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Home My Public Portal About9324 LOWER AZUSA RD_Mechanical__ ION affirm ttiat I have a certificate of consent to 20-W46 PW9/89 APPLICATION FOR PERMIT LIME GREEN 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 COPYthereof(Sec.3800 Lab.C.) Po IT'cy(40.1 mpany COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ Certified copy is hereby furnished. 71-0114:9— Certified 1°14:9—Certified copy is filed with the co ty buildi Inspection FOR APPLICANT TO FILL IN BUILDING department. (PRINT OR TYPE ONLY) ADDRESS - 2_4 1-a—di; z pi Date�O O � Applicant LOCALITY TC NO. TYPE OF APPLIANCE OR EQUIPMENT FEE 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($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to BOILER,BTU 6 �� become subject to the Workers'Compensation Laws. 2 COMPRESSOR,BTU 2 APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code,you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY / LICENSED CONTRACTORS DECLARATION FLOOR BTU--6997 11,11 VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED—UNIT— (commencing USPENDED UNIT(commencing with Section 7000)of Division 3 of the Business and WALL Professions Code,and my license is in full force and effect. 1 up License Number S � Lic.Class G 7'� Contractor1146252tjELIa- SYS Data 10-_JZ&f% Q ❑ I am exempt under Sec. Plan check fee .._ ,� Cc BAP.C.for this reason PERMIT ISSUING FEE$ hC- Date: TOTAL FEE - -"""` C '.r• It Signature — — a PLAN CHECK APPLICANT _ _ l G +;5OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law NAMEfor the following reason (Section 7031.5, Business and Professions Code): ADDRESS ` ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the CITY TEL.NO. structure is not intended or offered for sale (Section 7044, - Business and Professions Code). OWNER r r r 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). CITY TEL.NO. CONSTRUCTION LENDING AGENCY J I hereby affirm that there is a construction lendingagency for CONTRACTOR �� Icr�L s-•!s the performance of the work for which this permit Is issued (Sec.3097,Civ.C.). ADDRESS Lender's Name 4 CITY TEL.NO.1914 X Z Lender's Address STATE LIC. I certify that I have read this application and state that the above LICENSE NO. Uy CLASS G ztJ information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize repr entatives th's County to enter upon the above-mentioned pro rty for ins SEE REVERSE FOR EXPLANATORY LANGUAGE NATUR F APPLI NT OR AGENT DATE WORKER'S COMPENSATION DECLARATION 766A364�PW 9/89 I hereby affirm that I have a certificate of consent to self insure, I1E GREM APPLICATION FOR PERMITVA Ior a cdrtificate of Worker's Compensation Insurance,or a certified HEATING-VENTILATING-AIR CONDITIONING u� LI rd t0 copy thereof(Sec.3800 Lab.C.) Policy NoLZ-4,5; ny �VJZ COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ Certified C.M.hereby furnished. Certified copy is filed with the county building inspection FOR APPLICANT TO.FILL IN ADDRESS , department. C �/�®�/� a (PRINT OR TYPE ONLY) Date�23'� 2"`Appilcaaf e �.1�/,iJ�f�s� LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTN FROM WORKERS' NEAREST IO 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($700)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to BOILER.BTU become subject to the Workers'Compensation Laws. / COMPRESSOR,BTU Date ApplicaVENTILATION SYSTEM APPROVALS DATE INSPECTOR'S SIGNATURE nt NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code,you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU 13 ITY LICENSED CONTRACTORS DECLARATION FLOOR BTlo—c— 0 VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business and WALL Professions Code,and my license is in full force and effect. License Numbe 1� Lic.CC O D Contras) � �' Date V^3 0 9z c ❑ I am exempt under Sec. Plan check fee Q B.&P.C.for this reason PERMIT ISSUING FEE$ Z1 F Date: TOTAL FEE !3 Signature D OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT a 1 hereby affirm that I am exempt from the Contractor's License Law NAME for the following reason(Section 7031.5, Business and Professions ® , Code):❑ ADDRESS - a I, as owner of the property, or my employees with wages %1(.t•I e a as their sole compensation, will do the work and the CITY TEL.NO. ;-79-7 — ' structure is not Intended or offered for sale(Section 7044, Ii 1�. 1 Business and Professions Code). OWNER .1 Tt-� LTENE ti ❑ I, as owner of the property, am exclusively contracting MAIL A �� 57 m with licensed contractors to construct the project (Sec- ADDRESS l tion 7044,Business and Professions Code). -- CONSTRUCTION LENDING AGENCY CITY' TEL.N °1HIri it "i.i IJ I hereby affirm that there is a construction lending agency for f C"'H NGE the performance of the work for which this permit Is Issued CONTRACTOR 114ZG (Sec.3097,Civ.C.). ADDRESS Lender's Name .! —sly Lender's Address CITY 91,_i� j Ari f $7 I certify that I have read this application and state that the above ILCENSE NO. Z LIC. �O 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 r inspectZw rppses. SEE REVERSE FOR EXPLANATORY LANGUAGE OI O PPLICANT OR AGENT DATE