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HomeMy Public PortalAbout8943-8951 EMPEROR AVE_Mechanical__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, 7aA3e4c HEATING - VENTILATING - AIR CONDITIONING or a certified copy thereof (Sec. 3800, Lab: C.) CE-818(REV. 10/81) Policy No. Company Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY $1 ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING r? tion department. (PRINT OR TYPE ONLY) ADDRESS NO. TYPE OF APPLIANCE OR EQUIPMENT Date Applicant LOCALITY FEE "l!v CERTIFICATE OF EXEMPTION FROM WORKERS' NEARESS7. V� b v COMPENSATION INSURANCE CROSS ABSORPTION UNIT, BTU DISTRICT NO PROCESSED BY (This section need not be completed if the work involved by �-. the permit is for one hundred dollars ($100)or less.) AIR HANDLING UNIT, CFM I certify that in the performanceof the work for which this permit is issu d, I shall not e loy any per in any mann SO a5 t0 ec me subj not O rs'C pe s i La BOILER, BTU T(n /A APPROVALS DATE PE TOR'S SIGNATURE Date App COMPRESSOR, BTU ✓`� V ROUGH NOTI APPLICANT: If, after m ing 1 s Certificate of VENTILATION SYSTEM FINAL Exemption, you should become su ' ct t the Workers' Compensation provisions of the Labor Co e, you must forth- EVAPORATIVE COOLER VALIDATI N with comply with such provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVJJY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED-UNIT- '(commencing USPENDED UNIT WALL - (commencing with Section 7000) of Division 3 of the Business � and Professions Code,and my license in full force and effect. License mbe��� v Lic. Class V 5 �f 0 Contractor• ate O ❑ I am exempt under Sec. U Plan check fee B.&P.C. for this reason T 4n PERMIT ISSUING FEE $ ;20 6 2 9 A Date: Signature TOTAL FEE # ° ° ° ° ° S OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT rI ° ° 4 4,5 0 I herebyaffirm that I am exempt from the Contractor's License Law fothe following reason (Section 7031.5, Business and NAME o o'0 4 4 5 0 c=i Professions Code): El 1, as owner of the property, or my employees with ADDRESS 09. 09'-88 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section CITY TEL. NO. 7044, Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting MAIL \ with licensed contractors to construct the project (Sec- ADDRESS V tion 7044, Business'and Professions Code). CONSTRUCTION LENDING AGENCY CITY2 -�'he TEL. NO.*?&0 ?'�1 I hereby affirm that there is a construction lending ag6ncy for , the performance of the work for which this permit is issued CONTRACTOR (Sec. 3097, Civ. C.). ADDRESS Lender's Name f CITY /VVC:,,-- a TEL. NO. � Lender's Address STATE LIC. I certify that I have read this applisption and state that the LICENSE NO. CLASS above information is correct. I agre to comply with all County o dinances ar -Stat� laws relating to building construction, a her putorize represer}tativespf this Co my to enter ab e- �ti ne'd pfo erty or in ecti n Pyoses.. SEE REVERSE FOR EXPLANATORY.LANGUAGE � .. q q Signature of A is nt or Agent _ s Dote WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT I'hereby affirm that I have'a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING CE-81 or a certified copy thereof (Sec. 3800, Lab. C.) C CE 818(REV. 10/81) Policy No.-Company Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING ye/� tion department. (PRINT OR TYPE ONLY) ADDRESS Oct t k:y"tnt�ti_I Vilma Date Applicant LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST v COMPENSATION INSURANCE CROSS ST. 1 (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. PROCESSED BY the permit is for one hundred dollars ($100)or less.) I certify that in The perfVhe r which thi AIR HANDLING UNIT, CFM �l L permit is issued, I shall ny p rson i ann r BOILER, BTU so as t0 ec0 a subject Om O aw APPROVALS DATE IN E O 'S SIGNATURE Date ApCOMPRESSOR, BTU � C-0® ROUGH NOTIC T APPLICANT: long Thi ertificate of VENTILATION SYSTEM FINAL Exemption, you should 'ect to the Workers' Compensation provisionsr u must forth- EVAPORATIVE COOLER VIA 1 IDATI;ON with comply with such provisions or This permit shall be deemed revoked. FURNACE: FAU i) LICENSED CONTRACTORS DECLARATION FLOOR BTU V (� (/ I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED-UNIT- (commencing USPENDED UNIT(commencing with Section 7000) of Division 3 of the Business WALL and Professions Code, and my license is in full force and effect. >' License umber ?qR Lic. Clacsys �y� t �D , O Contract r 'Date ❑ I am exempt uncle Sec. V Plan check fee 9L B.BP.C. for this reason' PERMIT ISSUING FEE $ Date: 1 9 0 6 3.O,A TOTAL FEE Signature # o o t�0 0 0 OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License , I o o 4 4 5 0 Law for the following reason (Section 7031.5, Business and