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HomeMy Public PortalAbout9547 GARIBALDI AVE_Mechanical__ '"° COMPENSATION carte DE°'o'n°" APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self • InInsure, or la certifkattee ofWCA Ion Ihsuranc*,� HEATING - YEMTILATING - AIR C"DMONING y ,�(�� DPW 9/W-r• Polley o.�Comperny `� - - -E] Certified copy Is hereby furnished: COUNTY OF LOS ANGELES BUILD AND SAFETY Certified copy is filed wl th my building I FOR APPLICANT TO FILL IN ��NG C— l (PRINT OR TYPE 6NtY) AD{�6 / -A VA- r APPI16 �� scant 1`{0. TYPE OF APKL NC'E OR EQUIPMBdT - FEE LOCAUTY dui ' CERTIFICATE OF DffiWq ON F WORDS' NEAREST COMPUNSATION IN$URANCt _ CROSS ST. ABSORPTION UN9, BTU (This secffon need not be coe�fel+d!f tee work hryoty by oarA�NQ-. t!w Pei IN Is For ono bundnd deign(i10� or 1sss.) e{r tertIfy,th&t In the perforfnance of tai work for which this I AIR UNIT CFM'- _ pirmtt Is issued,I shall►lot employ any�erwn In arty manner I s,6'm to become subled to the Worker C robin calor Laws. TSTLI APPROVALS o•rE &Z W-41AT Rt COIv MM MII ROUGI•+ NCnCE.TO APNJ ANT: If, afW mcddw this Certificate, of VHJRLATION SYSTEM.- _ FINAL Exemption, you'should become cabled: to The Workers' Compensation provision of the Labor .'ode, you must forth- EVAPORATIVE COOLER IDATI N with camr,1�,with suchprbvWorr or this permit&hall be deem- ' ed revo(ced FURNACE FAU tt. LICENSE)CONTRACTOR$DECLARATION' BOOR BTU "I hereby affirm that f am licensed under provhlons of chapter 9 HEATER: UNIT (commencing with Section 7000)of Division 3 of the Business WALL and Professions Code,and my Ikwue is in full fomAcind effoo. LicenseNumbef` t c Clogs C I~ cpntroctor�• l , 09 I am.exempt Under Sec Plan check fee r " B.d,P.0 for this Hasan PERMIT ISSUING FEE $ &gnat.ure — TOTAL FEE owNisz4wLw DECLARAnoN PLAN C}4ECX APPLICANT - — _ I hereby affirm that I am exempt from the Can tradors Ll cense pool for the following reason (Sedbn 7031.5,Business and NAME Profe"ons Code): 8y w 1, as owner of the property, or my employees with ADDRESS— s wages as their sole a anion nation,,wl II do the work and CTFY NO. ACCT.z the structure is not hterded or offered for sale(Section ] 7 14 1.44 7044, Business and Pro%a ions Coded owio u _.. I, as owner of the fxop.rty, am utcluslwy contracting i ITErtS with licensed controc orx to Wnatrud the.prQlect (SecMkd - tion 7044, Business¢nd Professions Code Amoss — TOTAL 103-00 .W00 CONSTWCTiON IEDtNG CITY T9..Na - -ECK 1 I hefeby affirm that there is a construction lending agency for the performance of the work for which this permit is Iswwd OONTRA,CTCR 1 . (Sic. 3091, chs. C,)L OWE ADDkESS y yy. L.nders Nam. aTY� TEL- No. ., I.ryLRaJ-0�]1 5/2"13/90Lenders Address STA tit 09 1 Alt 7:14 I certify thatw l have rood thls application and state that the NCL CLASS above Information Is correct.I agree to corrply with all County nT and Stole laws relating to bu ng construction, and eby authorizeof this County to enter n o abov an fur Fns Purposes- SU RlH1Ei U FM DCPLANATORY LANGUAGE ora,,, of AoellcaM.,y Anwnt Dar. }ir WO ESS'�MPENS TION DECLARATION 78A384C pp {� p �j -PERMIT I"'Rareby rto;,,th I4rave a certificate of cpnsant to self. ( CE -8 8 (2 80)" P`i 11- �'C P"tT �. _�O hN; LG 1Vtl �� Insure,br"a oKun"te of WorkerFCompengation Insurance,or HEATING-VENTILATING-AIR CONDITIONING a�ertif�ed ere cp00, Lab.C. iq Policy Na. om y COUNTY OF LOS ANGELES. BUILD ARID SAFETY Certified cVgv Is hereby furnished. Ej Certified copy is flledwith the county b ding inspection FOR APPLICANT 10 FILL IN FOR d art e r ADDRESS Da. L+pplfcent (PRINT OR TYPE ONi.Y) ' LOCALITY Ile CERTIFICATE OF EXEMPTION FROM WORKERS' - NO. TYPE OF APPLJANCE 6H'EQUIPMENT FEE COMPENSATION INSURANCE - NEA-REST('This. eect]on nepd,not be completed if'i)Ie work•rriohred• ABSORPTION UNFT, BT -U CRO$$ST. by the permit is for one.hugdred`dodare ($100)-or•IeaL) V"ICT No. or �qoc a eY I certify,that {n the'performancA of-14a work- for which this AIR HANDLING UN-ITCFM pormit is Issued, I shall.00t.employ any person In any manner Cr 99 aA tq. become sub*t to the Workers' CompeIp ati" Laws.