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Home My Public Portal About5013 GOLDEN WEST AVE_Mechanical__ OWPENSAT`ON 'ant to �°°"'°�"°'°` APPLICATION FOR PERMIT LIME GREEN > I hereby affl�that I have a certificate of convent to avis Insure, or a certificate of Workers Compensation,Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy th f(Sec.3800 Lab_C.) t+o �OR1p'n1 'd COUNTY OF LOS ANGELES DEPT OK PUBLIC WORKS BUILDING AND SAFETY DIV. CertffW oopy is hereby fumohed. Certmed oopy Is filed with the county buDc%V hv9paodon FOR APPUCANT TO FILL IN S (PRINT OR TYPE ONLY) Det/� APpO., - --�— NO. TYPE OF ADPL ICE OR E-OUIPMENT FIE NEARE& r—r �s C=FICATE OF EXEMPTION FROM WORtMIS' C8068 8T. LA COMP04SATFOfiINSURANCE AB80RpTION UNIT BTU (This soodan need not be completed ft the work Invoived by the MAP PAO PAACac1 7 permft to foramhundred donors($100)or lees.) AIR HANDLING UNIT CFM DsrrrCr KKL Pnocsem BY f oertJfy that In the performance of the work for which this permit Is Issued, I shall not employ any person In any manner to as to BOILER,BTU p pao eme subject to the Workers'Campensatlon Laws / BIIJ .wnwxs oATE sweeclorav sarKAnra Date AppRoant VEN7TL-ATK>R SYSTEM NbTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compermatlon EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith oomply with such ANAL provisions or this pamIt shall be deemed revoked. FURNACE: FAU GRAVTfY LICENSED CONTRACTORS DECLARATK>N FLOOR BTU � I VAUDATION - I hereby affirm that I am licensed under provisions of Chapter 9 HFATFR SUSPENDED—UNfr X- ( (commencing with Secticn 7000) of DMslon 3 of the Business and WALL 1 Professlons Code,and my license Is In full force and effect Llcerre Number LIc cies.L:.L�. ' ACCT..i contrasIx� _ 3307 %.40 ❑ I am exempt upder Seo- Plan Check fee 1 ITEr S CC B-BP.C.fm this reason PERMIT ISSUING FEE; , TOTAL '90 40 Date: TOTAL FEE O alp MCK g[1.icl d PLAN CHECK APPLICANT •00 Z gwr�sUILDEA DEOLARATION — I hereby storm that I am exempt from the Contraotor'a Llcenae Law NAME ' i� [0/7a for the following reason (Section 7031.6, Business and Professions OBD-ODO1' 11 `i Code): ADDRESS. �-;L ��fayy,�� F-1 1, as o*nor of the property, or my employees with wages 6363 1 t v:ti3 as their sole compensation, will do the work and the CITY TEL NO. structure to not Intended or offered for sale (Sectlon 7044, Business end Profeestohs Code). OWNER m ❑ I, as owner of the property, ■m exclusively oontrdcting MAIL with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professlons Code), CONSTRUCTN LENDING AGENCY CITY r TEL NO. IO I hereby affirm that there te'a construction lending agency for , the performance of the Work for which this permit le Issued (Sec.3097,CN.C.). F Lenders Nanhe - TEL NO. Larder's Address STATE LIC. I certify that I have read this application and state that the above LICENSE NO. Ct1,88 tnformatiori Is correct- I agree to comply with all County ordinances and.St%e larva relating to buLdbng construcbm,and hereby authorize reprosantativee of this County to ter upon the above-mentioned nspectb SEE REVERSE FOR EXPLANATORY LANWAt3E Z— oe DATE WORKERS'COMPENSATION DECLARATION CEA 1540 -SO) P"i IL ECi'y�O O 1 tl �.®� i<Vll �� I hereby affirm that I have a certificate of consent to self Insure, or a certificate of Workers'Compensation Insurance,of HEATING-VENTILATING-AIR CONDITIONING Is 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 department. FOR APPLICANT TO FILL IN BUILDING ADDRESS J�r-,o c Date Applicant (PRINT OR TYPE ONLY) CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY COMPENSATION INSURANCE NEAREST (This section heed not be COAPleted if the work Involved ABSORPTION UNIT, BTU CROSS ST. by the permit is for one hundred doUm ($100) or less.) 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 ■nner so as to become subject to the Workers' C ensatl La BOILER BTU APPROVALS ' DATE INSAE CTOR3616HATURE lJJ Datez�—�Appllcanl COMPRESSOR BTU ROUGH NOTICE TO APPLICANT: If, after ma ng this Certifla e o VENTILATION SYSTEM Z Exemption, you should become subject to the Workers' FINAL Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be EVAPORATIVE COOLER VALIDATION deemed revoked. FURNACE: FAU CzAAVITY � LICENSED CONTRACTORS DECLARATION FLOOR: BTU s mo � I hereby affirm that I ■m licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Section 7000) of Division 3 of the Busi- WALL nese and Professions Code, and my license is In full force and effect. �� 0 License Number ..,��`��,,,,,,�� Lic. Class C20 Contractor Date I am exempt from the licensing requirements as I am a licensed architect or ■ registered professional engineer Plan check fee 25`}6 of above. acting In my professional capacity (Section 7051, Bus- iness and Professions Code). PERMIT ISSUING FEE $ Lic.or Rog.No. Date TOTAL FEE HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that 1 am exempt from- the Contractor's NAME License Law for the following reason (Section '7031.5, Busi- Jg_ 1 3 6�9 A ness and Professions Code): ADDRESS M I, as owner of the property, will do the work and the , o 0 o e o a structure is not Intended or offered for sale (Section CITY TEL. NO. 7044, Business and Professions Code). 2 0•' 3 Q'5 0 D I, as owner of the property, am exclusively contracting OWNER C4,6RKUIL 2y r with llcansed contractors to construct the project MAIL �+n^ o 0 0 3 Q 5 05 (Section 7044, Business and Professions Code). ADDRESS `7 v L PJ 0421 =83 CONSTRUCTION LENDING AGENCY CITY TEL. NO. 29(p- 7 1 hereby affirm that there is ■ construction lending agency for the performance of the work for which this permit is CONTRACTOR Issued (Sec. 3097,Civ.C.). 404/if— 015CALD&S Lender's Name ADDRESS S- 3 Lender's Address CITY TEL.NO. 94- I certify that I have road this application and state that the STATE LIC. above Information is correct. I agree to comply with all County EN NO 302'rov CLASS v ordinances and State lavas regulating Heating, Ventilating and Air LCoynditioning, and hereby author) repretentatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE Couto ent u the v entloned property for 1 n p -z -dam S uture o Permittee Date