HomeMy Public PortalAbout5233 SERENO DR_Building__ APPLICATION FOR BUILDING PERMIT
_ COUNTY OF LOS ANGELES �M►�I , BUIL NG AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN AyP9F,�
I hereby affirm that I have a cerhfl fs of consent to sell insure
or a certificate of Workers Compensation Insurance or a cerhhed
Copy thereof(Sec
"n f 1 e�c/3800 Lab C) CT zw LOCALfTY `
Pct" No WW Cornpany-AA V.
SIZE OF LOT OF B1-DGS NOW ON LOT
❑ Certified Copy s hereby famished SIZE
CROSS/�$T
11CeAdletl copy s tiled with the county bwldug mspectcn TPACi BLOCK LOT NO •-0'r� 64A%' '
-department ` - -- `l USE ZONE nwr NO -
Date e� Applicant Rt B VO N7 TlNlri T�O N ASSESSOR MAP
,D a SPECT L co MONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OW R/L,4(4
V TEL No /L -
COMPENSATION INSURANCE E �`�` r w 11,1 1000 FT OF SCHOOL' YES No
(This seathoh read not be completed d the permit a for ane hundred AOORSS S ��k {
�c DISTRICT OROUP TYPE CONST FRE ZONE PROCESSED BY
dolens($100) a less) -
I Certify that m the Performance of the work for which the permit CITY r 1.� ,�0�
is issued I sha11 not employ any person in any manner so as to �f y
beCome sublect to the Workers Campensatm Laws ARCleTIECT ORENGINEER TEL NO
STATISTICAL CLtFTICATIONAPT CONDO
Date Applicant ADDRESS CLASS NO DWELL UNITS T� '
NOTICE TO APPLICANT If after making the Certificate of REOUIRED TOTAL SETBACK FROM EXIST
Frampton you should bBCOrThe sublect to the Workers CONTRACTOR y� /` ,� q/�, TEL N{115T,
SET BALD(
CanhpeneetKm PTOwshae of the Labor Code you must forthwith rTa \gyp W7 `yyL�f (Q 5 YARD I-M14Y PROP LINE WIDTH
comply with such pro✓I9tms or the permit shall be deemed revoked ESS DC NO _ PIL
FLONT
LICENSED CONTRACTORS DECLARATION 1 SIDE
CRY(7�� r% LIC CLASS P L
I hereby affirm that I am licansed underproviswns of Chapter B .•J7� SEbvER Mop
(COMMencurg with Sectron 7000)of Division 3 of the Business and N1 SO FT S17E NO OF STORES NO OF FAMILIES '
Profeasiore Cade and rrry license is in full icense force end act NEW SK PG d
LNumber LIC Cleave ����� NORK ADD ❑ vAL0AT10N O
Contractor ..UNG 4411 Date — 7 'ALTER ❑ $ �m�'SFOO• Bit V
cc
❑ lam e ���" I REPAIR ❑
xarhW order Sec $
B&PC for the reason DEMOL ❑ LDf4A Pic A 1 ISI
Date USE OF EXISTING BLDG URM El (Rn•
SignatureDate
(FRINT) TEL NO LOMA Perm A t >ArcrccTf.-T Z
❑ 1 as owner of the property or my employees with wages as ( ';., z ,>JW 1501.59 —
their sole Compensation well do the Moak and the structure Is FINAL ADDRESS Q • ,t 1
not Intended or Offered fa sale (Sactwn 7044 Busmess and ORTE TITGT 1.7
PfOfe99gle Cade) THE APBJClNT Oq FUTURE BUILDING 00CUT1N?HIIdILE A IMZMeDOUS MATERA. - ,,/� 1
111 as owner of the property am exousmaly contracting with OF A MIXnFiE CON AININU A WTERA-EIX TO OR GREATER THAN THE _y TOTAL 1501.59
FINAL BY
MgINTS SPECIFED ON TIE HAZAAOU9 MATERVLS NFOfU4(np1 GUN'
4r;ensed conhectos to conshuct the Prosect (Section 7044 YEs 1:1No 11 _ ! r 1501.1{{,
Business and Profasswrs Code) LHKJI
wLL TIE INTENDED USE of THE lUCLNG BY TIE APP_cANr OR Furore "LONG
AOCCUREOUA RERIAIT FOR OR MOO,nGTJCN FROM TIE SOUTH ,
M RE OONmRUCTltt1
CONSTRUCTION LENDING AGENCY CCMT W1 Y +-"asrFucr(sc.CuD)SEE%WTTNo CECKusr For+
I hereby affirm that there Is a constrLom lading agency, fa rFs❑ No❑ !7 /f�Y� ��-•T r- r�_,n�nr_nnn-
the performance of the work for which the permit a Issued(Sac �j r� _LR�LA-LF�ul1 7/27/95W97 CN C)
TbE� �°aGaM a 1593 1 PM 5:19
IRE z auPrER z x0 5FCT CNS z 201W THK)UGH s so W coNCERNNa hVSMA0115
Lenders Name MATEH/d9 RLPORiIIq MID FOR OeUNllq A PERMT FROM TIE 9CAOA0 )
Lenders Address
O ITNfe d•mr
o I Certify that I have mad the application and state under penalty Q
of penury that the above Information s Correct I agree to earn* PC FEE PERk4T FEE
$ with all county ordinances and State Tawe relating to budding -
corshuctan and hereby auNonze mpresentahves of the County ISSUANCE FEE
to enter t above-mentioned Property for inspect v
INVESTIGATION FEE TOTAL FEE/, 11
