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Home My Public Portal About5915-5927 OAK AVE_Mechanical__ WORKER SCOMPENSATION DECLARATION 204M DPW 9/89 APPLICATION FOR PERMITLIME GREEN I hereby affirm that j have a certificate of consent to self Insure 78A3s4C �.(or a`bertlfit:ate ofWp, C"borkers Compensation Insurance or a certiiled HEATING-VENTILATING-AIR CONDITIONING may" ( 4 Ttyr / Co Po NO nte �� COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV E l� Certified copy M hereby furnished NG Certified rartm copy led with t building 1 FOR AUNT OR TYPE ON SILL IN BLESS, Al S71 Date Applicant LOCALITY IQ 0--i NO TYPE OF APPLWrCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION M WORKERS CROSSST SST COMPENSATION INSURANCE ABSORPTION UNITBTU SSOR (This section need not be completed If the work Involved by the MAPBOOK PAGE PARCEL permit Is for one hundred dollars($100)or Ion) AIR HANDLING UNIT CFM olsrRwr NO pip BY I certify that In the performance of the work for which this permit Is Issued I shall not employ any person in any manner so as to BOILER BTU 0 O ry become subject to the Workers Compensation Laws d COMPRESSOR BTU Date Applicant AMOVAte DATE msFecroR s SKMTURE VENTILATION SYSTEM NOTICE TO APPLICANT If after making this Certificate of ROUGH k�� Exemption you should become subject to the Workers Compensation EVAPORATIVE COOLER provisions of the Labor Code you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked FURNACE FAU GRAVITY 00 LICENSED CONTRACTORS DECLARATION FLOOR BTU VAL ATION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business and HEAT WALL Professions Code and my license is in full force and effect w`��`b,.' mss Ger D LicenseNumberv ��,,IL{� (Llc Class v��0 �� ' �r 0 Contractor a w &k.0 Data Q , 8 ❑ I am exempt under Sec Pian check fee B AP C for this reason PERMIT ISSUING FEE$ p Data TOTAL FEE QD n Signature y OWNER BUILDER DECLARATION PLAN CHECK APPLICANTZ I hereby affirm that I am exempt from the Contractors License Law NAME , for the following reason(Section 7031 5 Business and Professions AUT. Coe) ADDRESS ��y►7 S s 13 I as owner of the property or my employees with wages 3M as their sole compensation will do the work and the CITY TEL NO i ItGrS structure Is not Intended or offered for sale(Section 7044 t,4 Business and Professions Code) OWNER M1 ' RAJ LV TOTS.. X01-00 ❑ I as owner of the property am exclusively contracting MAILruC with licensed contractors to construct the project (Sec ADDRESS V.rtll4r$ (XCK M1.0D tion 7044 Business and Professions Code) CITY • JIFEL NO �'L—'l SrILa9t7G. 00 CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for � �� ,l `D /� , the performance of the work for which this permit Is Issued • lu ( V (Sec 3097 Civ C) 0000— M 1 12/12/90 ADDRESS LR��V Lender s Name cffw NO 4�,Jm—F' 3 4¢35 1 AM I I O.38i Lender s Address TATE A I certify that I have read this application and state that the above LICENSE NO CCIAa 11110111 Km 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 for Inspectionp SEE REVERSE FOR EXPLANATORY LANGUAGE ONATURE OF17LWANT OR AGENT DATE WORKER I have ate of consent to 78ASW PN►9f� APPLICATION FOR PERMIT LIME GREEN I hereby affirm that 1 have a certificate of consent to self Insure 78A98eC or a certificate of Worker a Compensation Insurance or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec 8800 Lab C) U Policy No >' d Compamr :90= COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV Joh Certified copy is hereby furnished ' Mme IS filed with Ste cunfy building Inspection FOR APPLICANT TO FILL IN BUILDING (PRINT OR TYPE ONLY) ADDRESS r Date Applicant NO TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY CERTIFICATE OF EXEM N FROM WORKERS CROSSSSST COMPENSATIO INSURANCE ABSORPTION UNIT BTU (This section need not be completed if the work Involved by the MAPA aPAGE PARCEL permit Is for one hundred dollars($100)or lea) AIR HANDLING UNIT CFM oxnwcr NO PROCESSED BY I certify that in the performance of the work for which this permit Is issued I shall not employ any person In any manner so as to BOILFJT BTU become subject to the Workers Compensation Laws d COMPRESSOR BTU 611� APPROVALa DATE iiievEcioR s SIGNATURE Date " Apphoant VENTILATION SYSTEM NOTI E TO APP CANT If after king th s Certificate of ROUGH