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Home My Public Portal About10786 LIVE OAK AVE_Mechanical__ WORKERS'COMPENSATION DECLARATION CEA S SIB ( 2-80) A\ P P UC A�o u `YI FOR PERM ff I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers''Compensation Insurance,or CONDITIONING * Cv a certified copy thereof(Sec 3800,Lab C.)' , - N� Policy No. 231079_A_0, 7r9ny Ca. -Casua 1 ty Indemnity COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is hereby furnished. / )U( Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING dPoat}�+ent. ADDRESS 10786 Live Oak Date 0 Applicant E. Lo PAYNE COMPANY (PRINT OR TYPE ONLY) LOCALITY Temple City CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST COMPENSATION INSURANCECROSS ST G�G a (This section need not be completed if,the work involved ABSORPTION UNIT, BTU ,by the permit is,for one,hundred dollars ($100) or less.) DISTRICT NO PROCES,_D B!---• V i certify that in the performance of the,,work'for which,this AIR HANDLING UNIT,CFM a: permit is issued, I shall not` employ any person m in any anner ' 0 so as to become subject to the Workers' Compensation Laws BOILER, BTU Date Applicant f 1 1 APPROVALS DATE INSPECTOR'S SIGNATURE U l / ' COMPRESSOR, BTU 6_0,000 1Q• QQ W ROUGH N NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject•to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER /_ //Ll VALIDATION with comply with such provisions or this permtt shall be l�/ deemed revoked. FURNACE. FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that 1 am licensed under provisions of Chapter HEATER* SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi- WALL -ness and Professions Code, and my license is in full force and- effect ` License Number 120228_ Ii..Class C-20 E. L.- PAYNE,CO. 7-22-81 Contractor Date I am exempt from the licensing requirements as I am a- licensed architect or a registered professional engineer Plan,check fee 25%o of above. acting in my,professional capacity (Section 7051,'Bus- iness and Professions Code). PERMIT ISSUING FEE $ 7° QQ Lie.or Reg No. Date TOTAL FEE 117-90 HOME OWNER-BUILDER DECI:ARAtION PLAN CHECK APPLICANT Orb 1� A o�olo o o 1 hereby affirm that ],am exempt from the"Contractor's • ,NAME Evergreen' Con°_Hospital $07 ° ' ' License Law for the following-reason (Section 7031.5, Busi- ness and Professions Code) ADDRESS 10786 Live-Oak 2 0 l R7,i4 1, as owner of the property, will.do the work and the o'oio 11 60"U' structure is not intended or offered for sale Section CITY TE L;•NO. ( Temple: C i ty 447_-5 0 ) 7044, Business and Professions Code). OWNER 0 , I, as owner of the property, am exclusively 'contracting Evergreen, Con, HOSptal with licensed contractors•to construct the project MAIL (Section 7044, Business and Professions Code). ADDRESS 10786 Live Oak CONSTRUCTION LENDING AGENCY CITY TEL.NO. k47=5140-4— T_emp 1_e City _ I hereby affirm that there is a construction lending agency CONTRACTOR for the performance of:the work for which this permit is EL PAYNE COMPANY issued(Sec 3097,Civ.C.). °—O- Lender's Name ADDRESLX166 We Live Oak Lender's Address CITY _ TEL NO.446-6118 I certify that I have read this application and state that the STATE LIC. above information is correct I agree to comply with all County LICENSE NO 1208 CLASS C-20 ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE Cou enter upon the above-me ed property for i pection rposes` Signature of ermitteea e �/ WORKERS'COMPENSATION DECLARATION 76A364Ce