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Home My Public Portal About6247 KAUFFMAN AVE_Mechanical__ ION WORKER'S I have a certificate of consent to 76A3C6DPW9/89 APPLICATION FOR PERMIT LIME GREEN " 76A364C I heret5y affirm that I have a certificate of consent to self insure, or'^cer'tificate of worker's Compensation Insurance, or a certified HEATING -VENTILATING -AIR CONDITIONING copy thereof(6ec.3800 Lab. C.) Policy No� Company yFfLG► � JCOUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑-� Certified copy is hereby furnished. ' M� - Certified copy is filed with the count buildinginspection FOR APPLICANT TO FILL IN BUILDING 64)q 7 / „F-Fpn j department. y p (PRINT OR TYPE ONLY) ADDRESS -7 /`(jV f V Datec.� �7 LOCALITY ! r1 /'- l Applicant 1 NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS ST. COMPENSATION INSURANCE ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed if the work involved by the 50 00 MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLI G UNIT,CFM .�/ "-�- DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit r is issued, ].shall not employ any person in any manner so as to BOILER,BTU 4k212, become subject to the Workers'Compensation Laws. 3 OO yt ®p y� aC1 Q COMPRESSOR,BTU ! '7Z OO �y-•�pp OO APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant 1 VENTILATION SYSTEM to NOTICE TO APPLICANT: If, after making this Certificate of 1 ROUGH Exemption,you should become subject to the Workers' Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY 1;'Al IlAATION LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and WALL Professions Code,and my license is in full force and effect. 44 C70 License Number 5 � �5 X Lic.Class Contractor&ZD D a)' + ate -�� -�"1 O El am exempt under Sec. Plan Check fee Q PERMIT ISSUING FEE$ I3 O B.&P.C.for this reason � I Date: —C,LTOTAL FEE W •/ Signet 44^=4e a PLAN CHECK APPLICANT SIJ OWNER-BUILDER DECLARATION Z I hereby affirm that I am exempt from the Contractor's License Law NAME �G� , for the following reason (Section 7031.5, Business and Professions _ Code): ADDRESS 6 C' Owe l I EJ1, as owner of the property, or my employees with wages �J1 •�^`. �• X, as their sole compensation, will do the work and the CITY fl � TEL.NO.g�R .�s '..+_¢ o F structure is not intended or offered for sale (Section 7044, I® M v ti"p , -*s j j Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting •TEM-- MAIL with licensed contractors to construct the project (Sec- ADDRESS 7% -1 H.L. `r ,d00 tion 7044, Business and Professions Code). CITY TEL.NO. i HECK !,-;•; CONSTRUCTION LENDING AGENCY _.;-tECK ft.5`-` I hereby affirm that there is a construction lending agency for CONTRACTOR ' "WEE I performance of the work for which this permit Is issued Lp �•iiiis?7� (Sec.3097,Civ.C.). rn� ADDRESS Si C Z a� >�$� Lender's Name J CITY /V T/ TEL.NO. V4 _144 L r!Cis(fj-=3'Il� G��irl�`�. Lender's Address STATE I LIC. '12 I certify that I have read this application and state that the above LICENSE NO. �3 7.9 $ CLASSr`i�tL � �� ' 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 profor i spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE x pert k '�4-17-9 SIG T F APPLI ANT OR AGENT DATE ION WORKER'S I have a certificate of consent to 76A346DPW9/89 APPLICATION FOR PERMIT LIME GREEN 76A364C I her@byeaffirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING- AIR CONDITIONING copy thereof(Sec. 3800 Lab. C.) 1 Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑, Certified copy is hereby furnished. ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING SS ' department.- (PRINT OR TYPE ONLY) LOCALITY Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS ST. COMPENSATION INSURANCE ABSORPTION UNIT,BTU ASSESSOR • (This section need not be completed if the work involved by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM o0 DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit / OicCO— i o00J A0 0 IV is issued, I shall not employ any person in any manner so as to BOILER,BTU Zee)—O, 600 0 (J become subject to the Workers'Compensation Laws. /V�•oOd eOQ POG) j�a 00 -�d COMPRESSOR,BTU /d APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of O ROUGH Exemption, you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT' (commencing with Section 7000) of Division 3 of the Business and WALL Professions Code,and my license is in full force and effect. ^: License Number. Lic.Class , I_I FAL 10� 5 = 1-J0 0 Contractor Date ❑ Plan check fee 2 i'il:.'_•T=. _t•=y It-� (J I am exempt under Sec. �✓ 0 0 PERMIT ISSUING FEE$ J ( [1 �" IGE B.&P.C.for this reason Date: TOTAL FEE p(' I ..t 1 4. — _ W Signature co PLAN.CHECK APPLICANTtI';;;I�-' OWNER-BUILDER DECLARATION ='+ I hereby affirm that I am exempt from the Contractor's License Law NAME l _f"�LI L(_ 's dC/�7j s' r , for the following reason (Section 7031.5, Business and Professions AL AJ W w1 Code): ADDRESS 6� S �/� .GCRI DRQ L�tiA ❑ I, as owner of the property, or my employees with wages l� as their sole compensation, will do the work and the CITY TEL.NO.�/3-_3N structure is not intended or offered for sale (Section 7044, n V �r Business and Professions Code). OWNER ❑ I, owner of the property, exclusively contracting MAIL withh co licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CITY TEL.NO. CONSTRUCTION LENDING AGENCY / I hereby affirm that there is a construction lending agency for CONTRACTOR the performance of the work for which this permit Is issued ' (Sec:3097,Civ.C.). ADDRESS 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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANT OR AGENT DATE