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Home My Public Portal About9082 LAS TUNAS DR_Mechanical__ WORKER'S COMPENSATION DECLARATION 20-0046 DPW 9/89 APPLICATION FOR PERMIT L I hereby affirm that I have a certificate of consent to self insure, 76A364C or a certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING Awl copy thereof(Sec.3800 Lab. C.) Policy No. ❑ Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. "5646043 Certified copy is hereby furnished. ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING ADDRESS department. (PRINT OR TYPE ONLY) �} y 082 FEE LOCALITY 9 E.Las unas ro 'mf' e i tJ Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT. CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS 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($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU become subject to the Workers' Compensation Laws. COMPRESSOR,BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such EVAPORATIVE COOLER FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY . f LICENSED CONTRACTORS DECLARATION FLOOR t BTU VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and HEATER: WALL Professions Code,and my license is in full force and effect. t I� License Number G#332Lic.Class } CL Contractor Date 0U ❑ I am exempt under Sec. Plan Check fee W J BAP.C.for this reason PERMIT ISSUING FEE$ LL Date: °!. TOTAL FEE {i >_ Signature PLAN CHECK APPLICANT .- OWNER-BUILDER DECLARATION O 1 hereby affirm that I am exempt from the Contractor's License Law NAME MPE1 !INSTALLATIONS I for the following reason (Section 7031.5, Business and Professions Code): ADDRESS ,� H I, as owner of the property, or my employees with wages 48 as their sole compensation, will do the work and the CITY TEL.NO. structure is not intended or offered for sale (Section 7044, W tf Business and Professions Code). OWNER ❑ 1, as owner of the property, am exclusively contracting MAIL Corporatien with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY TEL.NO. I hereby affirm that there is a construction lending agency for CONTRACTOR , the performance of the work for which this permit Is issued AS ABOVE (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. W-432021 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 76A364-C 18-1/70 APPLICATION FOR PERMIT HEATING - !VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING ryry DEPARTMENT OF COUNTY ENGINEER ADDRESS OCA BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE.'COUNTY ENGINEER COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING NEAREST CROSS ST. FOR APPLICANT TO FILL- IN OWNER (PRINT OR TYPE ONLY) MAI L / NO TYPE OF APPLIANCE-OR EQUIPMENT FEE ADORE p� J CITY ABSORPTION SYSTEM, BTU TEL. NO. -7111 CONTRACT AIR HANDLING UNIT, CFM ADDRESS, ' 3 BOILER, HORSEPOWER CITY -TEL. N0. I COMPRESSOR, HORSEPOWER Dd LICENSE NO. 1VO� CLASS VENTILATION SYSTEM DISTRICT NO CLASS GROUP ZONE PROCESSED BY EVAPORATIVE COO ER or r c, j FURNACE: FAU VITY INSPECTI N RE D / FLOOR BTU HEATER: SUSPENDED UNIT_ S~Z 2 WALL 0 0 U NEW-ADDITION- PERMIT $ 3 00 h Z_ ALTER_REPAIR- TOTAL FEE $ /L, /5 PLAN CHECK APPLICANT cv! V NAME ADDRESS CITY TEL NO. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE CTOR'S SIGNATURE LATING, AIR CONDITIONING i [ROUGH HEREBY CERTIFY THAT I AM NOT ACTIN 1 VIOLATION OF,C HAPTER 9, DI I 3, OF THE BUSI SS A P OFESSIONALNALCODE OF THE ST LIFORNIA.SIGNATURE /► i JACK R. ALLEN,S P RVIS EC ANICAL ENG'R. OF PERMITTE (iL/" ERMIT VALIDATI CK. M.O. CASH PLAN CHECK VALIDATION Li1C 15 77 8 7- RU 2 4 1 D 15-50 SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE - 76A364 - CE818 - 3-69 APPLICATION FOR PERMIT g HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING NEAREST CROSS ST. FOR APPLICANT TO FILL IN (PRINT OR TYPE ONLY) OWNER MAIL ' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS ABSORPTION SYSTEM, BTU CITY TEL. NO. I AIR HANDLING UNIT, CFM CONTRACTOR: ADDRESS BOILER, HORSEPOWER CItY TEL. NO, COMPRESSOR, HORSEPOWER STATE LIC. i LICENSE NO. CLASS VENTILATION SYSTEM DISTRICT NO.. GROUP ZONE PROCESSED BY EVAPORATIVE COOLER +✓' . ro.. FURNACE: FAU GRAVITY FLOOR BTU INSPECTION RECORD HEATER: SUSPENDED UNIT WALL . -. � d O V w J u- K Q NEW_ADDITION_ PERMIT $ 3 00 0 Lu ALTER_REPAIR_ TOTAL FEE $ i PLAN CHECK APPLICANT < NAME ADDRESS CITY TEL. N0. IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING,VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE LATING, AIR CONDITIONING. IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL CODE OF THE STATE OF CALIFORNIA. SIGNATURE JACK R. ALLEN, SUPERVISING MECHANICAL ENG'R. OF PERMITTEE PERMIT VALIDATION CK. M.0. CASH PLAN CHECK VALIDATION SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 1