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Home My Public Portal About5734 NOEL DR_Mechanical__ PW WORKER SCOMPENSATION ate of consent to Deter APPLICATION FOR PERMIT LIME GREEN I hereby affirm that I have a certificate of consent to self insure or a certificate of Worker a Compensation Insurance or a certified HEATING-VENTILATING AIR CONDITIONING copy thereof(Sec 9800 Lab C) Policy 140 Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV Certified copy is hereby fumished BUILDING dCertifieddepartment copg is Hied with the county building Inspection FOR APPLICANT TO FILL IN ADDRESS I department (PRINT OR TYPE ONLY) J LOCALITY � Date Applicant NO TYPE OF APPLIANCE OR EQUIPMENT FEE e CERTIFICATE OF EXEMPTION FROM WORKERS C OSS ST COMPENSATION INSURANCE (This section need not be completed if the work Involved by the MAPBOOK PAGE PARCEL permit Is for one hundred dollars(=100)or lose) AIR HANDLING UNIT CFM wsrRRcr 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 5/ ® COMPRESSOR BTU APPROVALS DATE B48PECTOR s S.T.Date6.5 Apphcam VENTILATION SYSTEM NOTIC TO PLICANT 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 Zr provisions or this permit shall be deemed revoked FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION ' FLOOR —BTU litbel 93if VALIDATION I hereby affirm that 1 am licensed under provisions of Chapter9 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 Number 3 244 Lic ClassCM 94 O � , } Contractor xi��ft�_T[► Date� ` o 10 1 am exempt under Sec Pian Check fee V at B&P C for this reason PERMIT ISSUING FEE S O Date TOTAL FEE V W Signature OWNER BOLDER DEC TION PLAN CHECK APPLICANT N D 1 hereby affirm that I am exempt from the Contractors License Law NAME 10. ? for the following reason(Section 7091 5 Business and Professions + Code) ADDRESS I as owner of the property or my employees with wages ACCT a as their sole compensation will do the work and the CITY TEL NO 77 70 structure Is not Intended or offered for sale(Section 7044 Business and Professions Code) OWNER 1 ITEMS EATS I as owner of the property am exclusively contracting MAIL j ATAL. 77 v 70 with licensed contractors to construct the project (Sec ADDRESS rucru tion 7044 Business and Professions Code) CITY TEL NO CHECK 77 7t CONSTRUCTION LENDING AGENCY e�� I hereby affirm that there Is a construction lending agency for v � , CHAD • QI the performance of the work for which this permit ra lasued COIRYJH •^/ (Sec 3097 Civ C) IF IF ADDRESS Lender a Name ��—��1 , ,1 9�t/23/9,t CITY TEL NO 7099 1 Mt i 7*CIp Lender s Address I certify that I have read this application and state that the above LICENSE NO CLASS Z0 Information Is correct I agree to comply with all County ordinances and State laws relating to budding construction and hereby authorize representatives of this County to enter upon the above-mentioned property for Asp ction rn&es SEE REVERSE FOR EXPLANATORY LANGUAGE apNATURE O&PIPPLICANT OWASENT DATE WOR at I hpwCOMPENSATION ate of consent to DPW 9189 APPLICATION FOR PERMIT LIME GREEN I llereti(i affirm that 1 hj3lve a certificate of consent to self Insure MANC or a ce ificate of Worker a 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 Certified copy Is hereby furnished ❑ Certified copy Is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING department (PRINT OR TYPE ONLY) 403 dM1 Date ApplicantLOCALITY NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST COMPENSATION INSURANCE ABSORPTION UNIT BTU (This section need not be completed If the work Involved by the ASSESSOR PAGE PARCEL permit Is for one hundred dollars(=100)or low) AIR HANDLING UNIT CFM DIarMCT RO PROCESSED BY I certify that in the performance of the work for which this permit la Issued I shall not employ any person in any manner so as to BOILER BTU p become subject to the Workers Compensation Laws �QQ COMPRESSOR BTU APPROVALS Date t , Iicem �� a SxiNMURE VENTILATION SYSTEM / NOTIC TOA P I ANT If afteVW#Ing thli Certificate of ROUGH d' Exemption you should become subject to the Workers Compensation EVAPORATIVE COOLER provisions of the Labor Code you must forthwith comply with such I FINAL Z-1 Q provisions or this permit shall be deemed revoked FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION 1 hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED—UNIT— (commencing USPENDED UNIT(commencing with Section 7000)of Division 3 of the Business and HEATERWALL Professions Code Land my license is in full force and effect 10 License Number vim' Uc CIK. A a Contractor8 I am exam under Sec Plan Check fee W B IAP C for this reason l PERMIT ISSUING FEE$ ! 0 Date TOTAL FEE a Signature OWNER BUIC I PLAN CHECK APPLICANT z L !rr ? I hereby affirm that I am exempt f m t e Contractors License Law NAME PON. ACC a for the following reason(Section 7031 5 Business and Professions 7r Coe) ADDRESS 3303 70 ag I as owner of the property or my employees with wages 1 ITEMS as their sole compensation will do the work and the CITY TEL NO structure is not intended or offered for sale(Section 7044 P OL 70-95 Business and Professions Code) OWNER ❑ I as owner of the property am exclusively contracting MAIL (HECK 70.99 with licensed contractors to construct the project (Sec ADDRESS 60 tion 7044 Business and Professions Code) CHANE CONSTRUCTION LENDING AGENCY CITY TEL NO 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued COLOR , Q[I- 1 10/ r'+r'74 (Sec 3097 Car C) i ADDRESS 6 Z'z. 7161 1 AM E-38 Lender a Name CITY TEL _ Lender s Address STATE LIC I certify that I have read this application and state that the above LICENSE NO C 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 for i spection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE c SIGNATURE OF APP OR AGE DA