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Home My Public Portal About5829 ROSEMEAD BLVD_Grading__ WORKERS'COMPENSATION DECLARATION 76A641 APPLICATION FOR GRADING PERMIT I hereby affirm that I have a certificate of consent to self insure, CE 807(REV. 2-80) 10/80 or a certificate of Workers' Compensation Insurance, or a cer- tified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY pot, A,P,l8631:Qiiimpony Fripmnrlt SITE 4 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS SITE Certified copy is filed with the county building inspection ADDRESS LOCALITY Z'Cry^)1 c C L ii department. LOT BLOCK NEAREST Date 1—3-91 Applicant C.E. F'ril NUMBERS CROSS STREETnc� p TRACT DISTRICT NO MAP NO. STATE HWY, PROCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' NUMBER � COMPENSATION INSURANCE ' YES D NO O e OWNER CUBIC YDS. (O (This section need not be completed if the work involved by MAIL HANDLED: C c the permit is for one hundred dollars ($100)or less.) ADDRESSw. ;Ra °' vN 4., r x • TEL 1 J iJ T{ USE ZONE SPECIAL I certify that in the performance of the work for which this per- CITY STA f ' STATE CONDITIONS,z jj L- mit is issued, I shall not employ any person in any manner so as G to become subject to the Workers'Compensation Laws. ENGIMA I[NEER REG. NO. Date Applicant ADDRESS 11a t* / TEL NOTICE TO APPLICANT:If, after making this Certificate of Ex- CITY ilosAngeles N(5213-471-822e, emption, you should become subject to the Workers' Compen- GRADING TEL FINAL BY sotion provisions of the Labor Code, you must forthwith comply CONTRACTOR NO. 71 ,7 DATE with such provisions or this permit shall be deemed revoked. ADDRESS 1.5 5, c. CC St. ruj to P` LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 P L1$�bIF GRA $ITE($) VALIDATION (commencing with Section 7000) of Division 3 of the Business I'le sr Bali j: racul t!) and Professions Code, and my license is in full force and effect. t- License Number 45 389 Lic.Class a 1-3--91 Contractor rrvac Cons Pate CHECK IF SUPERVISED GRADING ❑ 1 am exempt from the licensing requirements as I am a SIGNATURE licensed architect or a registered professional engineer 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. HOME OWNER-BUILDER DECLARATION SURETY COMPANY I hereby affirm that I am exempt from the Contractor's License D Law for the following reason (Section 7031.5, Business and Pro- FDATE RECILED BY RE fessions Code): CASH RECD DATE ❑ 1, as owner of the property, or my employees with wages DEPOSIT$ BY FILED as their sole compensation, will do the work and the struc- THIS IS A LIMITED TIME PERMIT ture is not intended or offered for sale (Section 7044, Business and Professions Code). ALL WORK AUTHORIZED MUST BE COMPLETED BY ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section TIME LIMIT: 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY EXTENDED TO: BY: I hereby affirm that there is a construction lending agency for EXTENDED TO BY: the performance of the work for which this permit is issued(Sec. 3097, Civ. C.). P.C. Fee $ Permit Fee Lender's Name ' Issuance Fee Lender's Address_ I certify that I have read this application and state that the Total Fee above information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE. Signature of Permittee Date j: COUNTY OF LOS ANGELES TEMPLE CITY # 0508 GRADING PERMIT__- DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS GR 0508 9710020001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA — " PHONE: (818) 285-0488 EXT: GA - • D' NG D SS: TR: 3623LOT(S): 105 5829 ROSEMEAD BL TEMP CA 917801832 ASSESSOR 0 0 NUMBER: NEAREST CROSS STREET: HERMOSA 5387-012-018 CUBIC YARDS HANDLED THOMAS PAGE: 596 'GRID: H3 LOCALITY: TEMPLE CITY TENANT: E SED GRAD 0 *******FEES PAID THIS IS A LIMITED TIME PERMIT ******* OWNER: TEL. NO: ISSUED ON: PROCESSED BY: EXPIRES ON: PEPE'S FINE MEXICAN FOOD (000) 000-0000- FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 10/16/97 UT 10/16/98 08 PLAN CHECK - B&S 648.00 CU 873.30 2A GRADING PERMIT 648.00 CU 730.35 EXP. EXTENDED TO: EXTENDED BY: 2G PERMIT ISSUANCE FEE 27.75 APPLICANT: TEL. N TOTAL FEES 1.,631.40 INNOVATIVE DESIGNS (909) 428-1307- P.O. BOX 4434 RANCHO CUCAMONGA,CA � n 1� fINALDA E FINAL BY: CODE: CONTRACTOR: TEL. NO- 5—�� INNOVATIVE DESIGNS (909) 428-1307- DESCRIPTION OF WORK P.O. BOX 4434 LIC. NO GRADING FOR NEW DRIVE THRU RECTA NT - PEPE'S RANCHO CUCAMONGA, CA 91729 716219 B S ARCHITECT OR ENGINEER: TEL. NO: - `✓ SPECIAL CONDITIONS: ��• LIC. N0: 1`r ' / 1'Ii APPROVALS DATE INSPECTOR SIGNATOR SURETY BOND: S BOND N0: �'I—� w % �`� J INITIAL GRADE PREP. A COMPAQ 0 E OR ECID SURETY COMPANY: —-- SUP. ENGNRIS CERT RECD DATE FILED: RECD BY: <: j _ f� aq�� ROUGH GRADING APPROVAL CASH DEPOSIT: DATE FILED: ,`4�¢,va'`�_•, - // �� ',y'„ .�b`� PLANTING AND IRRIGATION RECID BY ,\� �--- e SUP. E GIS FINAL CERT OTHER LEGAL S: SURETY BOND RELEASED c te, T�r ., STATE S 0 0: GEOLOGIC AND SOILS REPORTS FILED YES C-2 150H265 TYPE PREPARED BY DATE RECEIVED APPROVED REPORT ID: DPR262 ROUTE TO: BS0508