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Home My Public Portal About6153 LOMA AVE_Mechanical__ • •W_'1RKEI�S'COMY)~NS.4-`sON D,f��LARATI'JN a ,Cc -818,(2.80) , ,�� - 1" I:fiireby aftirm-than I='have a certificate' of consent to el — •� - - - _ t `insufe,.-oc a.cert ficatet`of Workers'Compensation,Insurance,o'r HEATING-VEIV�TIL`ATING-AIR CONDITIONINGa �� T a certified :Y, y th_ereot;(Sec. 3800„Lab.C:) �Pchcy,No. @ompany _ �� Cirt�.fi6d copyA heri 1 y,fur`mshed. ; : COUNTY dF LOS ANGELES_ BUILDING AND SAFETY Certified^copyi;filed,With.the-county,buildmg inspection FSR �1PPLiCANT�TO�FI'LIN BUILDING t�'� -� department ; Dade TYPE ONLY Applicant (PRINT OR ')- . .- m LOCALITY �- CL .•-CERTIFICATE OF,EXEMPTION,FROM WORKERS” NO. TYPE OF.-,APPLIANCE OR EQUIPMENT'. .`,FEE COMPENSATION INSURANCE NEAREST CROSS ST *� -C9M1�► :" 1' (This section, need-not be completed, if the work involved _ ABSORPTION UNIT,_BTU ' tl "by the,permit is for 'one hundred"dollars_(S1GO) or less.) DISTRICT NOPROCESSED By - • 0 I certify that in the..peiformance of the`work for which this ;AI•R,HANDLINd,UNIT,CFM t V' permit as-issued, I shall not employ^any person m-any'mann �� xso as to become subject'to t`'Workers' Ccmpensatibn Ltw�: BOILER, B_T,U �` ��•' - - 0 `AP,PROVALS DATE PECTOR' IGNATURE>' z' W e•Datt �� Applican._ COMPRESSOR',BTU' �� ROUGH f � 1 7 - _ NOT ICE,T'O"�PPLICANT,`If,•after making,this,Certificate of VENTILATJON SYSTEM' ' Cn Exemption„•you•should become subject to the 'Workers' FINAL �?� Z; Compen`satio'n.provisions of'the Labor Code,,you must forth- - VALLA ION with'comply,•with• such provisionsor this perrjid shall be EVAPORATIVE COOLER a �' *deemed revoked. FURNACE. FAtj GRAVITY FLOCiR BTU ^LICENSED CONTRACTORS DECLARATION, .1 hereby affirm that•I•am"hcensed under-proviswnsof Chapter 'HEATER SUSPENDED UNIT. n F 9_(co`mcnencing with_Section 7000)`of Division 3 of.the Busi-• WALL e nes's find Professions.Codi, and my license is in full force and. effect . . �. 'License Number. Lia Class • Contractor Date -1 am-exempt from the lieensirig,requirements.as'l-iirn a ,liceriged`architect or a registered};professional''engineer PI8f1,Check fee 25%Of,2hOVl3, „t - acfing;in my professional capacity (Section 7b51,'Bus•' • " mess_and Professions Code). �"., PERMIT ISSUING FEE:$�•0° �b. _,� 1 ic_ orReg 110. Date` TOTAL FEE 3,�, _ r -s., •^ . . 9 , ��,; HOME OWNER-BUILDER DECLARATION ` 0 4• R a PLAN -APPLICANT „ I' hereby» affirm that I�am, exempt from-the Contractor's NAME• Licerise,Law for the following reason'(Section 7031.5, Bust- ness an el'rofe-ions Code) . ADDRESS ��/++ isdownerof the-property, will-do the-work and the T om_ �•^• ACCLav, r^ < structure'is 'not-,intended ,or affered far sale (Section CITY TEL:NO.', �< �6 •7044,.Businiss and'Professions Code)- f «' OWNER 1, as owner of the property, am_ex,clusively,contracting s - �' 1• ITEP� `- " with •licensed contractors to cbnstruct . the' •project MALL _ _ •'+. - - _ r "f ` • (Section 7044;Business and Professions Code). ADDRESS - " TQ1� .50 of- CONSTRUCTION LENDING AGENCY ,CITY TEL NO. (M� 30.50 I hereby affirm that there is a construction lending agency .r *for'the performance of the work.for which this permit is. CONTRACTOR issued(Sec. 3097,Civ.C). �•e ` - w" Lender's Name ADD'R'ESS _•^ a �t� ,ply Lender's Address CITY TEL.NO ±p OKHM1 �6/14/t89' I certify that I have read this application and state that the STATE LIC 39b1 �-1 Ah 9' ` above mforrhatton'i; correct.'I agree to comply with all County. LICENSE