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HomeMy Public PortalAbout10009-10011-10015 OLIVE ST_Mechanical__ WORKER'Shave a certificate of consent to 20-0046 DPW APPLICATION FOR PERMIT LI E 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 copy thereof(Sec.3800 Lab.C.) Policy No.J%g44-3Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING C, / f ,LIE Certified copy is filed with the building inspectio ADDRESS Li (_/�J G departme . (PRINT OR TYPE ONLY) Date Applicant LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTIO OM RKERS' C OSS ST. �A rV COMPENSATION IN ANCE 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($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as toBOILER,BTU become subject to the Workers'Compensation Laws. COMPRESSOR,BTU �_ D 0 O APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of k ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code,you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY VALIDATION LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business and HEATER: WALL Professions Code, ,aand my license is in full force and effect. ' _ License Number �" 7,7 bl- Lic.Class C �j000. qonua S��s0aUs Oct- y r rac or Data C t11r[.T u V ❑ I am exempt under Sec. Plan Check fee 3303 50,55 t B.&P.C.for this reason PERMIT ISSUING FEE$ I ITEMS I Date: TOTAL FEE �!' TOTAL 50-55 Signature CHECK 50.55 ( OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT u , I hereby affirm that I am exempt from the Contractor's License Law NAME 001. CHANGE6fJ�l for the following reason (Section 7031.5, Business and Professions Code): ADDRESS ❑ I, as owner of the property, or my employees with wages 00013-131301 67 Z/93 as their sole compensation, will do the work and the CITY TEL.NO. 00-83 3 i Ai:� 9-25- structure is not intended or offered for sale(Section 7044, / n `t' Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting MAIL / with licensed contractors to construct the project (Sec- ADDRESS 6 C T_0SL tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY J��otU�[}(/ C TEL.NO. I hepp by affirm that there is a construction lending agency for CONTRACTOR ��Uf2 f;�sa� R L the erformance of the work for which this ermlS t Is Issued (Sec.3097,Civ.C.). ADDRESS 50 Lender's Name _ CITY G�..EtU�°�o TEL.NO.-335-2;4 9 b Lender's Address STATELIC. I certify that I have read this application and state that the above LICENSE NO. 3317 '6 Z CLASS C Z 0 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 3 p p tp p ty for insp ' n p oses. SEE REVERSE FOR EXPLANATORY LANGUAGE OF SIGNA I OROR AGENT DATE WORKER'S COMPENSATION DECLARATION 76A348DPW9/89 APPLICATION FOR PERMIT LIME GREEN I heleby affirm that I have a certificate of consent to self insure, 7sA3ff4C or a certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec.3800 Lab.C.) Policy No. 113 Company � �� COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ Certified copy is hereby furnished. B DING 1 Certified copy is filed with the ca my building Inspection FOR APPLICANT TO FILL IN ADDRESS QQ j ©L 1 u apartment. (PRINT OR TYPE ONLY) /�` _!_ / L I LOCALITY —rCM 1 `C C' '"'��l Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION OM RABSORPTION UNIT,BTU ASSESSOR r cl KERS' NEAREST ILD'.) COMPENSATION INS ANCE CROSS (This section need not be completed If the work Involved by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($700)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to BOILER,BTU �� become subject to the Workers'Compensation Laws. COMPRESSOR,BTU 0 APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code,you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business and HEATER: WALL Professions Code,and my licee7nse is in full force and effect. License Number 9"nd7 7"Z LID.Class C_;�_O } u 5�-�so AlC y �9�/ ACCT.