The URL can be used to link to this page

Home My Public Portal About9808 DAINES DR_Mechanical__ WOR:<ERS'COMPENSATION DECLARATION CE 8 8C(2 80) A P P UCAT 0®N FOR p E IRS WT I hereby affirm that I have a certificate of consent to self I _ - - insure, or a certificate of Workers'Compensation Insurance,of HEATING-VENTILATING-AIR COWDIYIONING d certified copy thereof(Sec 3800,Lab C) Policy No Company COUNTY OF LOS ANGELES BUILDING AND SAFETY. Certified copy is hereby furnished • , • - " ,- �'F IMP�...� G,"�"'C' Certified copy is filed with the county building inspection _ BUILDING Cl + department FOR`APPL'ICANT TO FILL IN ADDRESS r ��ff r Date Applicant - (PRIRT OR TYPE ONLY). -- LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE _ COMPENSATION INSURANCE NEARCROSST �j a (This section need not be completed if the work Involved ABSORPTION UNIT, BTU 0 by the permit is for one hundred dollars ($100) or less) DISTRICT NO PROCESSE BYU I certify that iii the performance of the'work for which this AIR HANDLING UNIT„CFM r,� 1A V�V' r permit is issued, I shall V not employ any person in any manner µ &, 1C)%, C) 0 so as to become subject to the Workers'Compensation Laws BOILER,BTU r- - APPROVALS DATE INSPECTOR'S SIGNATURE (� W Date Applicant COMPRESSOR, BTU ROUGH /Z'ZQ- Cn NOTICE TO APPLICANT If, after making this Certificate of ` VENTILATION SYSTEM Z Exemption, you should become subject?to the Workbrs'_ FINAL Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER r VALIDATION with comply with such provisions or this permit shall be deemed revoked , FORNLICENSED CONTRACTORS DECLARATION L FLOOR FAURAVITY � 88�1"UU 1 S Q�` I hereby affirm that I am licensed under provisions of Chapter HEATER SUSPENDED, -UNIT -9 (commencing with,Section 7000),of Division 3,of the,Busi- WALL ness and Professions Code, and my license'is in full force and _ effect 'License Number Lic Class Contractor Date I am exempt from the licensing requirements as I am a • _ licensed architect or a registered professional engineer Plan check fee 25%of above acting in my professional capacity (Section 7051, Bus- iness and Professions Code) - Lic or Reg No Date TOTAL FEE S HOME OWNER-BUILDER DECLARATION PLAN,CHECK APPLICANT - I hereby affirm that I am exempt from- the Contractor's NAME `��_i ��L` Sn(�'_ I-V License Law for the following reason (Section 7031 5,,Buse-.-. I i ness and Professions Code) ADDRESS ' I, as owner of the property, will do the work and the yJ�' ` ( CITY—r �+o / TEL NO ag q� i structure is not intended or offered for sale, Section M�t7 _\ � � �, �3 # o o oro o 7044, Business and Professions'Code) ; OWNER I,as owner of the property, am exclusively contracting _ 2 ,,?- 2 31,5, with licensed contractors to construct the project MAIL r (Section 7044, Business and Professions Code) ADDRESS _ _ -Jo,--2-3'5-0,6 CONSTRUCTION LENDING AGENCY CITY TEL NO I hereby affirm that there is a construction lending agency - 2.2'J�—8-l` for the performance of the work for which this permit is CONTRACTOR issued(Sec 3097,Civ C) _ Lender's Name ADDRESS Lender's Address CITY TEL' NO I'certify that I have read this application and state that theSTATESE LIC i above information is correct I agree to comply with all County - LIC ENNO CLASS ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY•LANGUAGE OL., ty to nter up” i 21e, lboye-mentioned properly for t& r 3ses ,a �r 7` tur or Perrr d ee Date r W6. ,KERS'COMPENSATION DECLARATION CEA3818C(2y80) A P P UC A T B O `Yl II-®R Ir E R M UT X' y I"hereby affirm that I have a certificate of consent to self msurr,'or, a ce tificate of Workers'Compensation Insurance,or HOkATING-VENTILATING-AIR CONDITIONING a certified copy thereof(Sec 3800,Lab C_) Policy No Company . .. ` . ❑ Certified copy is hereby furnished- ' COUNTY OF LOS ANGELES , _ BUILDING AND SAFETY .