p, I hereby affirm that I have a certificate of consent to self } ,CE-818(2-80) A P P UC AT I O 1\7 .F®� Y�7U 0 U ; insure, or a certificate of Workers'Compensation Insurance,or. l(illy_�1EY11TILl�TI�IG-Ali3'GORID,IYIOWIWG a�e213i�c0�7900779f(seo. 3so�a:abCasual ty' 1 ndemn Liy Policy No Company a`. " COUNTY OF-LOS ANGELE ;LMILDING ANb SAFETY - Certified copy is hereby furnished. ' ,R,Certified,copy is filed with the county building inspection :' BUILDING` department FOR-APPLICANT TO FILL IN', el Date Applicant (PRINT OR TYPE'ONLY) ADDRESS_ X1,67 6° L'1 e'Oak : ' LOCALITY` CERTIFICATE OF EXEMPTION FROM.WORKERS" NO,. TYPE OF'AP_PL1ANCE•OR EQUIPMENT ��- ,FEE' _Temp'1 e City COMPENSATION INSURANCE - _ _ NEAREST - ti CROSS ST Pers I mmo,n (This section need not be cornplefed if the work involved geoRPTtoN UN IT,,BTu a by the permit is for one hundred. dollars ($100) 6r,1 less.) PR o BY O t DISTRICT NO ' I certify that in the performance of the work for-which this AIR HANDLING UNIT,CFM �-�• �� permit is,issued, I shall not employ any person in any mannei.•_ �� 0 0 so as to:become subject to the Workers'°Compensation Laws. BOILE�R,.BTU a 12-11-80 E. L. PAYNE COMPANY APPROVALS DATE' INSPECTOR'S ATURE = Date Applicant COMPRESSOR,-STU UJ" ROUGH pr `d, NOTICE TO APPLICANT' If, after_makmg this Certificate ofVENTILATION SYSTEM- FINAL ° «Z ca •,E-zemption; you should-become sdbject.,to the, Workers' Compensation provisions of the Labor Code, you must forth= EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be i deemed revoked. X FURNACE "FAU ' GRAVITY LICENSED CONTRACTORS DECLARATION 1 FLOOR• ° - BTU-1-50- 000 2O OO I hereby affirm that I am,licensedunder provisions of Chapter HEATER SUSPENDED ' UNIT- 9 UNIT9 (commencing-with Section 7000) of.Division 3•of the Busi- ' WALL pG - •ness and Professions Code, and my license ism full force and _ License Number 120228 Lie.Class C-20 _ Contractor E.-L. PAYNE .Date 12-11-80 I am exempt from the licensing requirements as I am a •licensed• architect or a'registered professional engineer= Plan,Check fee 25%tof_abOVe. ' z - � acting in my professional capacity`(Seciion 7051; Bu's-' mess and Professions Code). -PERMIT-ISSUING"FEE'.$L ]- 00 Lie,or Reg-Nq. Date TOTAL FEE 2] 00 HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby•affirm, that I am, exempt from- the Contractor-s NAME a .` License Law for the following-reason `(Section 7031 5;Busi ness and Professions Code) ADDRESS 4 - F] 1, as owner of the property, will do the work and the CITY TEL NO. structure ,is not intended or offered-for sale, (Section , e 7044, Business and Professions Code).-- - °" �- #i,5'Z 4 1jt� OWNER, Ever Teen' COnva,lesCent' HOSp• I, as owner of the property, am exclusively contracting 9 rr 'i � 41 with licensed contractors to construct the project MAIL (Section 7044, Business and Professions Code). ADDRESS 107W-Live Oak ' CITY TEL NO 446-6118 _ �. 12 i',' 2,.7,0 01 CONSTRUCTION LENDING AGENCY -Temple C I ty y I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is CONTRACTOR E'.' L. PAYNE COMPANY issuedSec 3097,Civ C.) Lenders Name ADDRESS 166 W. Live Oak Ave nue Lender's Addresb 446-1-6118 1 -'��` 0• $ CITY TEL Arcadia NO I.certify that I have read this application and state that thegTATE 1 20228 LIC C-20 above information is correct.I agree to comply with all County LICENSE NO CLASS ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby a 'hortze representatives of this SEE REVERSE FOR-EXPLANATORY