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Home My Public Portal About5806-5808 PRIMROSE AVE_Mechanical__ . ' WOR that COMPENSATION DECLARATION APPLICATION FOR PERMIT I herebyyaffirm that P have a certificate of consent to self ' insure, or a certificate-of Workers'Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING or a certified copy thereof(Sec. 3800, Lab. C.) CE-81 C CE 818(REV. 10/81) ,Policy No. Company COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is hereby furnished. Certified copy,is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING tion department. ADDRESS -- 1 _ �( ? (PRINT OR TYPE ONLY) . Date Applicant LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. ,4, (This section need not be completed If the work involved by ABSORPTION UNIT,'BTU DISTRICT NO. PR19CESSED BY ' the permit Is fogy one hundred dollars($100)or less.) J_ I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM ``/1 �( ?A/ permit is issued, I shall not employ any person in any manner BOILER,BTU so as to become subject to the Workers'Compensation Laws. APPROVALS DATEI P R'S SIG TORE Date Applicant Z— COMPRESSOR,'BTU V6 ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,-you must forth- EVAPORATIVE COOLER VALIDAT ON p� with comply with such provisions or this permit shall be J� deemed revoked. FURNACE:. FAU RAVITY �/f) /] LICENSED CONTRACTORS DECLARATION OR TU p (/ I hereby affirm thata am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT '(commencing with Section 7000)of Division 3 of the Business - WALL and Professions Code,and my license is in full force and effect. IL License Number3'yZA51CP Lic. Class <--ZG , V Contractor Date — - a �tSm exempt under Sec. :r � g � �5194A 9L Plan check fee C # 0 0 0-o o 8 B.BP.C. for this reason PERMIT ISSUING FEE$ 5(150 TOTAL FEE o 0 Sienature� t ' OWNER.BUILDER DECLARATION PLAN CHECK APPLICANT 0.o o 5,0,5 0'0 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and NAME v _ Poo 0 a 06-86 Professions Code): ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and CITY TEL. NO. the structure is not intended or offered for sale(Section 7044, Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting MAIL with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY 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 (Sec. 3097, Civ. C.). ADDRESS Lender's NameL21_ ,e2e [STATE Y TEL. NO.—j3,0,�4r 4!y Lender's Address +�5�•C't� C LIC. I certify that I have read this,application and state that the LICENSE NO. a 1,W / d CLASS G- ZCJ above 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 up the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ature of Applicant or Agent 7 Date ERS'C'OMPENSATION DECLARATION -I Aerreliy�.dl`firm ti,at ; have a''certificate of consent to self APPLICATION FOR PERMIT insure, or a certificate of Workers'Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING or a certified copy thereof(Sec. 3800, Lab. C.) CE-81 C CE-818(REV. 10/81) Policy No. Company Certified copy is hereby furnished. COUNTY OF'LOS ANGELES BUILDING AND SAFETY R ,Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING tion department. (PRINT OR TYPE ONLY) ADDRES " Date Applicant LOCALITYa^ NO. TYPE OF APPLIANCE OR EQUIPMENT. FEE L CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST (�fj COMPENSATION INSURANCE CROSS ST. Oar E (This section need not be completed if the work 1e461ved'by ABSORPTION UNIT,BTU DISTRICT NO. PRO B.y -the permit is for one hundred dollars(;100)or less.) AIR HANDLING UNIT,CFM' c W 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner BOILER,BTU so as.to become subject to the Workers'Compensation Laws. - APPROVALS DATE ECTOR'S SIGNATURE /� ant -COMPRESSOR,BTU. C3 + 1 ti ROUGH — Date �Applicl� ��/J NOTICE TO APPLICANT: If, afte-r making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the'Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATI N with comply with such provisions or this permit shall be deemed revoked. _ FURNACE: FA U GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU C .A to I hereby affirm that I am licensed under provisions of Chapter 9HEATER: SUSPENDED UNIT '(commencing with.Section 7000)of Division 3 of the Business WALL and Professions Code,and my license is in full force and effect. A. License Number,ZL!W_ �3-LnLic. Class C "'� e , ry rdlr. O Contractor. Date `7�C2AI V 2-11 am exempt under Sec. 5L4 ,- 99 Plan check fee ;2 519.5 A IL B.&P.C. for this reason' H Date: PERMIT ISSUING FEE$ # a o c 8 Z D Signature cj C I't,ATOTAL FEE .1 a o 5(15 0 OWNER-BUILDER DECLARATI N PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License 01111. 0 0 0 5 Q.5() Law for the following reason (Section 7031.5, Business and NAME 10.4 �V _ o a Q 6 t 8 6 Professions Code): ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and CITY TEL. NO. the structure is not intended or offered for sale(Section 7044, Business and Professions Code). ' OWNER ❑ I, as owner of the property,am exclusively contracting with licensed contractors to construct the project (Sec- MAIL / tion 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY CITY TEL. NO. L I hereby affirm that there is a construction lending agency for , the performance of the work for which this permit is issued CONTRACTOR (Sec. 3097, Civ. C.). y� ADDRESS - ID, Name n t��JGG) .� tA/@G9 !�`Cep_ CITY41TEL. NO. Lender's Address�d,. � �—'�, STATE LIC. I certify that 1 have read this application and state that the LICENSE NO: 6.1Z d4rdCLASS above 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 i5 gnature of Applicant or Agent Date