❑ Certified copy is filed with the county building inspection =OR APPLICANT TO FILL IN BUILDING'~ department 4� ADDRESS7go� �� r Date' Appltcant (PRINT OR TYPE ONLY) 3 'LOC'ALITY CERTIFICATE OF EXEMPTION FROM WORKERS' {�° NO TYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE - NEAREST E CROSS ST G, ` (This_section.need not be bompleted if the work involved, ABSORPT1pN UNIT, BT IJ = 0 • O by the=permit is-for one hundred dollars ($100) or less.) DISTRICT No PROCESS, A°IR HANDLING UNIT,CFM e _ I.certify that in the'performance'of the work for which this `' permit is issued, I shall not erriploy any per`son'm any manner � O: so as to b come subject to the Workers'.Compe atio Laws BOILER, BTU APPROVALS DATE, IN CT SSiGN�TURe+ Date - �pplicant — � COMPRESSOR, BTU=i -�f�f�� ROUGH ° — — --- C. T N 0 NOTICE.TO AP,PLICANT'-If,`after making is Certificate,of VE'NTYLA'TION-SYSTEM - FINAL ,' ` Z _.ExempticI You should become: subject-to the Workers,1 - ` ,Compensation provisions of the,'Labor,Code, you°must forth- 'EVAPORATIVE-COOLER' ;> ,• VALIDATION L �� i `; vJith comply_wdM such'pro"visions'or this permit shall be de reed revoked �' FURNACE FAU .GRAVITY lICENSED CONTRACTORS DECLARATION FLOOR BTU I'hereby,affirm that 4 am licensed under provisions of Chapter HEATER SUSiPENDED UNIT ; 9'(commencmg with Section 7000)of Division 3 of the,Bust- WALL ness and Professions Code, and my license is in full force and effect r r ° License Number `�_ Lic.Class' Contractor Date - a ❑ I-arr exempt from the licensing requirements as 1 am a y �' licensed architect or;a registered 'professional-engineer Paan check fee 25%d Of above. - acting in my' professional capacity (Section 7051, Bus- iness and Professions Code)' PERMIT ISSUING FEE$ LO50 ; Lic orAReg No Date TCJTIlL FEEUi N �^ 4637A: HOME OWNER-BUILDER DECLARATION PLAN CHECK'APPLICANT- P #'o_o�oi0 0 8" ` I. hereby affiI that I iam exempt from-the 'Contractor's NAME e.• a 5 nQ License Law fog the following reason (Section-f7031 5, Busi- �� C �'- t a ess and Professions Code)' �n " ADDRESS y "Q_ 0,h;A �( ' 1, as owner'of„the,property, will'do the }vork'and the . r ==i✓ IfniCITY j 'TEL NO` �.=b 73' structure.is not-:intended.or offered for sale (Section /Z°•/Y� 7044, Business-and Professions Code) / -C_J�l S a - ❑ OWNER I, as owner of the p-roperty, am exclusively contracting F � 'q ° •;�, with licensed contractors to construct the project MAIL (Section 7044, Businelss and Professions Code) ADDRESS- `� I CONSTRUCTION LENDING AGENCY CITY TEL N I hereby affirm that there is a construction lending agency for'-the' performance of the work for which this permit is- CONTRACTOR issued(Sec.3097,Civ-C) Lender's Naine ADD`R5SS Lender'sAddre"ssCITY � TEL-NO : o I certify that I have read this application,and state that theSTATE e LIC above information is correct.I agree to comply with all County ULICENS&NO ' CLASS tc ordinances and State laws regulating Heating, Ventilating and Air Conditioning,and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County--to enter u on the above-mentioned property for i�s e o urp ses nature of Verinittee Dae _{