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Home My Public Portal About5708 NOEL DR_Mechanical__ WORKERS COMPLNSATION DECLARATION CEA 878(2 80) APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self insure or a certificate of Workers Compensation Insurance or HEATING VENTILATING AIR CONDITIONING cied py thereof(Se 3800 L b C) Policy No � s'3'C�o�pany— ❑ Certified copy is hereby furnished COUNTY OF LOS ANGELES / ' ' BUILDING AND SAFETY Certified copy is filed wit the count) building inspection FOR APPLICANT TO FILL IN BUILDING /� /� 04405 d part nt ADDRESS �00 s /V S V G Datepplica (PRINT OR TYPE ONLY) CERTIFICATE OF EXEMPTION FROM WORKERS NO TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY C of L- Q COMPENSATION INSURANCE NEAREST CROSS ST �1 d (This section need not be completed if the work involved ABSORPTION UNIT BTU V� �/ 0 by the permit is for one hundred dollars ($100) or less) DISTRICT NO PROCESSED Y V I certify that in theerformance of the work for which this AIR HANDLING UNIT CFM r r permit is issued i shall not employ any person in any manner �1�v 0 so as to become subject to the Workers Compensation Laws 1BOILER BTU ti DATE INSPECT R S SI ATURE W Date Applicant COMPRESSOR BTU ROUGH U) NOTILE TO APPLICANT If after making this Certificate of VENTILATION SYSTEM FINAL — 2. Z Exemption you should become subject to the Workers Compensation provisions of the Labor Code you must forth EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deemed revoked FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that i am licensed under provisions of Chapter HEATER SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi LL ness and Professions Code and my license is in full force and ) effect License Number Lic Class Contractor Date ❑ I am exempt from the licensing requirements aq 1 am a licensed architect or a registered professional engineer Plan check fee 25%of above acting in my professional capacity (Section 7051 Bus iness and Professions Code) PERMIT ISSUING FEE$ Soo Lic or Reg No Date TOTAL FEE St7 HOME OWNER BUILDER DECLARATION PLAN CHECK APPLICANTjOWOR45,6-& M I hereby affirm that I am exempt from the Contractors NAME License Law for the following reason (Section 7031 5 Busi VHess,nd Professions Code) ADDRESS E' I as owner of the property will do the work and the TEL NO structure is not intended or offered for sale (Section CITY-/2"&,4C- —.Z 7044 Business and Professions Code) if ❑ OWNER22609A I as owner of the property am exclusively contracting :i�41101 dr with licensed contractors to construct the project MAIL ¢M S/ , (Section 7044 Business and Professions Code) ADDRESS # •�• e • • 8 CONSTRUCTION LENDING AGENCY CITY TEL NO CL'?_X -S '• • I hereby affirm that there is a construction lending agency 21 1 2 3 5 0 % for the performance of the work for which this permit is CONTRACTOR • e * 2350x" issued(Sec 3097 Civ C) ! Lender s Name ADDRESS 01 13-827 Lender s Address CITY TEL NO 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 CLASS ordinances and State laws regulating Heating Ventilating and Air Conditioning and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter upon the above mentioned property for iii ection purpose zolao ignature f Permi tee Date f /lp�ai WOPKERSCOMPENSATION ate of consent to . 7SA384 DPW 9189 APPLICATION FOR PERMIT LIME GREEN 1 hereby affirm that 1 have a certificate of consent to self sure 78A384C or a ceRDicate of Worker s Compensation Insuranc a certified HEATING VENTILATING AIR CONDITIONING copy thereof(Sec 3800 Lab C) Policy No Corn COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV ❑ Cer0ed copy is h furnished ❑ Certified is filed with the county building Inejx4ctwn FOR APPLICANT TO FILL IN BUILDINGDp d ent (PRINT OR TYPE ONLY) Date Applicant NO TYPE OF APPLIANCE OR EQUIPMENT �. FEE LOCALITY �♦ G CERTIFICATE OF EXEMPTION FROM WORKERS pROgg ST COMPENSATION INSURANCE ESSO (This section need not be completed if the work Involved by the M P BOOK PAGE PARCEL permit Is for one hundred dollars($100)or less) AIR HANDLING UNIT CFM oisTRicr Iw PROCESSED ev 1 certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to BOILER BTU �D l become subject to the Workers Compensation Laws O COMPRESSOR BTU Da APPROVALS DATE INSPECTOR 8 SIMATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT If afte making this Certificate ofROUGH Exemption you should become subject to the Workers Compensation EVAPORATIVE COOLER ` 5 provisions of the Labor Code you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked / FURNACE FAU G VQ�L. * VALIDATION LICENSED CONTRACTORS DECLARATION FLOOR BTU O(�U CJ 1 hereby affirm that I am licensed under provisions of Chep HEATER SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Bus s and WALL Professions Code and my license is in full force and 08/l A{�T 8 License Number Lic Class 70♦'f— Contractor Date 1 I TEMP Ulz ❑ I em exam oder Sec Plan check fee TI GAL 122-25 cc B aP r this reason PERMIT ISSUING FEE$ 0 i jE�� 'f i�� a� 0 Date ZZ TOTAL FEE p'1 t HAFT 3E � LU Signature PLAN CHECK APPLICANT * y OWNER BUILDER DECLARATION 6I300-OCO1 t 3IP4194 Z I hereby affirm that I am exempt from the Contractors License Law NAME for the f owing reason(Section 7031 5 Business and Professionsloo. bb" Sa ..tC Code) ADDRESS av I as owner of the property or my employees with wages as their sole compensation will do the work and the CITY TEL NO Y r structure Is not Intended or offered for sale(Section 7044 t Business and Professions Code) OWNER �, u I as owner of the property em exclusively contracting MAILL with licensed contractors to construct the project (Sec ADDRESS Q Q tion 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY C TEL NO C Z s I hereby affirm that there is a construction lending a or CONTRACTOR ► the, performance of the work for which this per Issued (Sec 3097 Civ C) ADDRESS Lender a Name CITY TEL NO Lender s Address STATE LIC I certify that I have r this application and state that the above LICENSE NO CLASS Information is cor I agree to comply with all County ordinances and State la lating to building construction and hereby authorize represen es of this County to enter upon the above mentioned Pinspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE A PLICANr OR AaEM DATE