-'•• BOILER, BTU - _ - •gppROVAI,-.S DAT19 E I TDR'a41dNA e Oita Applicartt-' COMPRE OR lJ ROU{3H NOTICE,-TO APPLICANT: If, gfter making this'Oertm;,te of VENTILATIQN SYSTEM •Ekemp4ion, you should become aub}ecf .to the Wo ken' . FINAL ',,Campenaafion prevbioris of the Labor Code; you'must rth- EVAPORATIVE COOLER -- VALI O with comply with sucb •provWoni or this' permit shxU be,.. deemed revoked. FtJFtNACE:' FqU 6RAV1TY f LICENSED CONTRAGTORS DEC),AR,ATION PLQOR: BU v I hereby affirm that J em licensed under piovblona of Chapter HEATER': SUSPENDED • UNIT 9 '(donimencing with 000) 0T.Division 3 of the Buil- WALL neaa end Pr ons'Code,'and en" b'in full force and •pffeet. - - - NumBer��� �, Lie.i LI Con ctc� ��U�bt 43 „ w t c , A e m the lice requLlameRtll As-I am a ' ti6anaed atered professional- enginegr Plan check fee.26%of ebOvQ.•..' bc"gln m1 pro capacity (8eotion 705t, Bus-, PERMIT ISSUING FEE Lneaa and.Professions Code). d Lid or Rel;.No. - bate : TOTAL FEE I4OM1;OWNEP-BUILi)ER.DECLAItATION PLAN CHECK APPLICANT'' l7erpby aTftrm' that I am .exempt fr -om th6 Contractor's NAME lcense Law for the following raason (Section 7031.5, Bust• O neas-and Professions Coda): - ADDR SS I, as owner of the property,,;will do the.loork'and'the. • �1 CITY TEL,NO. i ❑ structure b nob lgtended of offered 'fpr, aala.(Section w - . � � •.}�8.50 •' ; 70.44, Business and Profbeslons.Code).•. ° OWfyERIltm L Ys•ownar'df the property-, em exclustKdly aontractlnia 1- with licensed Zontractors to construct. the proJdTOTAL' I. MAIL ' IV1iL78a+�lL.a '1 .(S;bctioq 7044,Business end Professions Code). ADDRESS /•.yy. �p qq'yy CONSTRUCTION LENDING ,1kGENQY' CITY- TEL.NO. 41\ ,. 1M.50` I hereby affSrhr that then •'is a co ttuMlon Ipnding agency for the perforrpance A'f the work for which this parrgtt-4 -CONTRACTOR • - 3.i'IT�L _ -iaiued Sec. 3097,Civ.C.). 'Lender a Name ADDRESS. /+7� Lender's Address - GTY TEL.NO. - I certify that I have read this.apptication and state that tbe, STATE- LIC. '►(,y7 1 1'7110=52 above informatlonis correct.I agree to comply with all County, I NO CLASS .or dinances and State taws regulating Heatin4, Ventliating And Air Conditioning, and hereby authorize representatives of this SEE RKVERSE FOR EXPLANATbRY LANGUAGE County to enter upon the abovo-mantioned property for Inspection Signature of P mittee � D;te IT—� ,vweby rm have COMPENSATION °E"'cate o" ,, to „ff APPLICATION FOR PERMIT iawr, a certificate of Worker on Insurance, yl� HEATING - VENTILATING - AIR CONDITIONING a�a fi t}rlpgf J �T / - DPW 9/8�--. , Po4Icy� -+� -Company COUNTY OF LOS ANGELES BUILD AND SAFETY El Certified copy Is hereby furnished © certified copy Is filed wl th So ty bulldirg I BUILDIN(, I FOR APPLICANT TO FILL IN part rbeef (PM OR TYPE oraY) ADD��ss / 'r pate applicant NO TYPE of APPLIANCE OR EWPMEW FENEAJnT LOCALITY dAAI CERTIHCATE OF bMMPTK)N 110N INSURANCE _ . GRI=ST, d ABSORPTION UNTT. BTLi I, M1 s section need riot be opmpl•� �tk•work 4svall bar D45lA1CT r�o the o•rmtt,b for On•kund •d do#lart($1.001 or kee.) C� Ar.pla AIR FNl�DUNCa LN IT,CFM._ .