SEE REVERSE FOR EXPLANATORY LANGUAGE
�. _APPLICATION FOR BUILDING PERMIT
COUNTY OF LOVANGELES BUILDING AND SAFETY
WORKER COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BDILONG ,
I hereby affirm that I a certificate of correent to self Insure Bl1ILDINO a00RE53
or a certificate of Works mpensabon Insurance or a certified NO 5E
copy thereof(Sec 3800 Lab ) CITY - LP
>t= LOCALRY '
Policy No — yy party p
SIE OF LO NO OF SLOGS NOW ON LOT
❑ Certified copy is hate y furrlfs /'�— / L Z� \ NEAREST CROSS Si
❑ Certified copy is filed with the county, bu rig Inspection TRACT BLOCK LOT NO
de
..r/f.q/(/f r/ - /' USE ZONE MAP NO
Dat APpIICent ' ASSESSOR MAP jP PAGE 7 PAfiCEL
v I� " �5( SPE CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORth.ndm�d
O',YNER TEL No
COMPENSATION INSURANCE HU WITHIN 1000 OF SCHOOL'' rES NO
(This sector,need not be completed d the per mR is fa ADORERS
dollars($100)or less) I\ V 1 ) ds GROUP TYPE CONST FIRE ZONE PROCESSED ar
I certify that In the performance of the work for which this permit �!6V ZIP
is Issued I shall not employ any person ,n arty manner so as to Xly
became subject to the NAxFers Compensation Lane ' ENGINEER - TEL NO
I I STATISTICAL C TION APT CONDO
Date Applicant I ADDRESS L CLASS NO DWELL UWTS
NOTICE TO APPL/C4NT If after making this Certificate of \\ — 111 FjtA—) REQUIRED TOTAL SETBACK FROM E>aST
Exemption you should become aubject to the WorkersT TE NO SET BACK ypgp FM1YV PROP UNE WIDTH
Compensaton provisKlris of the Labor Code you must forthwith
comply with such provisions or this permit shall be deemed revoked ADDRESS pILL NT _
0_7
LICENSED CONTRACTORS DECLARATION I l '�^ SIDE
CLASS P L
I hereby affirm that I am licensed untlerprovmgre of Chapter 8 SEWER MAp
(commencing with Section 7000)of Division 3 of the Bumnees and SO FT SIEOF STORE FAMWES d
Professlols Code end mY Ircen in full force and affect r Zi 1 NEW 10 BK PO 10. O 1 ,
Lx:ense Number Lc Claus DESCRIPTION WORK �• ADD ❑ VALUATION o=, _ ACCT.t
Compacta Ow/_12 Date O TER El 10 Q O O
1469.31 cc
❑ 1 am exempt under Sec R IR ❑ $ 1 ITEMS
88PC for this reason DEMOL
ONA P/C' - I OTAL 1469.31
liate USE of Eco G BtDO URM ❑ C _ r�-
CYA 1469.31
Signature • C441 _
1 PRNTI TEL NO Farm• , ' j ' Z
El as owner of the property or my employees with wages as L N L) 1 —Q _ ! , i z GLT .00
their sole compensation 61 do the work and the structure is O ( _
not Intended or offered for sale (SectKxt 7044 BinADDRESSusess N FINAL DATE Q -'-'`J''
Professiom,Code) wL-THE APR1GVm cR F %auuNp occu~rr A HnzAnocua WTERVL f ' •I, _ ��—DOJ£n', 5/19/95
licens❑ I as owner of the property am exclusively con rig with oR A rAacnrr�coNwrm+o A HAZNmous MATERUL EOWL ro oR aEATER TwH T�
AMOWIe a AHED ON THE 1VSAROWs"TEAWB lFOnAWTpN GUIDE? FINAL BY > T�-�p�
Kismetl and
to Goode) t the protect tron 7oaa Lp}UIdIL 1 A3L '`.l�i
Business antl Profeavorm Code) O WU❑ No❑
CO THE TRREEEOURE PET w C014s° T O ,a' THE .HE'_i 12L.:_
CONSTRUCTION LENDAGENCY COAST NR DUNAALITY IJENOLmWCT T IaCAWBE
DI E PERAITTING CI-ECKDaT FOR
DUDauHEs CtIAN' ,III
I hereby affirm thatre theis a tru lion lending agency for mss C1 io❑
the perfamence of the work which this permit Is issued(Sec I /✓?/
m
3087 CIIWIEPfI.D TIE HASHrpOU9MATERVL44FORMATION(LHOE NO THESUIXdDPERMITTINa / _
w C) CHECNLIBT UNDER3PN0 M1'RECtAREMEHI9 UNDER THE L09 NgEI..ES COUNry CODE I_T I —I'I Ij 11 7!�','
Lender a Name INTITILtiRN.S REP'Eos I,G Niro FOR spzaa ar00+o A FRROOM THE A
Lender Addie
� CMEA O9 ApEYI
1 certify that I have read this application and state under penalty
5x� of perjury that the above Information is cpRect I agree to comply PC FEE , PERWT FEE ([/
X. vnth all county ordinances and State lewe relating to building Ol
COfLRhIICIIOfI and hereby authorize representatives of this County ` • ISSUANCE FEE at,,
enter upon t above-mentioned property for Inmpec put
m AL �A�� INVESTIGATION FEE TOTAL FEE / Il /1 /
ewn.�•e.. o., J
SEE REVERSE FOR EXPLANATORY LANGUAGE