� c finor Date F1I am exempt under Sec. Plan Check fee 510.55a BAP.C.for this reason PERMIT ISSUING FEE$ S 1 ITEk(=3 C Date: TOTAL FEE j"sj j��llITAL 50 o 55 : Signature CHECK 50.55 V. 11 PLAN CHECK APPLICANT +� OWNER-BUILDER DECLARATION u Rt I hereby affirm that I am exempt from the Contractor's License Law NAME , CHANGE .00 s — for the following reason(Section 7031.5, Business and Professions Code): ADDRESS ❑ I, as owner of the property, or my employees with wages 00-00-00191 6/ 3/917 as their sole compensation, will do the work and the CITY TEL.NO. structure is not intended or offered for sale(Section 7044, IZ0,87 1 Aid 9:25 Business and Professions Code). OWNER GLESS ❑ I, as owner of the property, am exclusively contracting MAIL y� O� with licensed contractors to construct the project (Sec- ADDRESS I;J /y I` tion 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY CRYm Q JV e_[) v ( TEL.NO. I hereby affirm that there is a construction lending agency for , the performance of the work for which this permit is Issued CONTRACTOR QV r P r)5 pn, % (Sec.3097,Civ.C.). _ ADDRESS 3 —7 & V(-J�J1K p )V Lender's Name _ �y CITY G _�fl0 YZ TEL.NO. 2 35=� ki Lender's Address STATEy LIC. 1 certify that I have read this application and state that the above LICENSE NO.3R7/ b 2 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 Ity,fOr.,insp a n pu.p ses. SEE REVERSE FOR EXPLANATORY LANGUAGE OF 'CANT OR AGENT DATE ' WORKER'S COMPENSATION DECLARATION 20.0046 DPW 91 e9 LI E GREEN I heGeby affirm that I have a certificate of consent to self insure, 76A364C APPLICATION FOR PERMIT or a cprtifioate qj Worker's Compensation Insurance, or a certified HEATING-VENTILWING-AIR CONDITIONING copy thereof(Sec. 3800 Lab.C.) Policy No.?T7 3 Company LCOUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ Certified copy is hereby furnished. e Certified copy is filed with the ty building inspec Ion FOR APPLICANT TO FILL IN BUILDING UL— department. (PRINT OR TYPE ONLY) 00 0 v 0 f �/`� Date Applicarpz n NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY —)* LC-- e CERTIFICATE OF EXEMPTI jV RO . ORKERS' CROSS ST. B A[ U, I N COMPENSATION IN FRANCE ABSORPTION UNIT,BTU ASSESSO (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. ,Op COMPRESSOR.BTU 4-9_Z 0 U Q 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 VALIDATION I hereby affirm that I am licensdd under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business and HEATER: WALL Af.4T■v Professions Code,and my license is in full force and effect. �LtZei 3303 50.rr Licensee Number >s 7 7 t�Z /Lic.Class �L � �ry p I j EMM CoYltraCtOr� J� S�r�,� �(DtiB 11 Ll—gt, ® IUTI't? -`��0o�`� C ❑ I am exempt under Sec. Plan Check fee CHECK _c'■55C B.BP.C.for this reason PERMIT ISSUING FEE$11,:� 16, ]E ■ jC H Date: TOTAL FEE '6L Signature 0000-0001 v/ !y-.G PLAN CHECK APPLICANT �� 1 i 9 o iG OWNER-BUILDER DECLARATION /a 1 AM '�o';�4 1 hereby affirm that I am exempt from the Contractor's License Law NAME oU✓) S( S p3L:S �. for the following reason (Section 7031.5, Business and Professions f� Code): ADDRESS2n (1 _ i f � Ia_Nou 7 1, as owner of the property, or my employees with wages _0 +� V as their sole compensation, will do the work and the CITY GLC PO o)eA TEL.NO. �S s'�!Cj6. structure is not intended or offered for sale(Section 7044, 7 Business and Professions Code). OWNER ^`�� ❑ I, as owner of the property, am exclusively contracting MAILf 1C with licensed contractors to construct the project (Sec- ADDRESS 63) tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY U 0V 1)� TEL.NO.j5 7.5-1 CONSTRUCTION Z I hereby affirm that there is a construction len ding agency for CONTRACTOR L•V 12 L S Q I the erformance of the work for which this permit Is issuedt (Secp .3097,Civ.C.). ADDRESS 3 0-7 ilk C` v �.�0 Lender's Name [J J CITY Gc.epi i) we Y4- TEL.NO..a Lender's Address I certify that I have read this application and state that the above CENSE NO. > 7 7 b Z CLASS C information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize retivea of this County to enter upon the above-mentioned opRNS for Inspect i pur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE 6-3-91 SIGNAL U OF APR NT AGEN DATE