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Home My Public Portal About6356 OAK AVE_Mechanical__ 7GA364C p \V affirms'COMPENSATION DECLARATION CE-818 (2-80) ^ A P P LI—� C A T�®11'51 FOR P E R� T I herchy affirm that 1 have a' certificate of consent to self I —f—/�• insure, or a certificate of Workers'Compensation Insurance,of / 1 HEATING-v ENTILATING-AIR CONDITIONING a certified copy t1preof(Sec.3800,Lab.C.) �. Policy No Company �L Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING-ARID SAFETY I � I Certified copy is filed with tete county building inspection FOR APPLICANT TO FILL IN BUILDING i� � ADDRESS A •4�-� llate Applicant LL?Zi�, raj (PRINT OR TYPE ONLY) LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE.OR EQUIPMENT FEE COMPENSATION INSURANCE NEAREST } (This section need not be completed if the work involved ABSORPTION UNIT, BTU CROSS ST. 0 by the permit is for one hundred dollars ($100) or less.) DISTRICT 140. PROCESSED Y V 1 certify that in the performance of the work for which this i AIR HANDLING UNIT,CFM permit is issued, 1 shall.not employ any person in any manner - I so as to become subject to the Workers' Compensation Laws. BOILER,BTU 1 1APPROVALS DATE INSPECTORS SIGNATURE LJJ Date Applicant COMPRESSOR,BTU ROUGH NOTICE TO APPLICANT: If, after making this Certificate of i VENTILATION SYSTEM FINAL Z Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be EVAPORATIVE COOLER VALIDATION deemed revoked. FURNACE: FAU AVITY �2�� LICENSED CONTRACTORS DECLARATION FLOOR:—BTU I hereby affirm that I am licensed under provisions of Chapter I HEATER: SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi- WALL ness and Professions Code, and my licenseis in full.force and 1 effect. License Number Lic.Class o� Contractq, 1r® lS Date d- �v ElI am exempt from the licensing requirements as I am a 1 licensed architect or a registered professional engineer Plan check fee 25%of above. acting in my professional capacity (Section 7051, Bus- iness and Professions Code). PERMIT ISSUING FEE$ ,�p Lic.or Reg.No. Date TOTAL FEEa �Q HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from- the Contractor's NAME _kWds 111as.0AR-101 License Law for the following reason (Section 7031.5, Busi- ness and Professions Coda): ADDRESS 3 I, as owner of the property, will do the work and the CITY TEL.NO� �� structure is not intended or offered for sale (Section 7044, Business and Professions Code). 4 3 Q 8 A. ❑ , I, as owner of the property, am exclusively contracting OWr4ER with licensed contractors to construct the project MAIL <D 0 0 0 0 0 $ (Section 7044,Business and Professions Code). ADDRESS , CITIY TEL.NO. 2 - - 4350 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constru,ct ion'lending agency y ` U for the performance of the work for which this permit is CONTRACTOR �S Il o o'o I = f, issued (Sec. 3097, ,:iv.C.). 0 6 08-82 B_8G Lender's Naate_ ADDRESS Lender's AdCITY ', � 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 LIOENSE NO. 1 CLASS 1 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 •bove-mentioned property for in pectig• poses. G-y-s-2 Signature of Date %- t KERS'C ONIPENSA I-ION DECLARATION 1 7GA364C pp gg�� fft�pp 22 R pp�� y� .`r CE-SIS(2-80)� A ��L�,��6=i��®III ®� �LC�p�TU� 11 1 herelty affirm that I have u• certificate of consent to self I 7 C/�' insure,or a certificate of Workers'Compensation Insurance,or / HEATING-VENTILATING-AIR CONDITIONING a certifiedccopy tl arcof(Scc. 3800,Lab. CC...) Police No. J7Company U,x f Certified copy i;hereby furnished. COUNTY OF LOS ANGELES I BUILDING AND SAFETY Certified copy is filed with the county building inspection I FOR APPLICANT TO FILL IN ADDRESS 1) ite �ApPlicant � �+f (PRINT OR TYPE ONLY) 1 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.. TYPE OF APPLIANCE OR EQUIPMENT FEE � F. COMPENSATION TNSL'RANC E NEAREST d CROSS ST. (This �cction need not be completed if the work involved ABSORPTION UNIT, BTU L�— O le by the periinit is for one hundred dollars ($100) Or less.) DISTRICT NO PROCESSED Y V 1 ccrlify that in the performance of the work for which this AIR HANDLING UNIT,CFM—iWE ' fr hermit is issued, I shall not employ any person in any manner O ,n as to become subject to the Workers'Compensation Laws. BOILER, BTU 1 ,L APPROVALS DATE INSPECTOR'S SIGNATURE L1J i)ate Applicant COMPRESSOR,BTU &I ROUGH V) VFINAL OTICF TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM �` I;xemptlon, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION v,ith comply with such provisions or this permit shall be deemed revolted. FURNACE: FAU K Ci AVITY -;7 LICENSLDCONTRACTORS DECLARATION FLOOR: BTU 1 herchy affirm that 1 am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Stiction 7000)of Division 3 of the Busi- WALL mess and Professions Cade, and my license is in full force and affect. LILense Number Lic..Class iontracta [_ ��v r_l�llt* 19 !S' Date I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer Plan check fee 25%of above. acting in my professional capacity (Section 7051, Bus- iness and Professions Code). PERMIT ISSUING FEE$ r� I.ic or Reg.No. Date TOTAL FEE IIONIF OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's NAME �,SQ �� p License I.a%v for the following reason (Section 7031.5, Busi- 46299— ness and Professions Coda): ADDRESS 3 I, as owner of the property, will do the work and the CITY .� TEL. NOaS'� structure i% not intended or offered for sale (Section 7044, Business and Professions Code). 3 O F F-1 OWNER ze i, as owner of the property, am exclusively contracting with licensed contractors to construct the project MAIL f' 0 0 0 0 0 £± (Section 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY CITY TEL.NO. I G 0 0 4J.J (� I hereby affirm that there is a construction lending agency NCONTRACTOR o 0'0 •t ;, for the performance of the work for hich this permit is issued(Sec.3097. rv.C.). ,v `� C c�i—ii t Lender's ADDRESS �(o Lender's Add re:,. CITY 1�Lt t[ TEL.NO. • dJ— I certify that I have read this application and state that the STATE /s LIC. R above information is correct.I agree to comply with all County LICENSE NO. ordinances and State laws regulating Heating, Ventilating and Air conditioning. and hereby atlthori/c representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter upon theBove-mentioned property for f1 pectiases. Signature of Permiltee Date