LANGUAGE County enter upon th ove-mentioned property for nisi c urposes 12�-11-80 Signato a of Permittee/,'— Date _ _ _ iATION DECLARATION CEA 81 8 (2-80) A P P C AT�O CI FOR. P E R IIVU T • a'certificate of consent to self _ kers'Compensation Insurance,dr HEATING-VENT IL.ATI NG-AIR CONDITIONING 3800,Ldb C.) Ca, Casualty Indemnity my.' COUNTY OF LOS ANGELES BUI LDING AND SAFETY furnished. ,py u filed the county-building inspection FOR APPLICANT TO FILL IN BUILDING tn,ent =8t— Applicant_E�—La—L. —CO�P�1N� (PRINT OR TYPE ONLY) ADDRESS O-]H6—L.1_V_e_Oak_AV_enUe LOCALITY iIFICATE OF EXEMPTION FROM WORKERS' NO. " TYPE OF APPLIANCE OR EQUIPMENT FEE T_empl e' C i ty ` 'COMPENSATION INSURANCE NEAREST } this section need-not be•completed if the work involved ABSORPTION UNIT, BTU CROSS ST McCulloch by the permit, is foi one hundred. dollars ($100) or less.) DISTRICT NO PRocesseo v V I certify that in theerformance of the work for which this AIR HANDLING UNIT,CFM pi d permit is issued, I shall not employ any person in any manner- O so as to become subject to the Workers' Compensation Laws. BOILER,BTU -1-- APPROVALS DATE INSPECTOR'S SIGNATURE L) UJI Date Applicant' COMPRESS,OR,BTU_60 1O OO , ROUGH • CL NOTICE TO APPLICANT. If, after making this Certificate of - VENTILATION SYSTEMFINAL Z Exemption, 'you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such�-provisions or this permit, shall be deemed revokedFURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU / I hereby affirm that I am licensed under provisions of Chapter HEATER SUSPENDED UNIT '9 (commencing with Section 7000) of Division 3 of the Busi- WALL ness and Professions Code, and my license is in full force and effect. License Number 120228 Lic.Class C-20 Contractor_E.._L—P-AYNE- Date 8—.11-81 I am exempt from the licensirig requirements as I am a licensed architect or'a registered professional,engineer Plan check fee 25%of above. acting in 'my professional capacity (Section 7051,-Bus- 'r iness and Professions Code) PERMIT ISSUING FEE $ ] OO Lic.or Reg No. • — Date TOTAL FEE 17 100 HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from- the Contractor's NAME License Law for the following reason (Section 7031.5, Bust- ness and Professions Code) I I IADDRESS I I, as owner of the property, will do the work and the CITY TEL NO. structure is not intended or offered for sale (Section 2 07 2A 7044,Business and Professions Code).O ) OWNER Ever reen Cony Hosp i tot # °! ". --° ',8 I, as owner of the property, am exclusively contracting 9 . '• '' ' with licensed contractors to construct the project MAIL 2;-:-J,7,0,0 (Section 7044, Business and Professions Code). ADDRESS 10786• Live Oak CONSTRUCTION LENDING AGENCY CITY -Tem le, City TEL.NO. 447-5404 ° ° °:1 7'0 015 I hereby affirm that there is a construction lending agency w - i .for the performance of the work for which this permit is CONTRACTOR Ea L. PAYNE COMPANY, 0 8i1 '8p1 ' issued(,Sec 3097,Civ C). Lender.s Name ADDRESS 166 W, Live Oak Aven Lender's Address 7-3553 CITY Arcadia TEL NO. , - . I certify that I have read this application and state that the STATE LIC. I above information is correct.I agree to comply with all County LICENSE NO 1-2228 CLASS C=2-0 iOrdinances and State laws regulating Heating, Ventilating and Air Conditioning, and he by authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE '6C un to enter upo he above-mentioned�propert�yfor ills on pt.rposes. 8-11-81 griature of Per tee Date