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Home My Public Portal About5246 SERENO DR_Building__ APPLICATION FOR BUILDING PERMIT �] COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILoyG �s I hereby affirm that I have a certificate of consent to sell Insure BUILDING ATXIRESS, or a certificate of Workers Compensation Insurance or a certified ` / ��f n Q COPY thereof(Sec 3800 Lab C) CfTY T -117 O LOCALITY /. Policy No Company ZIPSIZE OF LOT NO OF BLDGS NOW ON LOT ❑ Certlfod copy a hereby furnished I NEAREST CROSS ST ❑ Certified copy Is filed with the County building Inspection TRACT 5— Dff BLOCK LOT NO department USE ZONE MAP NO Date Applicant ASSESSOR MAP p PAGE PARCEL .7 O �4 �Q SPECIAL CONDMONS CERTIFICATE OF EXEMPTION FROM WORKERS CANNER a !I A ' I�O� '' TEL NO Z_� COMPENSATION INSURANCE Il.l Iii WITHIN 1000 F7 OF SCHCo ' YES No (This section deed not be Completed If the permit a for are hundred ADDRESS t(„ O>7 f DSTRICT GROUP PECON FlRE ZONE PROCESSED BY dolens(5100)or less) Q_ I certify that In the performance d the work for which thus permit CITY /Q� ��• ZIP 177 S n� - is Issued I shall not employ any person in arty manner so RS to became Subject to the Warkera Comparsaton Laws ARCHITECT OR ENGINEER TEL NO STATISTICAL CLA^u51FlCATgNAPi CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT If after making this Certificate of REQUIRED TOTAL SETBACK FROM EXST Exemption you Should become Subject to the Workers CONTRACTOR" I -' TEL NO SET BACK YARD HWV PROP UNE WIDTH Compensation provisions of the Labor Code you must forthwith v-/KNl FRONT comply with such Provisions or the permit&heti be deemed revoked ADDRESS I LIC NO PL LICENSED CONTRACTORS DECLARATION BIL CITY Lq CLASS PL I hereby affirm that I am licensed underpmvsions of Chapter 9 yIER MAp (commencing with Section 7000)W DivsIon 3 Of the BUSrTIBss and SO FT SIZE NO OF STORIES NO OF FAJAUES Professions Code and my license is in full force and effect NEW BK PG ,-L d License Number Lo Claes DESCRIPTION OF WORK ADD (3 "LIJI , Q Contracts Date ' ALTER ❑ $ `I BU✓ ❑ I am exempt under Sec REPAIR ❑ $ BBPC for this reason r DEMOL ❑ LDMA PIC/ W Date USE OF E%ISTING BLDG ` \ \ URM +\ 0•1 - a Signature APPLICANT(PR?VT) TEL NO LDMA Perms _ �• - Z Aes owner W the property or TTN employees with wages as t I� Z Ar (IT i heif sale Cornpersabon unit do the work and the structure Is ADDRESS O not Intended or offered for sale (Section 7044 Business and FINAL DA a J307 212.10 Professions Cade) ffl L THE MRJCANr OR FUTURE Wu NG OCCUPANT HANDIE A HAZA U'US AMTERVL O OR A MI%TURE CONTNWNG A HAZFIII S ANTERIAL EQUAL TO OR GREATER THAN THE❑ I eri owner of the property am the prosy contracting with NVOUN1S SPEco-n ON THE IAzxEcou9 ANTEFI s IHFogw\TON ou,c E, FINAL BY > 1 ITEMS licensed contractors Professions to Code) the project (SectKm 7044 1} A BIISIT1eSS arid PTOfBSSiona Code) YES❑ NO TOTAL WILL RM MEND D USE MI THE&II STT eI THE AFRICAN OR FUTURE 9US➢INn HECK 0 OGGWMNR nEOLTY A I{RMT FOR CgNSTRI1CTgN Di EE PERMIT N G CHI CTnEKU T FOR r•L��T\ 2U.1V CONSTRUCTION LENDING AGENCY ccNST as ouALTv MANAGEMENT asrmcT IscApMoi SEE RERMrrnNo cHECIkusT FOR C HANSE �O[I GUIDELINES I hereby affirm that there e o construction this prmitlending agency for YES❑ ND N the performance of the wok far which this permit s issued(Sec IHAVE REAO THE usruTEwALS INFORMAnovouoE un TIE suanD aEwarnm m` 3097 Cr, C) CMECKUST I UNDERSTAND MY REWIREMENTS UNDER THE Los ANGELES COUNTY CODE 7TE 2 C1A➢TIER 220 SECTIONS 220108 THROUGH 2 20140 CONCERNING INWiLOIN Af11V1�f111�11 L/1C/f.