� c'� A.�F terttfy that In the perfomance of t oro for which this A pbrmlt Is 1ssu4d, I shall not employ arty�ersorl In arty marviir BOI so ca to become subject to the Workers==Laws waRovws nxrr s+oNArurs Date �.AT,rllcbrit COMPRESSOR, BTU ROUGH F40-n .TO}APPLICANT: If, aft•f making this Certificate,of .I VUMLATION SYSTEM . FINAL g tiemption, you should become subjecf to the Workers' Compensation provlslons of the Labor Code, you must forth- EVAPORATIVE,COOLER DATA with comps•,),wlth iuch prbvislons or this permit I be deems A 4d revoked' _ FURNACE. I'AJU LICENSED CONTRACTORS DECLARATFON- FLOOR BTU �I hiensby affirm that I dm licensed under provisions of Chapter 9 HEATER;- ALL WALL D® lJNff- . (co mmencing with Section 7000)of Division 3 of the Busln&ss WALL and Professions Code, y license tr In full�/�'y"\/{%�and effect, License Numb•+r+- ..c. C1uss ► 0 Con rroStor�•L•C 1 i1C� (Ar I O I am,•xe-tnpt und•i Sec Phan Kheck fee BAP.C. for this roaitian d PERMfT ISSUING FEE $ TOTAL FEE Slgnaturo OWNER43UILDER DECLARATION RAN Q-IEOC APPUC ANT T I hereby affirm that I am exempt from,the Contxxkes License Low for the following redson (SecHon 7031.5, Buslrew and NAME _ MoF ons Cod•k AD { t, as owner of the property, or my employes with Y wages as their sole compensation;w IH do the work and ACCT.T - the structure Is not Intended or offered for sale(Section CITY TEL NO. 1. 7044, Business and Professions Code I. l 103'00 nI, as owner of the property, am exduslvty controding � 33971 YTQf9 with licensed controctots to cont rud the prp(ed (Sec- - tiort 7044, Business and Professions Coded - - TOTAL 103-00 CONSTRUCTION LEND LNG my I Ta Na GECK I hereby Affirm that there is a construction lending agency for 103.00 the performance of the work for which this permit is issued 7OR , ($•a 3097, ay. C} ADDRESS Lenders Nome �y ���yyyy�� _ 4/ �}f CITY T0. NO. UIJtJIi �JIJIJ 1 JJ 23 90 Lenders Address }r I certify that I have read thin application and stat• that the STATE NO. 0-AM above Information brr correct. I ogre•to comply with all County nc•a and Stab laws relating to building construction, and authorize repress vq of this County to enter gn abov endo for I purposesRSESEE RiViFOR EXPLANATORY LAIVGUA6!an f Acwllconl or Aoent Dass }t 'NORSTkS'&1NtPFNSX TION DECLARATION CEA38,8(2-80) APPLICATION FOR PERMIT I herat•Y rffirm ther I kava or �arttficete of consent to stir �.l insure,br'r "r. lncateof Workers'Compensation Insurance,or HEATING-VENTILATING-AOR CONDITIONING ■certlr�ed'Ir�'�thtrenf I z 00, Lab. C.) Policy No ^"t'ompa � COUNTY OF LOS ANGELES Certitled cnRy Is hereby furnished. BUILDINO AND SAFETY Certifled copy is filed with the county b Id ng inspection d art a FOR APPLICANT TO FILL IN BUILDING Date Applicant (PRINT OR TYPE ONLY) ADDRESS ; LOCALITY CERTIFICATE OF EXEMPTION FROM %VORRF-RS' h10. TYPE OF APPLIANCE OR EQUIPMENT FEE 0 COMPENSATION INSUP-ANCE NEAREST (This section need not be comppleted If the work Involved ABSORPTION UNIT, BTU CROSSST. a by the permit is for one hundred dollars. (S I OO) or lesa.) DISTRICT NO PROCESSED By I certify that In the performance of the work for which this AIR HANDLING UNIT CFM permit is Issued, I shall not employ any person in any manner so os to become subject to the Workers' Compensation Laws. BOILER, BTU O " APPROVALS DATEN6P OR's SIGNA a () Date_ Appli an[ COMPRESSOR U ROUGH — a W NOTICE TO APPLICANT: If, after making this Certificate of VENTILATIQN SYSTEM Exemption, you should become subject to the Workers' FINAL ,Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER �vlth comply