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Home My Public Portal About9216 LIVE OAK AVE_Mechanical__ ION WOthat.I have a certificate of consent to 76A346DPW9/89 APPLICATION FOR PERMIT LIME GREEN, 76A364C I hereby affirm 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.) Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. El Certified copy is hereby furnished. ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN gpoRESS department. (PRINT OR TYPE ONLY) LOCALITY Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST45 /CIA 117- CROSS ST. /�' COMPENSATION INSURANCE ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed if the work involved by the � permit is for one hundred dollars($100)or less.) _ AIR HANDLING UNIT,CFM MAP BOOK ��a PAGE �� PARCEL DISTRICT NO. PROCESSED BY certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU become subject to the Workers'Compensation Laws. Q f✓� 5.: / COMPRESSOR,BTU a Q®D 7� APPROVALS DATE =jGCaS (JgR'S SIGNATURE Date °"Applicant VENTILATION SYSTEM -, NOTICE TO APPLICANT: If, after making this C tificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER _ provisions of the Labor Code, you must forthwith comply with such FINAL IT ' provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION / FLOOR BTU VALIDATION jp= 7= 1 hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT _ i (commencing with Section 7000) of Division 3 of the Business and HEATER: WALL CH Lt_• 1L C, 1 Professions Code,and my license is in full force and effect. yI _ rt^!Ht3I= License Number 7 3.5 b4/ Lic.Class C-2-cl, n0110 -_+_0� irn CL Contractor(/?LZF6Gi �D ' O ❑ Plan check fee -1166 - .1. iii ,9 a 41, I am exempt under Sec. a: B.&P.C.for this,reason PERMIT ISSUING FEE$ 7d 0 Date: TOTAL FEEIII Signature CL OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT ,r7 Z I hereby affirm that I am exempt from the Contractor's License Law NAME [/ _ for the following reason (Section 7031.5, Business and Professions ' -j+.(. °g` Code): ADDRESS \ ,�y i �rl ❑ I, as owner of the property, or my employees with wages �'� �=° as their sole compensation, will do the work and the, CITY TEL.NO. `�a 1 I i structure is not intended or offered for sale (Section 7044, 7 r Business and Professions Code). OWNER y TOS 30 ^tl-7 ❑ e,v I, as owner of the property, am exclusively contracting MAIL CHECK with licensed contractors to construct the project (Sec- ADDRESS tion 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY a �.3 `+ °-- - I hereby affirm that there is a construction lending agency for CONTRACTOR „7-' the performance of the work for which this permit Is issued CI IMIg/ oil •t i (Sec.3097,Civ. C.). - l _ li E-11#_il? ADDRESS O AoI?l e oQ_e e_ v •� - q i Lender's Name nr 1'�•5 1 9:y7 CITY Grp/nq EL.NO. Lender's Address STATE LIC. I certify that I have read this application and state that the above LICENSE NO. Z CLASS �� information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize representativeof this County to enter upon the above-mentioned pr ty forFirspectio pur s s, SEE REVERSE FOR EXPLANATORY LANGUAGE 12— k_1gaWoeffE OF APPLICANT OR AGENT IV DATE ION DECLARAT WORKER'S I have -a certificate of consent to 76A346DPW9,69 APPLICATION FOR PERMIT LIME GREEN ' 76A364C I hereby affirm that I have•a certificate of consent to self insure, dr 9'certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof4$ec.3800 Lab.C.) Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV: Certified copy is hereby furnished. ❑ j Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING department. (PRINT OR TYPE ONLY) �' ADDRESS •� Date Applicant LOCALITY E C-iZ NO. TYPE OF APPLIANCE OR EQUIPMENT FEE VILE. NEAREST 1 1 /� /� CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. 1 COMPENSATION INSURANCE ABSORPTION UNIT,BTU (This section need not be completed if the work involved by the ASSESSOR permit is for one hundred dollars($100)or less.) MAP BOOK PAGE Z PARCEL AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU become subject to the Workers' Compensation Laws. COMPRESSOR,BTU 0 O ' APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL Z-L5 provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION / FLOOR BTU D O VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and HEATER: WALL - Professions Code, and my license is in full force and effect. ' 1 License Number Lic.Class Contractor Date -7t-j Y, ,r V ❑ I am exempt under Sec. Plan Check fee64170 B.&P.C.for this reason PERMIT ISSUING FEE$ 11 L7.! Date: TOTAL FEE (� I " �"'� '_ -z•• -111 Signature PLAN CHECK APPLICANT F°°'`•N ..3 i.:.r"•i" G. OWNER-BUILDER DECLARATION I��-,f"�•}mss o3_I_i 1 hereby affirm that I am exempt from the Contractor's License Law NAME L] 'Lr t , for the following reason (Section 7031.5, Business and Professions Cade): ADDRESS0 A. I, as owner of the property, or my employees with wages t 1: as their sole compensation, will do the work and the CITYI C ( TEL.NO. structure is not intended or offered for sale (Section 7044, 1. C. Ei 1 E9 Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting MAIL 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 (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 propert ' sectio es. SEE REVERSE FOR EXPLANATORY LANGUAGE �� 3 SIGNATOR APPLI T OR ENT DA