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Home My Public Portal About6351 ENCINITA AVE_Mechanical__ WORKERS'that t I hav a cerN DECLARATIONcorse APPLICATION FOR PERMIT I hereby affirm that I have o certificate of consent to self ,vl insure, or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING ora certified copy,thereof (Sec. 3800, Lob. C.) 76A364C t,U ti. (•- )U .. f , L.. .. (.. r - - 6:Cc's• aCE-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 •� / i tion de art enc. ADDRESS t •f 1-."- /v !' t .11 i P / rf (PRINT OR TYPE ONLY) / f bU !„',,, 7 LA f " - - LOCALITY ) ! • / Date' ! Applicant r I �• NO. TYPE OF APPLIANCE OR EQUIPMENT FEE _ CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. ti•C .T e•\ '•.l (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 performance of the work for which this - - permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Lows. BOILER,,BTU • APPROVALS DATE INSPECTOR'S 51GNAiDRE _` COMPRESSOR, BTU •x L txt' +Lr (/�• ROUGH Date APPlicant NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL ; Exemption, you should become subject to the Workers' • Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION 1 with comply with such provisions or this permit-shall be deemed revoked. FURNACE: .FAU GRAVITY LICENSED CONTRACTORS DECLARATION• r FLOOR -BTU I hereby offirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT_ - y '(commencing with Section 7000) of Division 3 of the Business WALL CL and Professions Code;and my license is in full force and effect. - - O. U• License Number r � j `-' � Lia Class G •-� r 11 f f - t,e 1 / r - D Wu� 1.�. !. 1.'/' Contractor:-Tic 'x e '�- ��"I° 'Date 1- .%t-' ° I t ❑ I am exempt under Sec. I - Q • Plan check fee ' B.BP.C. for this reason' s O • Date. PERMIT ISSUING FEE $ TOTAL FEE (I fir' Signature OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT ' 1ti} Q . hereby affirm that 1 am exempt from the Contractor's License . Law for the fallowing reason (Section 7031.5, Business and NAME D 4€�roji ll� l.8a Professions Code): ADDRESSI I r ti ❑ I, as owner of the property, or. my employees with t 11st s N PCCttyy,(,(' wages as their sole compensation,will do the work and i(iili'V,; Ji 1i"d the structure is not intended or offered for sale(Section CITY TEL. NO. t 7044, Business and Professions Code). 1 , ❑ OWNER I, as owner of the property, am exclusively contracting /fit �• �. G s. -� L� %rte„ with licensed contractors to construct theSec-ect j roMAIL / P ( ;; ) /syr'. C < % t 7 t••. •.. - tion 7044, Business and Professions Code).: ADDRESS ( ty y� CONSTRUCTION LENDING AGENCY CITY -J'� TEL NO..J (�1 011-1 I hereby affirm that there is a construction lending agency for �' ' �t {'' .� ,1 J- 'T : 'y'"� # eel la Ie L. the performance of the work for which this permit is issued CONTRACTOR. ,. r ( D M1 >l)I M, (Sec. 3097, Civ. C.). f" ADDRESS , is p�+j pIIIt1 Np H Lender's Nome CITY r.✓. TEL'NO, Lender's Address STATE 7 ! Ar ` LIC. I certify that I hove read This application and state that the LICENSE NO.r l� CLASS 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 fir`_-ft..�..�-� •/ ' �- �� Signature of Applicant or Agent Date �• Jr WORKERS'COMPENSATION DECLARATION p PPL IC p TION F6p (A(iP WT I hereby affirm that I have a certificate of consent to self APPLICATION P9 ®\7 Yl I�IIICCC hMMiCCEV� insu46, or a certificate of Workers' Compensation Insurance, - - HEATING - VENTILATING - AIR CONDITIONING ((o�rr,�a certyrtifiedl-copy thereof (Sec. 3800, Lob. C.) 76A364C ' PoiiC I�o.iG 1 % Com SLL +Oar . Ott WTINC-f181REV. 10/81) ,-,icy y P y COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is hereby furnished. Certified copy is filed with the county building inspec- - FOR APPLICANT TO FILL IN BUILDING /_ 4/ tion department. /� �• (PRINT OR TYPE ONLY) ADDRESS tl/ r 7-M C i ACF 7 Date/•` C r+ Applicant K/ C 4 e S LOCALITY vNr �p •� 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. c '/ PROCESSED By the permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM - I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner BOILER, BTU so as to become subject to the Workers'Compensation Laws. / nRFRovnls ante wsR TOR•B S Io IGNA RE Date Applicant COMPRESSOR, BTU 3A!t /V ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER I VALIDATI ' with comply with such provisions or this permit shall be deemed revoked. s FURNACE: FAU—GRaVV �I /l LICENSED CONTRACTORS DECLARATION FLOOR BTO 55 Ael (/ d V I hereby affirm that lam 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. d License Number 7 6 z b Lic Class F- .ZO / V f `�- C a/ G ty f P S D oe ControctorG 92 ruE J 5cs�PSDa C �a- ,��-S/ t_ 0 ❑ I am exempt under Sec. .. - Plan check fee B.&P.C. for this reasonW Date: PERMIT ISSUING FEE $ Z Signature OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT 22''gqU�l # I hereby affirm that I am exempt from the Contractor's License D a 'e \U Low for the following reason (Section 7031.5, Business and NAME Professions Code): El 1, as owner of the property,'or my employees with ADDRESS 9, 5nx • wages as their sole compensation,will do the work and - i I •.�.�, 8 O the structure is not intended or offered for safe (Section CITY TEL. NO. 7044, Business and Professions Code). ❑ 1, as owner of the property, am exclusively contracting OWNER �e b with licensed contractors to construct the project (Sec- MAIL ' tion 7044, Business and Professions Code). ADDRESS 6 , 73 i C. rV 1 4 C', CONSTRUCTION LENDING AGENCY ' CITY P C TEL. NEI _ Y1517.7 2 1 .O 4 0 A I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTORCS D # e -.-:-.o 8 (Sec 3097, Civ. C.). ADDRESSZc C & 'i `IV _ - ,T 1,'OONO Lender's Name r t I CITY Fa S G. TEL. NO.t Lender's Address STATE / LIC. I certify that I have read This application and State,;hat the LICENSE NO.f � 7 G 2 L•x CLASS I � above information is correct. 1 agree to comply with aCounty ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter - upon the above-mentioned property for inspection Fpu(t'poses. SEE REVERSE FOR EXPLANATORY LANGUAGE . Signature of Applicant or Agent Date