with such provisions' or this permit shalt be VALI JrW 0 deemed revoked. FURNACE: FAA GRAVITY LICTtNSEDCONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with 000) of Division 3 of the Busl- WALL nese and orts Code, and m enie Is in full force and effect. Lice Number 'p ``rr I,ic.,Cl Con cto�•� �UAb Date I a ce from the lice"I requirement; as I m a licensed Istdred professions] anjineer Plan cbeck fee 25% of above, seting In my pro at capacity (Section lost, Bus- PERMIT ISSUING FEES a Q ineu and Profesiiom Code). Lic,or Reg.No. Data TOTAL FEE HOME OWNER-BUILDER DECLARATION o_.aN CHECK APPLICANT I hereby aff5rm that i em extmpt from- the Contractor's `IAME License Law fur the foflowink reason (Section 7031.5, Busi- nets and Professions Cod;): ADDRESS Ma El1. as owner of the property, will do the work and the s ACC A structure is not int_nded or offered for sale (_~action CITY TEL. NO. 3M rota 7044, Business and Professlons Code). ❑ 0 rNER I, as owner of the property, am exclusively contracting 1 ITEMS iv17 wfth licensed contractors to construct the project a,tL ;y�,y 188.50¢� (Section 70.44• Business and Professions Code). ADDRESS TOTAL 1888.5Q CONSTRUCTION LENDING AGENCY CITY TEL. NO. MM 18$.54 I hereby affirm that there is a construction lending agency Lyre M for the performance of the work for which this permit is CONTRACTOR 4fT�3� .00 Issued (Sec. 3097,Civ.C.). Lender's Name aDr,RESS f1�W�fY�11 X17 Op Lender's Address CITY TEL. NO. 1.11.R�gsLpl—LII 1 7/27/89 �y/2 �O7 I certify that I have read this application and state that the 1—ATE LIC. 47U7 1 1711;52 ab0Ve infurm.ition u correct. I ijree to comply t%uh all County t--ENSE NO. CLASS ordinances and State laws re;uIaring Heating. �rntilating and Air Conditioning. and hereby auth ori;a representati••es of this SEE REVERSE FOR EXPLANATORY LANGUAGE Countv to enter upon the ,host-mentioned prparty for ut,F tenon 1�a'tDRK' Rm. th r IP?cave g10NDECLARATION I CE - (290) APPLICATION FOR PERMIT I 'y�r�h'Y•L�I_Fi'[ftt. that I ?cave a 4ertiFicate of consent to stir ti tt Insure, Or'* certificate nl' orkers'Compensutlon Insurance,or HEATING-VENTILATING-AIR CONDITIONING ■c6rtiried C' s thero�� 1 c 001 Lab C.) P, cy Nt, �C'Ompa-n- Q Certlfled cnRy is hereby furnished. COUNTY OF LOS-ANGELES BUILDI AND SAFETY Certified copy Is Bled withithe county h Iding Inspection FOR APPLICANT TO FILL IN BUILDING d art e Dote : • .Appllctint (PRINT OR TYPE ONLY) ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' No. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY Q COMPENSATION TNSURA.NCE NEAREST } (This section need not be Completed if the work Involved A9SORPTION UNIT, BTU CROSS ST. CL bythe permit is for om hunQred doRm (t 100) or les&) DISTRICT?*0 tBoc D BY I certlfy that in the performance of the work for which this AIR HANDLING UNIT,CFM permit is Lulled, I shall not employ any person In any manner 0 so as to become subject to the Workers' Compensation Laws. BOILER BTU t APPROVALS DATE INSP TORS aIGNA RE Date Applicant 'COMPRESSOR U _ d ROUGH r N NOTICE TO APPLICANT: It.after makinj this Certificate of VENTILATION SYSTEM Z Exemption, you should become subject to the Workers' FINAL / ~Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER with comply with such provisions or this permit shall be VALI 0 deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTR.3CTORSDECLARATION FLOOR BTU I hereby'afflrm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT .9 {commenting svitbJL,-S 00 0) of Division 3 of the Busl- WALL ncu and Pr ons Code. and In ense is In full force and effect. Lice Number G� .