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Home My Public Portal About9624-9626 LONGDEN AVE_Grading__ CE 807 (REV.2-SO)v y - APPLICATION -FOR GRADING PERMIT ,. 1'.": ',I hereby affirm that 1 have a certificate of consent to self 'Vr, `insure,or a certificate of Workers'Compensation Insurance,or , a certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ` ❑ Certified copy is hereby furnished. FOR APPLICANT-TO FILL IN SIrE /Z - ADDRESS r/ ❑ Certified copy is filed with the county building inspection SITERE 6 6 LOCALITY department. Date Applicant NUMBERS BLOCK NEAREST ROSS TREET CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT p ` MAP-yQ, STATE o ` PR0�,48E BY COMPENSATION INSURANCE NUMBER �03So YES Q [/ (This section need not be completed if the work involved OWNER AbFCUBIC YDS. IV MAIL HANDLED- 11 by the permit is for one hundred dollars (5100) or less.) DDREss `J A 0 7oQ �U. yps . I certify that in the performance of the work for.which this kENGINEER(�ill NOL permit is issued, I shall not employ an person.in any manner USE ZONE SPECIAL • l? P )' y P STATE - • - CONDITIONS - .0 so as to become subject to the Workers'Comp nsation Laws. REG.NO:3 5;-Date Applicant ESS NNOTIC T APPLICANT: If, making thiVertificate of NO —14SJ, Z Exemption, you should b" ome subject toe 3Vorkers'f — Compensation provisions of the Labor Code, you must forth`-- GRAD NG' TEL. FINAL - ]BY with comply with such provisions or this permit shall be CONTRACTOR NO. �" DATE deemed revoked. ADDRESS • — LICENSED CONTRACTORS DECLARATION PROPOSED USE OF GRADED SITE(S) VALIDATI I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the BusiAN - ness and Professions Code,and my license is in full force and effect. License Number Lic.Class Contractor Date CHECK IF SUPERVISED GRADING IGNATURE ❑ I am exempt from the licensing requirements as I am a OF APPLICANT licensed architect or a registered professional engineer ADDRESS NO. a 3 4 1.2 A acting in my professional capacity (Section 7051, Bus- iness and Professions Code). SURETY$ BOND # • • • •. 8 BOND NO. Lic,or Reg.No— Date SURETY • 42Q.00 COMPANY HOME OWNER-BUILDER DECLARATION DATE ' BYC'D • 0420,0045 I hereby affirm that I am exempt from the Contractor's .CASH RECD DATE � 1.05-85 License Law for the following reason (Section 7031.5, Busi- DEPOSIT$ BY FILED nese and Professions Code): THIS IS A LIMITED TIME PERMIT ❑ I, as owner of..the property-or or my employees with wages as•.,their sole compensation, will o the work ALL WORK AUTHORIZED MUST BE COMPLETED BY and the structure is not intended or offered.for sale (Section 7044,'Business and Professions Code). TIME LIMIT: I, as owner of the property, am exclusively contracting 7V with licensed--co'ntCactors to :construct the project EXTENDED TO: BY: • • (Section 7044,Business and Professions Code). ' 0= CONSTRUCTION LENDING AGENCY ' U I hereby affirm that there is a construction lending agency EXTENDED TO: BY. for the performance of the work for which. this 'permit is issued(Sec.3097,Civ.C.). P.C. Fee$ ' Permit Fee 112J 6 Lender's Name Lender's Address Issuance Fee /� ` I certify that I have read this application and state that the Total Fee 3 O SV above information is correct.I agree to comply with all County ordinances -aird,State laws relating to building construction, and hereby au .brize representatives of this County to enter u n the v ioned property for i e ti Purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE •i flu ie' e#nittee Dhte ,