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Home My Public Portal About6217 MUSCATEL AVE_Grading__ 76A64 W affirm that'have a N rti fi at of cohsent t se CE 8071(REV. 2-80)•1080 APPLICATION FOR GRADING PERMIT I hereby affirm that I have a certificate of consent to self insure, ., or a certificate of Workers'Compensation Insurance, or a cer- tified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY IuI Polic?No. Company SITE ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS U/2-j /n 1,f SITE •�f%l_,( _ ' ElCertified copy is filed with the county building inspection ADDRESS ;+ ! r;! L'Y �... LOCALITY department. LOT NEAREST BLOCK Date Applicant NUMBERS CROSS STREETTRACT F NUMBER DISTRICT o. MAP NO. STATEHWY. SSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' ,D� YES E3NO E3 I COMPENSATION INSURANCE. 7 � OWNER ,/C��7tL�� •J/ GJ'L• CUBIC YDS. � (This section need not be completed if the work involved by MAILX.. HANDLED: the permit Is for one hundred dollars($100)or less.) ADDRESS e- a ! 77 ,r1 TEL. ,} / �J I certify that in the performance of the work for which this per- CITY �� C-r NO. -6. —�� USE ZONE SPECIAL STATE. CONDITIONS mit is issued,I shall not employ any person in any manner so as ENGINEER REG.NO. to become subject to the Workers'Compensation Laws. MAIL Date Applicant ADDRESS NOTICE TO APPLICANT:If, after making this Certificate of Ex- CITY NO. emption, you should become subject to the Workers'Compen- GRADING TEL. FINAL BY sation provisions of the Labor Code,you must forthwith comply CONTRACTOR NO. DATE with such provisions or this permit shall be deemed revoked. •- LICENSED CONTRACTORS DECLARATION PROPOSED I hereby affirm that I am licensed under provisions of Chapter 9 PROPOSED USE OF GRADED SITE(S) VALIDAON TI (commencing with Section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and effect. - License Number Lic.Class Contractor Date CHECK IF SUPERVISED GRADING ❑ 1 am exempt from the licensing requirements as I am a SIGNATURE licensed architect or a registered professional engineer A OF APPLICANT acting in my professional capacity(Section 7051, Business ADDRESS TEL. and Professions Code). NO. SURETY$ BOND Lic.or Reg.No. Date BOND NO. IQ HOME OWNER-BUILDER DECLARATION SURETY I hereby affirm that I am exempt from the Contractor's License DA EFANY RECD ACCT.'Ir Law for the following reason(Section 7031.5,Business and Pro- FILED BY 3303 186.45 CASH , fessions Code): I, as owner of the property, or my employees with wages DEPOSIT$ BY D FILATE ED I ITEMS as their sole compensation,will do the work and the strut- THIS IS A LIMITED TIME PERMIT TOTAL �. r a - ture is not intended or offered for sale (Section 7044, �7 Business and Professions Code). ALL WORK AUTHORIZED MUST BE COMPLETED BY CHECK I$6°45 LTJ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section TIME LIMIT: CHANGE °00 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY EXTENDED TO: BY: n n I hereby affirm that there is a construction lending agency for EXTENDED TO: BY: 0000-0001 2/2If96 the performance of the work for which this permit is issued(Sec. 494 1 Ate 9 3097, Civ. C.). •/� P.C. Fee$ Permit Fee 0-54 Lender's Name Issuance Fee Lender's Address I certify that I have read this application and state that the Total Fee 14. above information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize fepresentatives of this County to enter upon the above-men t' .ned property for ins?ect'on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Suture of Permittee G Date