�'� tic. Cl - ��'� ' CI Cont ct�.th•W A _6W ate ED ,, a Ke from the linens' requirements as I am a licensed t c ered professional engineer Plan check fee 25%of above. acting In my pro capacity (Section 7051, Bus- iness and Professioru Code). PERMIT ISSUING FEE Q 6 Lic.or Reg. No. Date TOTAL FEE HOME OWNER-BGILDFR DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt rrom- the Contractor'sNAME w License Lass for the follo '.ns reason (Section 7031.5, Busi. 8 ness and Professions Coda): ADDRESS ii F1, is owner of the property, will do the work trod the s A structure Is not intended or offered for sale (Section CITY TEL. NO. 1M.50i� 7044, Business and Professions Code)- 1M ITEM / I, as owner of the property, am exclusively contracting OWNER 1 i taw with licensedcontractors to construct the proj&ct MAIL � (Section 7044, Business and Professions101Code). ADDRESS TIN AL 188.50 CONSTRUCTION LENDING AGENCY CITY TEL. NO. t WCK 188.50 I hereby affirm that there Ls a construction lending agency for the performance of the work for which this permit Ls CONTRACTOR O a00_ Issued (Sec. 3097,Civ.C.). Lender's Name ADDREa'S �y� /p Lender's Address CITY TEL. NO. OODD-Ul 727/8p 1 certifv that I have read this application and state that the STATE LIC. 4707 1 AM10:52 :,bone Information Is correct.l agee to comply with all County t_IC'E'dSE NO. CLASS ordinances and State lav3 regal ting Heating. Venrilatink and Air Conditioning. and hereby imhorl_,e repro ,mntati•:es •4 this SFE RE%rERSE FOR. EXPLANATORY LANGUAGE County to enter zp-in the ah„ce-rrtenri,�ned property fur InsFrc[ion r - `"°V01EFS" `OMPE"SA"°" cue °�'° w 1.hAreby affirm that I haw a certificate of ornerrt to s.ff APPLICATION FOR PERMIT insure, or a certificate of Workon Insurance, HEATING - VENTILATING - AIR CONDITIONING Cr a ' DPW 9/W,--. Policy Company Y Certified copy Is hereby fumlahed. COUNTY OF LOS ANGELES BUILD AND SAFETY Certified copy Is filed vel t my building i FOR APPLICANT TO FILL IN r" - MUNT OR TYPE ONLY ADDRESS / LOCALITY t byte Ilcant N0 TYPE OF APPUAtrc�04t EQUIPMBfT FEE ' m1 t CERTIFICATE OF IOCEAAfrflbN WORf03t5' NEAREST ler COMPENSATION INSURANCE . " +�. 1 - i ABSORPTION UNIT,BTU .-• _ CROSS ST.. is sectlw need not be��d lite work Involved by asratcr r+a ,OM1} peferl�.b for One hundred d.Gar�(=100 or less.) AM FVtDUNGNR, CFM •y f certify i}w In. the performance,of th`* work for which this . j"tt is Istwgd, I sF41 not employ any Person In arty manner BTU'so cis to becomb subject to the Workers Compersa.flon Laws. APPROYALS fRt gGNATLW ' COMPRE550k BTU - ROUGH Uata_ -. Arti-,1lcartt - r40TKE TO APR ICANT: If, aft*( marking this Certificate-of YENT1 ATION SYSTEM _ rINAl Exemption, you should become subjecf to the Workers' Comp.imatlon provfslons of the Labor'Code, you must forth EVAPORAT YE-COOLER IDA N 4fh comply with such provbloris or this permit ball b.deem- t rwolcad FURNACE: FAIL uCENSID CONTPACTORS bEC1.ARATION TBOOR BTU 1 hereby affirm that I am Ikertsed under provision of Chapter 9 HEATER: SUSPENDED UNIT '(con"n*rc1rvg wtth Section 7000)of Dfvlalon 3 of the Business W'L and Profeasbns Code,and rry Ikertse 4 In full and effect. a Lkense Numb. t Ic Clws O ry �1I U I am-exbimpt unow Seca O Pian 4heck fee _ W &&P.C. for thti repson PERMIT ISSUINGING FEE ; CL rte:. -TOTAL FRE Signature - OWNER-BUILDER DECLARATION RAN APPLICANT - I hereby affirm that I am exelnpf from tfte Contra s Lkense N1111.low for the following reason (Section 7031.5, Business and NAME aofesslard Codek S I, as ower of the property, or my employees with ADDRESS- wageswill s