Exemption you sho Id become subject the Workers Compensation EVAPORATIVE COOLER provisions of the Labor Code you mut forthwith comply with such FINAL provisions or this permit shall be deemed revoked FURNACE FAU GRAVITY of LICENSED CONTRACTORS DECLARATION I FLOOR BTU VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED—UNIT UNIT (commencing with Section 7000)of Division 8 of the Business and WALL Professions Code and my license is in full force and effect t� License Number. L U, Class__ Lf�S ALCT.i Contractor�/� � Date Poo. 330354.7"i--�s IITS% 8 ❑ I am exempt under Sac IL Plan Check fee I= B aP C for this reason PERMIT ISSUING FEE$ TOTAL �— C Date LACK 54.79 �j TOTAL FEE � � CWU a a Signature PLAN CHECK APPLICANT co OWNER BUILDER DECLARATION Z I hereby affirm that I am exempt from the Contractor a License Law NAME t ,/� �.� ► 0000—Ml 9/24/93 for the following reason(Section 7081 5 Business and Professions ��t AM A r Code) ADDRESS p 249 1 9:11 ri 1 as owner of the property or my employees with wages as their sole compensation will do the work and the CRY TEL structure is not Intended or offered for sale(Section 7044 / Business and Professions Code) OWNERG1�v ❑ I as owner of the property am exclusively contracting with licensed contractors to construct the project (Sac ADDRESS 45bX tion 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY CRY TEL NO 1 hereby affirm that there is a construction lending agency for , the performance of the work for which this permit rs Issued COFACTORMA5d AA/2 r (Sec 8097 Civ C) t ADDRESS Lender s Name CITY TEL NO Lender a Address I certify that I have read this application and state that the above LLIICENSE NO 466 y4a► UO information is correct I agree to comply with all County ordinances .and State laws relating to building construction and hereby authorize representatives of this Cou nty to enter upon the above-mentioned props or insp IoSEE REVERSE FOR EXPLANATORY LANGUAGE T ' SxiNAE OF APPLICANT OR AGENT I DATE WORKERS COMPENSATION Df consent �OCIBDPN►s/0 APPLICATION FOR PERMIT LIME GREEN, I hereby afflrlh that 1 have a certificate of consent to self Insure 79A384C or a certificate of Worker s Compensation Insurance or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec 3800 Lab C) PlAn•AnitioaticoV IJ Policy No Company �N'f• COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV 19 Certified copy is hereby furnished ElCenm,,d copy is filed with the county budding inspection FOR APPLICANT TO FILL IN BDL R ADESS department (PRINT OR TYPE ONLY) '� Date CO 516 •9 Q"ApplicanviJo ow t. M, NO TYPE OF APPLIANCE OR EQUIPMENT FEE • EST CERTIFICATE OF EXEMPTIO FROM WORKERS clow T L&—.?V s3A5 t?a s COMPENSATION INSURANCE ABSORPTION UNITBTU ESS(This section need not be completed If the work involved by the MMAAP BOOK . dJOOrd 7 PARCEL 00f permit is for one hundred dollars($100)or less) AIR HANDLING UNIT CFM Dlsrwcr No PRDCE99ED 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 APPipVALs DME eiaPEcroR s epNMURE Date Appllcent 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 VALIDATION 1 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 ap ' 1 70 License Number. V7 Lic ClassTOTAL) f, ' Contractor MIM0 0 Date 94-- ► ACCTA M ❑ I am exempt under sec Plan check fee 3307 47•V6 8 cc B&P C for this reason PERMIT ISSUING FEE: s' •X10.92 TOTAL 47.83 6 Date &gneture V� TOTAL FEE 3 CHECK 47 &: A NER BUILDER DECLARATION PLAN CHECK APPLICANT €HA6 •M Z 1 hereby affirm that I am exempt from the Contractors License Law NAME ► for the following reason(Section 7031 5 Business and Professions Code) ADDRESS 0000-O,,W 1 7/ 1/+r► ❑ I as owner of the property or my employees with wages as their sole compensation will do the work and the CITY TEL NO 421" 1 AM $'10 structure is not intended or offered for sale(Section 7044 Business and Professions Code) OWNER µ1�6 ❑ I as owner of the property am exclusively contracting MAIL `tom with licensed contractors to construct the project (Sec ADDRESS tion 7044 Business and Professions Code) CITY �� TEL NO CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for CONTRACTOR the performance of the work for which this permit fa 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 property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANT OR AGENT DATE