NO. CLASS - ordinances and State laws regulating Heating, Ventilating and _ Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County tip ter upon 11 above-mentioned property for urs ^tioosesA CA, ignature of mittee Date V • WORKERS' COMPENSATION DECLARATION ' ' /,� ��p �� /,��B®gyp 2®(� ��®pp�� I herebyJaffifm that,I Have.a•certificate o(,,consent.to',self !PU A. A N FOR 9�at!!9 inure; or,,a,r.eltrft�ate of Workers'Compepsation Insurance, HEATING - VENTILATIPdG:'- AIR CONDITIONING or arcertifled copy thereof( Sec '3800, La C ) 76A364C 20-0046 DPW 9/88 Policy No.' j Compa F-] Gerfifiedicopy Is hereby urnished' o COUNTY OF LOS ANGELES BUILDING AND SAFETY ' Certified copy,is filed wiili the county building mspec- FOR APPLICANT TO FILL IN i BUILDING /JJ.i�on`clepartment r (PRINT OR TYPE ONLY) ADDRESS DpfF9` Applican` LOCALITY „ NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEARES COMPENSATION INSURANCE CROSS,ST IS r' _one hundred dollars ($100)'or less.) (This sectio`n.need'not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO PROLE ev ' e `s for (/ s'+•''1 tin - AIR HANDLING UNIT, CFM / X "(% ,.Iccertify that,in.the perforance4of.the work for which this CC.J/ (J � the�prniit;i permit is'issued, I'shal{riot employ any person,in any manner BOILER; BTU so rT to,become sublect to the,Workers'Compensation Laws APPROVALS DATE SPECTOR'S Si TURE Date Applicant' COMPRESSOR, BTU00 ROUGH Z L iNOTICETO;APPL_ICANT If,:after making this Certificate',of, VENTILATION SYSTEM FINAL mp Exetion, y_ou• should` become' sublect to the Workers' ' Compensation provisions,of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATIO ` with comply with such provisions or this'permit shall be deem- : ; 'ed revoked k' z FURNACE FAU GRAVITY O� I LICENSED CONT RACTORS.DECLARATION' FLOOR gT • -1 hereGy,affirm that'I am Ircerised under Provisions of Chapter 9 HEATER SUSPENDED UNIT ' (commencing with'Section 7000)•of Division,3 of the Business WALL ,and Professions Code,'and my license is in.full fdree'and effect License Number ��/ ic'•Class46 (J)�-7+ h� D J 1 O l/ u Contra Date ❑- I'am exempt under;-Sec OF _ Plan'check.fee' UA u ~.'.' B&P C for this reason' PERMIT ISSUING FEE tL + DateZ ;Signature TOTAL,FEE OWNER-BUILDER DECLARATION PLPN CHECK APPLICANT' ' " •e' ' ' . .I hereby affirm that I am exempt from the Contractor's License 1' m e Law for the following reason (Section 7031 5, Business and • NAME'' Professions Code) -' J�r/� r ADDRESS' _�t1sCT°8 ❑ I, as owner of the 'property„or my employees with " wages as their sole'compensation,will do the work and _ z ` -. the stfucture,is-not intended or offered for sale'(Section CITY-- - _ TEL• NO r.'' - " 7044, Business and Professions Code) OWNER " 1.1 ITEClS _- �, -I, as owner,of,the property, am exclusively contracting 'y w1 - with licensed contractors to construct the prolect.(Sec- MAIL r TOTAL- :7 J-p L.50 tion 7044, Business and Professions Code) ADDRESS CONSTRUCTION LENDING AGENCY �' /^ CYt 71°`�I CITY G TEL NO 4,. - I hereby affirm that there is a construction lending agency fort" T ' ' _ 4I�'� ` the performance of the'work for which this permit is issued CONTRACTOR (Sec 3097, Civ C ) ADDRESS ® qy .y Lender's Name 0000—OW • •.11/ 2/89 TEL N14 j ° p Lender'sCITY wpb Address _ 619 _ 1 F91 STATE LIC I certify that I have read this application and•state that theLCENSE NO CLASS above 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. r upon the Ibove-me tinned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date Os