wages as thesole compensatfon,wI II do the work and - tJ I TEL. � _ - . __.. the structure is not Intended or offered for lble cti (Seon ACCT.lir 3307 1.03,00 j 7044, Busines and Profession Coda OWNIER 0 I,ax pwnr of the property, am exclustvely con%octing 1 ITM l with licensed contractors to construct the project (Seo- +MAIL tion 7044, Business and Profession Code) ADDRESS- TOTAL 103.00 CoruTRftCTION LENDING CITY TEL NO. I hereby affirm that there Is a construction lending agency for COCK 103.00 The performance of the work for which this permit is Issued CONTRACTOR ► ( ,0I (Sec. 3097, Cv. C.} ADDRESS Lenders Nam. CITY TEL NO. 130100-0001 5123/90 Lenders Address C. I certify that 1 haw read this application and date that the STATELN USS 9 1 ASI 7:10 above Information is correct. I agree to comply with all County pd1Nrxes and State laws relating to bullding construction, and authorize reprvee of this County to enter abov anti fa I Pum Sff R)r1/ERSE FOR EXPLANATORY LANGUAG! 07, rllt ' -Aootkrmt o Aj-&M Date *m µ' 'kff7r mSthir IPhave a' 10`r DECLARATION CEA9 a it-8o) APPLICATION FOR PERMIT [-harel,y'rfRrm that [ 4tJva e' ticrtiflce[e of consent to self Insure..br'si certificare of Workers'Cvmpensatlon Insurance,or HEATING-VENT IL.ATI NG-AIR CONDITIONING a certified c t'tri Qc i 00,Lab.C.) Policy No!"1C Company Rf Q Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILD( AND SAFETY I El Cerdfled copy is filed with the county h ding inspection BUILDING d arc a FOR APPLICANT TO FILL IN Da '�Aawwi Avg te l Applicant (PRINT OR TYPE ONLY) ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS` NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY _f Ale COMPENSATION rNSUR1.NCE _ NEAREST (This section nerd not be completed If the work Involved ABSORPTION UNIT, BTU CROSS ST. tl by the permit Is for,'Qne .hun rai dollars, (3100) or iess.) DtaTRICT NO OCESSEo BY S I certify that In the performance of the work for which this AIR HANDLING UNIT,CFM permit is Isslued, I shall not employ any person In aqy manner to as to become subject to the Workers' Compensatlon Laws. BOILER BTU 0 APPROVALS DATE r+sr R'S VG"/JURE Dite Applicant COMPRESSOR ULV NOTICE TO APPLIC.-1.NT: If, after making this Certificate of ROUGH — VENTILATION SYSTEM Exemption, you should becogta subject to the Workers' FINAL �4�T Compenautlon provisions of the Labor Code, you must forth- EVAPORATIVE COOLER with comply with such provisions or. this permit shall be VALI deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am Ilcemad under pro,lslomofChapter HEATER: SUSPENDED UNIT 9 (commencing svith_ay 000) of Division 3 of the Busi- WALL needCP —os Code, and ensa is in full force.andeffec (Llccefig Lk.Cont -UV ate �El from the licensi requirements m 12m a licensed c stered prormllonil engineer Plan check fee 25%of above. acting in my pro 1 capacity (Section 7051, Bw- mess and Profasslons Code). PERMIT ISSUING FEE S Lic.or Rey.No. Data TOTAL FEE HONIE O\VNER-BUILDFR DECLARATION PLAN CHECK APPLICANT I hereby affirm that I em exempt from- the C'ontractor's NAME Llceroe Law for the following reason (Section 7031.5, Busi- ness and Professions Code): aCD 3E53 MM ay - I, as owner of the property, will do the work and the � ACCT.0 structure is not intended or offered for tale (Section CITY TEL.NO. 18$.5+0 7044, Busintss end Professions Code). ❑ OWNER 1 ITM 1, as owner of the property, am exclusively contracting itL1f�7 with licensedcontractors to construct the project MAIL (Section 70-44, Business and Professions Code)- ADDRESSUAL 188.50 CONSTRUCTION LENDING AGENCY CITY TEL.NO. MCC 