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1106A 5304A 5313A
/ / '- �eRs'`°�,�`"S"T'°N°r�`"""T,°" '6A6"T APPl1CAT14N FOR GRADiNG PERMfT � �` � � CE807(REV.2�0D) � `; ,y affirm that I have a certificate of consent to'"iNP .. � n, ,, or a certeficste uf Norkeri Cnmpensution Insurance,or � � a certiCed cnpy thereof(Sec.3800,La6.C.) COUNTY OF l05 AN6ELE5 � BUILRING AND SAFETY Pnticy No, Cnmpany� � ❑ Certitied cnpy is hereby furnishcd. FOR APPLICANT TO F1LL IN n�oopeSS�'..1�%�%� ��^. .U��°F�'rv .:�.��,..:.,p � Certified c�py is filed with the county buflding inspection SITE SS F�3�bV � /Q!�/'j h S • LOCALITY /�!�+•�r�*-�""�..._J�f�✓ department. � LOT �~. . �Aate Applicant NUMBERS �Ld' j�/� p �L11�p NEAREST r� , � �r.,� .,�!�':{. � CROSSSTREET - "��'"'.'(. '�� CF,RT{PICATG OP GXEMPTION PROM t40RKERS' TFACY DISTFICT NO. MA�NO: STATE HWY. PROCFSSEO 9Y �} COM11P(3NS,1TfONINSURANCB NUMBER �� �-f�>�� � a _, a„p,,� p. � � OWNER�J�: !�t I�RF u h(r�n /Uj'�I CUBICYDS. (�j (T1eis section need not bC compteted if the work involved- MA11 % � HAM�LED: Ay the permit is for one tmndred dotlars(5100)or less.) p Z 3,�''00 , /,�riC'Fl )/^/�7( �"- C J i certify that in!he performance n(the wark tor�vhich Ihis CITV�/�=t/"�Y/.'Y/, '�<<r' NO� LL peimit is issued,I shall not e�.ptoJ�any pers n any ann USE ZONE SPECIAL . l=�-r.�iJetir . �/f!Y/��� STATE ��,�a� CONDITIONS } Sn as to become sub ect to�Jf e S�Vdrke�r'C ENGINEE R . REG.NO. ' � E/—l7�'3 � ��lre�C: ' I � MA1L ity .s1�'.r.,w r.� �,::�.�G�-� ucas+�u.��a �'.�- C+Iir' /.:'S�G Zt C' 9��,J St -Dat Applit;rt[ E ,r,� C, � NOTICL•TO APALICANT:!f,after making this Certific nf ���.,,�tC iC GL�GV1JUq��G Np�/5',�'u�C�i2�� ��f �/'� �%n�G d� � lixemption, you shoutd become subject tn the Wo kers' � ., � L GRADING�'' ��=4 � L TEI. Compensatton pmvisinns of ihe Labor Code,you must forth- ' J,,, `.� FINAI. 9Y w �vith comply with such prnvisions or this permit shall be ONTRA TORL,1ss�./LP��./ No. �� �"`�'�� oATE � . . F .� Cf::/�E'//_/ : / t"^::. deemedrevoked. qoDReSs� � f�Z"��yr '��r LICENSF.D CONTRACYORS DLCLARATION ppOPOSED USE OF GRADED SITE(5) VALIDATION , � : 1 hereby aftirm�that f am llcensed unJer provisions otChapter � �G C� U . 9(enmmenciog+vith Sectinn 7000)of Divtsion 3 of ihe Busi• , ness and I'rnfessi�ms Code,and my license is in fu11 forre anJ � � � � effect. �7 � n���:-.r1 License NumbLT` L C.Class —7 � '�'G;.J/G4fv, � /�J.r'G�� �,_ �! ��,� . . Contractot ����lfL✓�./-'���Date CHECKIFSUPERVISEDGRADING '�..