` Lender It Name ANTERULS REPCRTWG AND FOR OHTANND A PERMIT FROM THE SC/OMD rIVVV V V V 1 T ( T o Larders Address ou.ERVH,�m 9218 1 AM 7C4-, o I certify that I have mad the application and state under pensify O of perjury that the above Information Is correct I agree to comply PC FEE PERMIT FEE �+ with all county Ord and State laws relating to bulldog S co structon f bo\B Mbned property frrtivesf the; Count ISSUANCE FEE r Inspect � NVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE I/ s WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to ,elfinsure certificate•o certificate of Workers'' Compenwhon Insurance, or a certified copy thereof (Sec 3800, Lob C) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company BUILDING ElCertifiedcopy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS � ❑ Certified copy Is filed with the county,building InSpeC- AUDORING _Vf Lr`�r� �c hon department ADDI�55 !� p G. Date Applicant CITY /• ZIP /» LOCALITYNO OF BLDG$ " CERTIFICATE OF EXEMPTION FROM WORKERS SIZE OF LOT NOW ON LOT �0/✓-t. NEAREST CROSS ST COMPENSATION INSURANCE c �.s. p p _ (Thu section need not be completed if the permit is for one TRACT I `�C &OCK LOT NO fzi ,gP BOOK p O PAGE PARCEL hundred dollars ($100)or less ) TEL OWNER No 11/'17 1/ USE ZONE MAP a I certify that in the performance of the work for which this y permit Is issued;I shall not employ any n In arty mann ADDRESS 7 W r/ �� CONDITIONS a so as to become subject to the Wor Co pe ho L d -7 O Cm // ZIP !fes / V Dote/ Applicant ARCHITECT OR /I / t d TRICT GROUP TYPE IRE PROCESSED BY O NOT ad T CANT If, a erg g Is Certificate of ENGINEER /�//� G N�— NO Z ' / .� CONST ZONE Exemption, you should beco`liia subject to the Waken Compensation provisions of the Labor Code, you must forth- ADDRESS3'1, G d AI �! - with comply with such provisions or this Permit shall beTEL //�''z STATISTICAL CLASSIFICATON APT CONDO Z deemed revoked CONTRACTOR M %41 y77 A / LICENSED CONTRACTORS DECLARATION LIC CLASS NO 421C` DWEII UN-4 I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO SEWER MAP (commencing with Section 7000)of Division 3 of the Business UC and Professions Code,and my license Is in full force and effect CRL' CLASS BK /IJ PG GZ VALIDATION SO Ff NO OF '&0 O OF CHECK License Number Lic ClassSIZE STORIES !� FAMILIES l ONE joVALUATION � 2 Contractor ie DESCRIPTION OF YAM NEW S 5J /C --r ❑1 am exempt under Sec AW , AI'` I •x ALTER ❑ -L1% j B 8P C for this reason A. REPAIR ❑ $ _ Date V USE OF IT_t1� py EXISTING BLDG nFWX ❑ Signature +/ APPLICANTTEL FINALTCIT.,L 1.5; .�•- OWNER-BUILDER DECLARATION h (PRINT) NO _ I hereby offirm that I am exempt from the Contractor s License •U DATE LFINAL for the following reason (Section 7031 5, Business and ADDRESS BY `H 1� •]_ Professions Code) - L, ElI as owner of the property, or my employees with BUILDADDRESS waiges as their sole compensation,will do the work and O the structure is not Intended or offered for sole(Section LOCALITY fl, 7044 Business and Professions Code ) MOVING TEL r — I I,m owner of the property,am exchntely<ontractmCONTRACTOR NO g _J� L (• 1 with licensed contractorsto construct the project (Sec- ADDRESS n` ' tion 7044, Business and Professions Code ) EEFr CONSTRUCTION LENDING AGENCYRE D y HWY AL QEFROM WIDTH 17 i j hereby affirm that there Iso construction larding agencyfor FRONT x rt F the performance of the work for which this permit is Issued Pl. (Sec 3097 Civ C ) SIDE g PL � f• Lender's Name Ref In T a t~o-.• t r .f Lender's Address P C Fee f PermitFee r®Q• 30 I certify that I hove read this application and state that the Issuance F / S IDMA P/" "'• above Information Is cored I agree to comply with all County Investigation Fee /O2 3. 9 ordinances and State jaws relating to building construction, Total LDMA Perau 0 I+ ` and hereby authorize representatives of this County to enter 8$ upon th o-me done pro arty for Inspection purposes 10 f� tA J SEE IavERSE FOR EXPLANATORY LANGUAGE 4� 'l, Q ..pp not re of pliosn or Agent Date "' c•S `-' rf