HomeMy WebLinkAbout1664A 2990A 2991A (9) .vuKKEAS��o�,NEHSAT�oN����ARAT�oN .�.. �. 76A64,T . ppp�ICATION FOR GRADING PERMIT � CE 807(REV.2-80) (� : I hereby aFiirm that 1 have a certificate of consent[o self��, . {.��� insure,or n certificate ol{Vorkers'Compensation Insurance,or '� �� a certified copy thereof(Sec.3600,Lub.C.)� � COUNTY OF LOS ANGELES BUILDING ANO SAFETY - � Policy No:' �'� ComDany � { ���� � ❑ Certitied coyy is hereby furnished. FOR APPLICANT TO FI4L IN A�ooaEss � ,l"��' �''�"'�=� �°"� �',fl Certifiedcopy'sfiledwiththe�countybuildinginspection 517E 23656 Falcon� �OY1 �larmnd Bar � %u-.'�-•��-!1+<s� .�!<5��c/ � � LOCALITY' . department. :',.•/ /:- / /�. f/ - ���j'�r�/:.C_1:�. LOT � NEAREST �� �r / ' pate Applicant ' NUMBERS7z BIOCK R YFEE "�" �` ��`p�� ^' CtiRT�1��CATE OP EXE�IPTION�ROA11Y'OftKERS' 7RACT �I ICTNO. AC NO �STATE HWY. PROCESSEO BV � COMPENSATIONiNSURANCE NUMBER 30577 '� �� u� •55r � �� „�.c....._�� r- a � OWNER Mr', b F1t^s. Jack C. ��el�on cuaicros. � -(This section need not 6e compteted if U�e work involved HANOLEp: '!� � - V ,by ihe pertnit is For one hundted doltars ($100)or less.) M'�'�� ��J7� ��. �i'�Od �{Vd. $UttO 255 �-�� ���� � .� :1�.-. �'�� J I certify that in the pertormance ot tne wort tor which this c�rv Fu I i orton 92G35 rT,o`.714-f370-8540 �+- �permit is Issued,1 shall not emploY any person in any manner VSE 20NE SPECIAL STATE CONDITIONS } So as to htcome subject to th/e;�VOrkers'Compensation Laws. ENGINEER REG.NO. � � i �, � J"...:i!`i�%��.` MAIL �- � �. �t � ✓�n n...� -'..�.--�-.. C I Uate. . . APPlicant. � " � -NOTICE TO APPLICANTIIf,atter making thix Crrtificafe ot CITY ND�' =1 C'rr!f � ~ � d Exemption, you shoul�7 become subject to tl�e �4'orkers' / / � Compen5ation provisions of tlte Labor Code,you must fofth- GRADRAG k't����'"'V(C'•��NO�I����j� �y DATE ' � 0Y W with�comply with such provisions or this permit shall be � � . I— � deemed revoked, a�DRESS �/.J �'�� -'� '.'/�:�,''���i!!:%(/+ . � - � LICENSEU CON7RACTORS DECLARAT19N PROPOSED USE OF GRADED SITE(S! � vauoarioN ]hereby nffirm that I am licensed under provisionsoCChopter S(n �O Fami 1 Rosidsneo �' ' �4[commencing with Section 7000)of Division 3 of the pusi- . '�ness and Professions Code,and my license is in full force and t effect. I� License Numbet Lia Class , � � .f`,,�f?��4,ry � CHECK IF SUPERVLSED GRADING❑ ��� ��i Contractor Date ATIJR �/r �. ' i:.!.'�'�•.� ���. �� OF APPLICAN'�lt.''��f;�.l� . �.�'��Ll� �, . -J am exempt from the iicensing requirements as 1 am a .��,s F?�[�Q(�l � licensed arohltect or a regfstered protes:ional en ineer �j]O!���,�t,L" ' �L TEL.7 /��y � � � , g ADDRESS � �•'j :"C S/ ND. !IR'�U!�r��v S s � � acting in my professional capac(ty(Section A051,IIus- � �i i i,�}��'��.C.�1� ' - inessand RofeSsiontCode). SUFETY$ :� � UOND� � . '/ " . _ BOND � �'i � . NO. -4� �', � i �. � l ' .Lic.or Reg.No. Da[C COMPANY . � ',�:i:' . � . y.'��4�~'�� � H0:�1E OK'NER-BUILDER DECLARATIDN DATE \ REC'D'- `� � �� n^ � . . - FILED' BY ' . :�..F-�.��Vf1 .1 hereM1y af(irm that I am exempt (rom the Contracto�'s CASH REC'D DATE �;,!��+.,��,�� License Law for the following reason (Section 70Jt.5,Busi� OEPp51T5 BY FILED � Iness and Protess[ons Code): � � � � 'i �' � 1, as owner oi the property, or my employees with TNISISALIMITEDTIMEPERMIT ;��!,!,4�'�(�. ; waKes as theif sole compensution, will Jo�[he wark ALL WORK AUTHORIZED MUST BE COMPLETED BY �e��e����, � and lhe stmc[ure is not intended or affered for sale .,.� ��.Q�f r,. I (Section 704a,Ousiness and Professlons CodeJ:� TIME LIMIT' ,��E'.j!�.,,�,L � I,ns o+�ner of the property,am ezclusively contracting , with licensed confmctors to construct the project ';._��'.5.,,,.�,l �i EXTENDEO TO: BY: (Section 7054,Husmess and Professions Code). � CONS7RUCTION LlNDING AGCNL'Y EXTENOED TO: BY: t ������,1 � .�'I hereby affirm th�t there is a construCtiOn lending ugency . • f����•��.��••.F'� �for the performance of the �vork for which this permit is + ` . �i issued�Sea 3097.Civ.C.). - P.C.Fee 5 � �Q't� Permit Fee �l S`.1��."'� � .- ,�.�!�(;.a�;.J� .. ��Lender s Name � �t Lender's Address . ' ��'� ��l�. Issuante Fee �c\ "�� .. !,��.a�ra Q�. •�1 certify that I ha�r reod this upplica[ion anJ sta�e that the � Total Fee "�._�_� :. �i(j�],�-�;�� '�,�bave informatian is cormct.I agree to romply with all Cuunty . �prdin�nces and Stale laws relating to bailding construction, . � � , � . und hereby au[horitr represem�tives uf Ihls CountX��entcr . � - . upun the abo,ye-meniioned property f ninspecHop purposes. SEE REVEILSE FOR EXPLANA70F2Y LANGUAGE � �'../�/f/�f.i.,r.. �- fG.. j 2_-, . ' � �gnature bf Yermittee _ Uate � -_ ' � , . � 7. ,. . . . . �i . ! . �. ,.,� . � .��1 ..v �'i`�. 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