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Home My Public Portal About4925 FRATUS DR_Mechanical__ WORKER'S COMPENSATION Df consent to 76A346DPW9/69 APPLICATION FOR PERMIT LIME GREEN '76A364C I he'�eby affirm that I have a certificate'of consent to self Insure, or a rt1f Cate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING -AIR CONDITIONING copyghereof(8ec 3800 Lab C) • L ' Policy No Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV ,Certified copy Is hereby furnished r ❑ Certified copy Is filed with the county g buildin Inspection FOR APPLICANT TO FILL IN BUILDING P de artment (PRINT OR TYPE ONLY) ADDRESS Zr T 5 Date Applicant LOCALITY NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS NEARESTLA CROSS `� COMPENSATION INSURANCE ABSORPTION UNIT BTU ASSESSOR V R (This section need not be completed If the work involved by the MAP BOOK PAGE PARCEL permit is for one,hundred dollars($100)or less) AIR HANDLING UNIT,CFM DISTRICT NO . PROCESSED BY I certify that In the performance of the work for which this permit ' Is Issued, I shall not employ any person in any manner so as to BOILER BTU become subject to the Workers' Compensation Laws Op COMPRESSOR,BTU Date A llcant APPROVALS DATE INSPECTOR S SIGNATURE PP VENTILATION SYSTEM NOTICE TO APPLICANT If, after Making this Certificate of ROUGH Exemption,you should become subject to the Workers' Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL -2/ provisions or this permit shall be deemed revoked FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and WALL Professions Code,and my license Is In full force and effect JLAnn `�_✓` , a Q(.r S License Number Llc Class � 1�J � � GY, ' poll. } CL Contractor Date O FTI am exempt under Sec Plan check fee 0 Lr B&P C for this reason PERMIT ISSUING FEE$ O Date TOTAL FEE " U W Signature a- OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT CA _ Z 1 hereby affirm that I am exempt from the Contractor's License Law NAME , for the following reason (Section-7031 5 Business and Professions - Code) ADDRESS f_T a ® 1, as owner of the property, or my employees,with wages - as their sole compensation, will do the work and the CITY TEL NO — - structure is not Intended or offered for sale (Section 7044, Business and Professions Code) OWNER C� i I, as owner of the property, am exclusively contracting ` �/ I)_)iiaL -'z5 00 MAILwith licensed contractors to construct the project (Sec- ADDRESS �j(`�- (�f �� F r_= -- CITY TEL NO tion 7044, Business and Professions Code) o --HEY �-'°LI=y CONSTRUCTION LENDING AGENCY �� !lv 1_Q / i1 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 :* i tD "D L, f 1 / :d ;i 1 Lender's Name CITY TEL NO Lender's Address STATE LIC I certify that I have read this application and state that the above LICENSE NO CLASS 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 pro y for Ins on pur sas SEE REVERSE FOR EXPLANATORY LANGUAGE r SIGN A OFA ANT OR AGENT DAIL , CE 83613 4C (2 80) APPLICATION FOR PERMIT HEATING-VENTILATING-AIR ILATI NG-All R CONDITIONING a Certit i,J �� - ( ) "fl Policy Certified copy is hereby fLI17I1iSI1'1 COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is filed with the county building. inspe(tion BUILDING departure FOR APPLICANT TO FILL IN ADDRESS 1�r Date 1Applic3nt-41-� (PRINT OR TYPE ONLY) LOCALITYL� CLRTHACATE 01 ' EXEMPTION I ROM WORKLRS' NO TYPE OF APPLIANCE OR EQUIPMENTFEE COM PF INSURANCE - -T NEAREST 4 (This section nee(! ABSORPTION UNIT, BTU- CROSS ST, 0 by the permit i DISTRICT NO. PROCESSED BY I certify that in 0 permit is issued. i 1),f 0 s0 as to become t,, 5J 00C2 APPROVALS DATE I NSII'I'S SIGN LIRE ll UJ Date— Applicant t-----�COMPRESSOR, BTt ROUGH a- NOTICE TOZ �Xemption, VENTILATION SY' FINAL ith comply with qlia, shall he EVAPORATIVE CO VALIDATION -emed revoked. L------- !FURNACE: FAU. �FLOOR:--. LICIENS: I herebv affirm that . ,m pi i Chapter 1HEATER: SUSPENDED UNIT ? (commencing with Section 7000) of Division 3 of the Busi- less and Professions Code, and my license is in full force and License Lic Contra, are D am exempt from the licensitiv requirements as 11 licensed architect or a Plan check fee 25%of above. acting in my professi(, mess and Professions Co,.. PERMIT ISSUING FEE '5 162 or Reg.No.— - HOME OWNER-BUILDER Dl��'('LARATJON PLAN I CHECK APPLICANT TOTAL FEE 1�- I hereby affirm that .1 am exempt from the Contractor" NAME License Law for the following reason (Section 7031.5, Busi ness and Professions Codi): ADDRESS 1, as owner of the property, will do the lurk and tllc structure is not intended or offered for sale (Section CITY J. 7044, Business and Professions Code). ❑ OWNER 1, as owner of the property, am exclusivolv contracting with licensed contractors to construct the project MAIL (Section 7044. Business and Protessioms Code). ADDRESS CONSTRUCTION I.FNDING AGI NCY CITY TEL. NO. 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 Name ADDRESS Lender's Address CITY TEL. NO. A-Q I certify that I have read this application and state that th_ STATELIC. k— above information is correct. I agree to comply with all Co!- LICENSE No e, CLASs ordinances and State laws regulating Heating. Ventilatin,', Air Conditioning, and hereby authorize representatives of SEE REVERSIS FOR EXPLANATORY LANGUAGF County to enter upon the above-mentioned property 1,,r inspee ion purposes. jg -a Signature of Permittee UJI