188.50 I hereby affirm that there is ■ construction lending agency m for the performance of the work for which this permit Is CONTRACTOR aW Issued (,Sec. 3097,Civ.C.). Lender s Name A O D R E SS fyyy��yy� '7 +77/pp -Lender's Address CITY TEL.NO. Vt.I�Lllpr'LILRJI /(��/27/8+7� 1 certify that 1 have read this application and state that the STgTE LIC. 4/U7 � 171103•JG above InformJtion is correct. i agree to comply%�irh ill County ICE'd5E N CLASS -ordinances and 'Statt laws regulating Heating. Vendlar;ng and Air C'ondltioninj. and hereby Juth )rice representjd-: s 'rf this SEE REVERSE FOR EXPLAN.ITORY LANGUAGE County to enter upon the uh•r:a-mcnti•)ned property for ittiptCIL WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certfficate of consent to self APPLICATION FOR PERMIT h1surt, or a `ert1ficatt e of Workers' Co 'atlon Insurance, HEATING - VENTILATING - AIR CONDITIONING or a F-.c.J lr 2( J � oPw 9iea • Policy No----,,—Company- F-1 Certified copy Is hereby furnished. COUNTY OF LOS ANGELES BUILD AND SAFETY ❑ Certified copy Is filed wi th co my bullding I FOR APPLICANT TO FILL IN BUILDING part r' (PRINT OR TYPE ONLY) ADDRESS Cir �� Date Z Applicant LOCALITY NO. TYPE OF APPUANC�OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION F WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST• (Tbls sectlon need not be completed If the work lAwNed by ABSORPTION UNIT, BTU DrsTRtcr NO. e the pwm t Is for one hundred dollar $100) or lap.) (� I certify that In'the per of the work for which this AIR HANDIJNG UNIT, CFM rfA b permit Is Issued, I shall not employ anyCon In-any manner so as to become subject to the Workers Compensation Laws. BOILER, BTU APPROJAt5 DATE SIGNATURE Date ---_--Applicant COMPRESSOR, BTU 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 Lobor'Code, you must forth- EVAPORATIVE COOLER. LIDATI N with compI with such provisions or this permit shall be deemyj - ed revoked. FURNACE: FAU V UCENSED CONTRACTORS DECLARATION FLOOR BTU 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 WAl and Professions Code,and my license Is In full fort and effect. _ r CL License Num be• I Ic. Class O Contractor�'w Ale, M&A ❑ • I am exempt under Sec. 0 Plan check fee W B.BP.C. for this reason d PERMIT ISSUING FEE $ Data: _ Signature TOTAL FEE Q OWNER-BUILDER DECLARATION RAN CHE X APR ICANT T I hereby affirm that I am exempt from the Contractors License I , Law for the following reason (Section 7031.5, Business and NAME { Professions Code): u ❑ . I, as owner of the property, or my employees with ADDRESS— Wages DDRESS wages as their sole compensation,will do the work and ' the structure Is not Intended or offered for sole(Sectlon CITY TEL �' 7 .103.001 7044, Business and Professions Coded OWWR -I, as owner of the property,,am exclusively contracting 1 ITM with licensed contractors to construct the project (Seo- MNL tlon 7044, Business and Professions Code). ADDRESS TOTAL 103.00 CONSTRUCTION LENDING AGENCY CITY TT_ No 00 1 hereby affirm that there Is a construction lending agency for , NE�i 1Q�� the performance of the work for which this permit Is Issued CONTRACTOR (} +}� s00 (Sec. 3097, Ov. C). ADDRESS Lenders Name �y��� +y CITY TI1. NO. 000G— WI 5/1,-1/70 Lenders Address _ I certify that I have read this application and rtafe that the uCE� No Lr_ �S 1 AM 7'10 above Information Is correct. I agree to comply with all County nces and State laws relating to bullding construction, and eby authorize rdprese ves of this County to enter n e abov entl for.I purposes SEE REVERSE FOR EXPLANATORY LANGUAGE g of Applicant or Agent Dats