����:t�i�1t� � 1 am exempt.f�om fhe ticensing requirements as I am a dF A'PPLICP�NT ��,��j �. � � ��,�,!',a,�.,j ��� licensed arthihct or a registered D�afessional engeneer p��p�g ����,P,�r Crtr;/ . /GU�o�/� � ,�;+,;i('f[�(�j � acting in my professional capaci�y(Sectlon 7051,Bu5- � �inas and Pro(essioas C�de). � . �vR�TY s � � . [30ND NO. . ,�,�.r=.QC�L•G�., ' Lic.or Reg.Na, [)ate ,��{��Y r� .. (, . COMPSNV - � �I,L.�v'.'�.`��, Ei0\SG 06'NGR•IIOILOF.R�ECLARATION DATE RECD � . _ . FILED ' 8Y {�j j��(1� L hereby affirm thnt I am eaempt from the Contraclur's CASH 1 n�ry/�REC'D�\\ �` DATE . � Li:cr.se Larv(or!6e foiiowing reason(Srct�on 7031.5,Ausi• DEPOSI75,����LiBY ,� C1�\Cl� FILED' �1;` , Sq'�.�;!„�.2Q .. ness and Protessions Code): THIS IS A LIMITED TIME PERMIT � �I, as oirner of the property, or my employers with �� ,�,!,.i�i Z��i wages as their sole rnmperisation, wfll do the work qLL WORK AUTHORI2E0 MUST BE COMPLETED BY � � and the sttucture is not mtended nr afFered fur saie ��'��,a L`��.(��j� (Seclinn 7044,Duslrtrss and�Cmfessions Code). TIME LIN11T: � � �'"+ Y � I,as owner of t6e property,am exdusively eontrscting �.,�;.�,t�„',��,v � ry9th litensed mntrocturs in cnnstruct the project EXTENDEDTO: BY: � ' � (Section 7a44,IIusinesx and Nrofessions Code). . ;'?�j�j�(�5� CONSTRUCTION LENDING ACGNCY EXTENDED TO: BY: V � ,.[.hereby atfirm that there is a cqnstruction Iending agency � , \ 7.,��►����� ,�,(1 � for Ihe peffonnance oP the work for�vhich this perm�t is '/' , :issued(Sec.Ja97,Civ.CJ. P.0.Fee S y—c•'��J� �'"� Permit Fee + r`�` ("�} �;:�.` � ,�„ �.� `� i;�i i�SQ .. Lender'sName . — �•� ���'• _a_*,�., . Issuance Fee • ,•r� 7S �.-Lcnder'sAddress `�' � � :n- �. 217 . •! „1QF I��Il�certity that I hsve read'This appiication and stah that Ihe r ..��-,f1���� Total Fee ^ �-}"-� t�_,_(� 'I t� :� � -��� ' �f '�' � above in(olmution is C frect�I agree to comply wyh all Caunty �n Gq (P' ��_��� ' U,,7i�l L,,Qi v + ;ordi��nces�u�d Stsje lm�n �elalinR'to bu Idin�lconstructinn, . �p n p � 'anA�yereby�uJhor�. repre. � funty to enter � . . -� u 6�fie v-,�(�, n ct t for s ctwnvyv sys� SEG REVF.RSG POR EXPLANATORY LANGUAGE �{ �a�i/�� P �� "�L--/'�//^� . �• Signature oP Yermittee Dal � - Y � . .. 'i . .. � I _i � _1 _ , � � i l � { , , {� �. � , . : + � � �:,i I i i , . i, ! ; I', + � .. ; i , � � � � . - �T; ; ; i �_� , �:, ; ,_ , � -� I i ;� ;:_ � --= ' ' � �.� ! � ; � � I ; ( `` . �, I � t.. ,. . ' � ''' ' 1 � 4 � ;I i ; # � j i + c, - , .. rj � � t � - . , . � . . ; . . _ � � F � � �� , " � .. . , . '. .� I i� � I ':iL.e �, � ��� I I ", r.`... I I � . � ; � ' . I . . . �. � . . . . . 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