NAME Professions Code): ❑ I, as owner of the property, or,my employees with ADDRESS o 0 0 4 Q 5 O 5 wages as their sole compensation,will do the work and CITY TEL. NO. 09,o9-88 the structure is not intended or offered for sale(Section 0 9.0 9 7044, Business and Professions Code). ❑ OWNER ( z- I, as owner of the property, am exclusively cor)tracting � � �7 l with licensed contractors to construct the project (Sec- MAIL i ` tion 7044, Business f and Professions Code). ADDRESS \ V CONSTRUCTION LENDING AGENCY CITY TEL. NO. I herebyaffirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTORW , (Sec. 3097, Civ. C.). ADDRESS Lender's Name CITY TEL. NO. �� Lender's Address STATE LIC. ,tip I certify that I have read thisapplica ' nand state that the LICENSE NO. CLASS ��CJ above information is correct. I agree t co ply with all County inances and St ws relatin o b iIding construction, ereby out h ri re r ent Iv of this Cou ty't enter up ve- a ro rty nsp4 pu pQse=`/ SEE REVERSE FOR EXPLANATORY LANGUAGE I ure of A licant o Agent Date (0��00/ •.WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT • I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING -,AIR CONDITIONING or a certified copy thereof (Sec. 3800, Lab. C.) 76A364C CE-818(REV. 10/81) Policy No. Company Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY Q Certified copy is filed with the county.building inspec- FOR APPLICANT TO FILL IN BUILDING tion department. (PRINT OR TYPE ONLY) ADDRESS �`� lrsX1VC� Date Applicant LOCALITY �V\ CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEARESTUIVO . ' COMPENSATION INSURANCE CROSS ST. r V t �V "s(rte J (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. PROCESSED BY the permit is for one hundred dollars ($100)or less.) I certify that in the perf ante of the work for which th' AIR HANDLING UNIT, CFM permit' iss d, I shall t e ploy an ers n in any man r l Sos t be me subje O k 5' a ation L BOILER, BTU APPROVALS DATE I PE 'S SIGNATURE COMPRESSOR, BTU X75(OC © f/ ROUGH NOTI E Tb APPLICANT:' If, of makin t is Certifica e of VENTILATION SYSTEM FINAL Exemption, you should becom subje t to the Workers' Compensation provisions of the La r C e, you must forth- EVAPORATIVE COOLER VALIDAT C with comply with such provisions or is permit shall be deemed revoked. FURNACE: FAU G V Y A[ LICENSED CONTRACTORS DECLARATION FLOOR BTU (J I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business WALL and Professions Code,and my license is in full force and effect. L39 IOU License umbe O �!Lic. Class , y ad �' 3c 0 Contract Date ❑ V 1 am exempt under Sec. � Plan check fee B.&P.C. for this reason' PERMIT ISSUING FEE $ o Signature Date: TOTAL FEE 0 6'3. 1 A OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT # o o to o;o 8 1 hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and NAME J o - 44,5.0 Professions Code): ❑ I, as owner of the property, or my employees with ADDRESS o --® 44,5,0 wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Section CITY TEL. NO 9 p Q 7044, Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- MAIL - tion 7044, Business and Professions Code). ADDRES CONSTRUCTION LENDING AGENCY CITY ��" '`J TEL. N024-DSU 1 hereby affirm that there is a construction lending agency for /_ Boo.the performance of the work for which this permit is issued CONTRACTOR (Sec. 3097, Civ. C.). ADDRESS (� G v Lender's Name v CITY �� TEL. NO_53 Ill Lender's Address STATE ' LIC. I certify that I have read this appli tion and state that the LICENSE NO. CLASS bove information is correct. I ogre t comply with all County finances and ate s relati t building constr coon, out oriW r e t ve of this Co my t enter U ve a t' r ty r inspecti n P. poses SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Ap ' ant Agent Dote WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT I•hereby•affi+m that I have a certificate of consent to self insure,' or a certificdie of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING or a certified copy thereof (Sec. 3800, Lab. C.) 76A364C CE-818(REV. 10/81) ` t Policy No.—Company' COUNTY OF LOS ANGELES BUILDING AND SAFETY (�—{lu��•/`��Tj Certified copy is hereby furnished. ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING tion department. (PRINT OR TYPE ONLY) ADDRESSVIV Date Applicant LOCALITY NO, TYPE OF APPLIANCE OR EQUIPMENT FEENEAREST Ic CERTIFICCOMPENSATION INSURANCEORKERS' CROSS ST. q / 1f (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO, PROCESSED BY the permit is for one hundred dollars ($100)or less.) I certify that in the perfor nce of the for which this AIR HANDLING UNIT, CFM C/ permit i issu d, I shall not m lay.