NEAREST E��. ZB'sy Z8 6
r BUILDING C' ,a
OWNER ewt c f- ADDRESSMAIL � r-✓V
ADDRESS E.PFN �P LOCALITY
l�I /v, TEL No. COSSNEAREST
cm G G CROSS BT
04 PI NO OF ^� TYP OR
ENGIIN�
TEL
WE'o PLANS 1
LL
� ODr NLSETBACK LIN! 0 `
COZON _I BPROVED
DATE
ADDRESS HOUSE NUMB 6 0-4
LEGALMAPNUMB 20/ O ASSIGNEDBY
WCRIPTION I LOTNO JP-- BLOCK
. "-/2 -/3 cosaEcnoxs
vs�
SIZE OF Lar SS 2 SOI NNOOWOFBLOW LOT o 5 -
USKoF �� No of _
®11 NG O NIL
DESCRUITMIN OF WOEH Of G -
ALTERATION 10 O
2
RWAIR
DEMOLITION r
BO FT NO OF 2 S'
SIZE ROOMS ST RI
Err WALL ROOF 47 G
COVERING S T��CQ COVER NO / 0
o UCTL
ueER C Q'A BV
•
/ 7 \
O APPEOV
INSPKCTOFrSSIGNATURE DATE
FOUNDATION LOCATION
FORMS MATERIALS �l .-- 1 l�
1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME FIRESTOPS
PLICATION AND GTATE THAT THE INFORMATION GIVEN IB BRACING BOLTS
CORRECT
1 Q111 TO CO Y WITH ALL COUNTY ORDINANCES FURNACE LOCATION / J
AND STATE LA LATING BUILDING CONSTRUCTION GAS VENT DUCTS
SIGNATURE OF Z. LATH INT
PERM
LATH mtr li J
woo �
PLASTER, INT _
AUTHORIZED A
C •0-1-
PLASTER SRT r
FnH000ENUMBERCOR-
RECT AND POSTED /9
vwwwnoN FEs E FINAL
{ 7"a 0111111
. APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION unegAnoraFOR APPLICANT TO FILL IN �p ZRzI.a0
01st
I hereby affirm 1 have a certrfiate of consentau
to self Insure, CFss 0-ULM..e O
or a certificate of Wbrkers Compensation Insurance or a certified ,c.
copy thereof(See 3809,Tab C) Cm 21P
Policy No_111,04 7,1'1 Company TL ` L C /
L llPy le Ilarlby 111mlehad 912E OF LOT NO OF SLIMS NOW ON LOT
❑ dCearrrdillleer�d�,c,�opy ou filed with the county building inspection kGV"A(
,LOCK LAT NO „"^"� %USE ZONE ATn'O ,
Data—J��pPnCem 5 ASSESSOR
SPECAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' WfTI11N 1000 FT aF3aaoLTYES NO
COMPENSATION INSURANCE(This Section need not be compinted lf the permit le fa one hundred LP\I-01 dSTi1CT GRow TYPE CONST FIREZONE Ddollars({100)orIese) E nI-/�/�p� /f �f� /H1-
100"Meal In the performance of the work for which Mira Pemtlt >✓O L$ \l G� ✓•W 3 - /
IS Issued I *W not employ any person In army manner so as to ARCHnIECT OR ENGINEER TEL NO
p_9cOMPP subject otthe V*wkers CO(npenYtierl Ldwe' STATISTCAL CLASSIFICATION APT CONDO
Date.l AppikAld a�^� AGGRESS CLASS NO DWELL UNITS
r NOTICE TO APPLICANT If, after making this Cardlleate of �NfpACT� �� REDIIIRED TOTAL SETBACK FROM DUST
1 Exemption you should become subject to the Worker ` AIA L^L4u7 S TRK YARD HWY PROP UNE WIDTH
/ ComperroeMon provisions,of the Labor Code, you must forthwith U
comply with such provisions or Mm
this permit shall be deemed revoked ADDRESS LIC NO FRONT
1.111, LA j't- X ?k. 1 1 9 9 P`
LICENSED CONTRACTORS DECLARATION �pv CLA'18 SIDE a
I hereby affirm that I am licensed under provisions of Chapter 9 Joy- P��'` l�3ASEWER vow $
(commencing wlfh Section 7900)of Division 3 of the Business and 80 Fr SIZE NO OF STORES NO OF FAMILIES NEW El BK PG
Protenbrm Code and my le In full force and effent
License NumberE z I / 1 LIC qm@
1�
DRFCIPTKIN OF wOmt ADD 11 VrT V.O D ,
=ALTER ❑
❑ Ism exempt under See Y.NI. l ATZA'L�\ED REPAIR $
B IPC for this reasonqq 1dry!pp DEMOL ❑ LDMA P/C 1
/ Deft �OF O�l EX,1ST BI URM ❑ 1
Signehlre APPLICANT(PRINT) TEL NO LDLPA Penn a
❑ I, as owner of the property or my employees with wages as G ACCT.:
Meir We ccmpenaaMon,will do the work and the structure is ADDRESS _ ratAL Ij jy]7 70.3
I not inanoed or offered for sale (Section TO" Business and \
Professions Code) wuraA..uaNraFnxsauaawaocc.vNTa,meAHArARoomuATBaAL I 1 ITEMS
❑ THAINI
1 u owner of the propend am exclusively oonoaclbeg with Ando e m r m sasaerou� FRAL BY
Yoerued construct contractors to constrt the project (Section TON, ren❑ No TOTAL 70 . 33o
BuWnm and P(oleaslona Code) ChECY. •+�70.7°
wnL ns IMlFMOED use or T1s!ellrto,r0 sir ra APPIx'M!r OR Rhus aunmNo
CONSTRUCTION LENDING AGENCY �A A �-�(3C O 1 M��01004-18T CRAMISE .00
Pon auoslsrm
I hereby affirm that there is a construction lending agency for ❑ p❑
the performance of the work for which due permit to Issued(Sec
3007 CN C) �a "°.� MYALS a:oe; La A, x-0001 4/20/40
m,nrrYcaacTLREsoerrreazloeLcrcrmTmwOreagLroeesm,aoorrrxnrwo 0216 1 A1110:29
Landale Name HWImOI>'MxrBWlBrWlNgAID Fon aerAOMmAfBWlt rieoUTeYiecADLrD
( Lender's Address
a..au.mer
0 1 artily that I neve read this appllcadon and state that the above PC.FEE PEwtIT FEE
InlernatOn is correct I agrse to comply with all county _3
ordinances and State jaws relating to building construction and 3 0
L hereby uthed2e representatives of this County,to enter updn ISSUANCE FEE
the entloned property for Inspechen purposes g o
1-lu INVESTIGATION FEE TOTAL FEE ,.
39
I� SEE REVERSE FOR EXPLANATORY LANGUAGE
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