-y any rson n an man r so as to bec me sub'ect ers'C n L BOILER, BTU APPROVALS DATE N E OR'S SIGNATURE Date COMPRESSOR, BTU `F'�"� `� ® ROUGH NOTICE TO APPLICANT: If, after in this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become ubje to the Workers' Compensation provisions of the Lab C e, you must forth- EVAPORATIVE COOLER VALIDA with comply with such provisions or is permit shall be deemed revoked. FURNACE: FAU ITY /I LICENSED CONTRACTORS DECLARATION, FLOOR BT V I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT - '(commencing with Section 7000) of Division 3 of the Business HEATER: WALL and Professions Code,and m license is in full force and effect. ' n ti �` Licens Numb�� Lic. Class �{ , V CoJIM ntra ` 0- I am exempt un er Sec. LU Plan check fee a 8.8P.C. for this reason DarePERMIT ISSUING FEE $ : 5 Signature TOTAL FEE ;2063,2A OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT ' #,o o o o,o 8 I hereby affirm that I am exempt from the Contractor's License , o'0 4 IL 5 0 Law for the following reason (Section 7031.5, Business and NAME Professions Code): ❑ I, as owner of the property, or my employees with ADDRESS o,o ,0 4 U.5 0 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section CITY TEL. NO. 0 9,0 9-�8 8 7044, Business and Professions Code). i OWNER ❑ I, as owner of the property, am exclusively contracting with'licensed contractors to construct the project (Sec- MAIL C tion 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY CITY TEL. NO. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTORV , (Sec. 3097, Civ. C.). ADDRES Lender's Name t CITY \�� TEL. NO-55 (oil Lender's Address STATELIC. ^7 I certify that I have read this applic 'on and state that the LICENSE NO. CLASS Cv above information ' correct. I agree o amply with all County rdinances an State ows relati to building c str ction, e eby ou horiz- r en ti s f this Co y t enter u n o m ' n e t or insPgi "I e SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of A nt r Agent Date W(AKERS' COMPENSATION DECLARATION •I^'hereby'affirm that I 0 APPLICATION FOR PERMI ,have, certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING CE-818 or a certified copy thereof (Sec. 3800, Lab. C.) CE 818(REV. 10/81) Policy No. Company Certified copy is hereby furnished: COUNTY OF LOBS ANGELES IDI G AND SAFETY t ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL-IN BUILDING tion department. (PRINT OR TYPE ONLY) ADDRESS Date Applicant LOCALITY , NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. PROCESSED BY the permit is for one hundred dollars ($100)or less.) AIR HANDLING UNIT, CFM I certify that in the perfor ce of thew r which this --��'�� permit is iss d, I shall not m oy any p son in ny manner BOILER, BTU so as t be me s bject O e O k 5 O e LOWS. APPROVALS DATE 1 .ECTOR'S SIGNATURE �� COMPRESSOR, BTU � ROUGH � Date A NOTIC TO APPLICANT:, If, a er ng th rtlficate of VENTILATION SYSTEM FINAL Exemption, you should become ubject to the Workers' Yf( Compensation provisions of the Labor u must forth- EVAPORATIVE COOLER VALIDATI with comply with such provisions or this permit shall be deemed revoked. FURNACE: FAUG A �I J1 LICENSED CONTRACTORS DECLARATION FLOOR BTU (� d I hereby affirm that I,am licensed under provisions of Chapter 9 HEATER: USPENDED UNIT (commencing with Section 7000) of Division 3 of the Business JALL and ProfessioSCode, and my license is in full force `and effect. a^� ' � License Nu n Lic. Claiw��r�N 210 Il lam- /V60 kp`� �� 0Contra \ � Date O ❑ I am exempt un er Sec. IF U Plan check fee tQ. . B.&P.C. for this reason 4A Date: PERMIT ISSUING FEE $ z 0 6 a 3 A Signature TOTAL FEE OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT # o 0 o m o 8 I hereby affirm that I am exempt from the Contractor's License ° ° 4 4,5 0 Law for the following reason (Section 7031.5, Business and NAME, Professions Code): 44.5 0 El 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will clothe work and the structure is not intended or offered for sale(Section Ih CITY TEL. NO. C� o C� 8 7044, Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting q with licensed contractors to construct the project (Sec- MAIL MAIL tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY TELNO. t I hereby affirm that there is a construction lending agency for , the performance of the work for which this permit is issued CONTRACTOR (Sec. 3097, Civ. C.). ADDRESS j Lender's Name CITY TEL. NO. Lender's Address STATE LIC I certify that I have read this appapp ation and state that the LICENSE NO. CLASS --`/.' above information is correct. I agr e t comply with all County rdinances an a laws rela ng t building construction, d hereby uthor' re rese atives of this C my t enter e ab v ti d r erty or insect on ryas s. SEE REVERSE FOR EXPLANATORY LANGUAGE gnat,,,.o I ant or Agent Date 8V