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Home My Public Portal About5540-5542-5544 SULTANA AVE_Mechanical__ affirm thatRSave a certificate of consent 7BA364 DPW BIeD APPLICATION FOR PERMITLIME GREEN' T00M I hereby atlirm that 1 here a certlflcete of consent to self Insure •- or a crrruhcete of Worker•Compensation Insurance or a canlhatl HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec 3380000 ZLab C) Policy NO '-x-`-42 krl—C mp ny s�� COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV ❑ Ceuf ed cap/Is hereby furrdehed Gemmed 'Is filed wall the county,budding inspection FOR APPLICANT TO FILL IN BUILDING tleWrnned (PROR TYPE ONLY) ADDRESS e1T O.U. If el LOCAL" NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FR KERS NEAREST COMPENSATION INSURANCE CROSSST (Thla taction need not be completed R the work Involved by the ABSORPTION UNITBTU ASSESSOR MAP BOOK PAGE PARCEL permit Is for one hundred dalton(1100)or Nu) ' MR HANDLING UNIT,CFM owrPx:T� morf8®er I candy that In the performance of the work for which this permit is issued I shell not employ any person In any manner so as to BOILER BTU i become subject to the Workers Compensation Laws / �Q� ( ifliC6�sl Date APO COMPRESSOR BTU_ ♦rPAovws WTI! .ore 88040n —F�� VENTILATION SYSTEM NOTICE f0 APPLICANT If eller meklnhie Certificate of - ROUGHExemption you should become subject to the WO kers'Compensation EVAPORATIVE COOLER - provisions of the Labor Code you must forthwith comply with such RNAL provisions or this permit shell be deemed revoked I ' FURNACE LICENSED CONTRACTORS DECLARATION r / FLOOR BTU ./ J VALIDATION I hereby affirm that I am licensed under provisions of Chapter g "� SUSPENDED UNIT_ (commencing with Section 7000)of Division 3 of the Business and TER WALL Prolesstons Code said my license Is In'lull force and effect Licerue Number �O�!�-�. Lk Clem' O } a. Contractor , Data C—/ ZZ 0 ❑ Plan Check fee _ - .� U I am exam under Sac 1L 1 0 _ r / B aP C to,Des reason , PERMIT ISSUING FEE$ H , '0 Date TOTAL FEE 101 AL 10 1 09 W Signature OWNER BUILDER DECLARATION PLCHECK APPLICANT - _ 101- NECKZ 1C+1.�=' _ I hereby efflrm that I am exempt from the Contractor a License Lew NAME , �f{I ]C .I]h for the following reason (Section 7031 b Business and Professions - Gods) ADDRESS ❑ I as owner of the property or my employees with wages r1 as their sole compensation will do the work and the CRY TEL NO tJ!Illp—(1[1!11 5/14,P2, structure Ia not Intended or offered for sale (Section 7044 Business and Profenslorts Code) OWNER 1 , i AN r{1111 1Q ❑ I as owner of the property am exclusively contracting OWN ` with licensed contractors to construct the project (Sec ADDRESS tion 70" Buslness'end Professions Code) - ` CRY TEL NO CONSTRUCTION LENDING AGENCY _ I hereby affirm that there Is a construction lending agency for CONTRACTOR ,S/ , the performance of the work for which this permit le issued / (Sec 3087 Civ C) - - _ 1 ADDRESS O S Lenders Nemo CT' TEL NO Lender a Address J'` I cerilty that I he"reed this application and state that the above LSICE�NSE NO J � GLASS L 2 O information Of correct I agree to comply with all County ordinances and State lave relating to building construction,and hereby authorize representatives of this County to enter upon the above mentioned property for Inspection purposes �f SEE REVERSE FOR EXPLANATORY LANGUAGE Bxay aF APPaF APP flA FN _/ _ ` 1 - - WORKCOMPENSATION DECLARATION DPW 9/09 APPLICATION FOR PERMIT LIME GREEN, I hereby affirm ihptIhave have a certificate o1 consent to self Insure 7ttAJS/C or a cdrtdicete of Worker a Compensation Insurance or a certified HEATING-VENTILATING-AIR CONDITIONING I I copy thereof(Sec 3800 Lab C) - LI Policy No P 6 y7 0 Company -574pt d COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV ❑. Certified can is hereby Iumlahe0 ❑, Certified copy a Bled with the county building inspection FOR APPLICANT TO FILL IN BUILDING 'partment I (PRINT OR TYPE ONLY) ADDRESS J Date . ` �'q 7 2 Applicant- _j NO TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY d'e CERTIFICATE OF EXEMPTION FROM ORKERS NEAREST COMPENSATION INSURANCE CROSS ST ABSORPTION UNIT BTU ASSESSOR perms oMed not be completed the Work Involved by the MAP BOOK PAGE PARCEL permitt Is le for one hundred dollars($100) )or lees) AIR HANDLING UNIT CFM I certify that In the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to BOILER BTU x/ become subject to the Workers Compensation Laws / t�7 COMPRESSOR BTU VENTILATION SYSTEM MYIOIN.B DAM N9PEt 8810M.tnJ1W ROTI E APPLI AN II a making s kartolcate of I RIXIOH ('L Exemption you should become sub)ect to the W kersLxNfflP8nAaIIDn EVAPORATIVE COOLER provisions of the Labor Code, you must forth comply,wlth such FINAL provisions or this permit shell be deemed revokedFURNACE FAU G9AYITY� ? S VALIDATION LICENSED CONTRACTORS DECLARATION II FLOOR BIU .t lC�sd :J I hereby affirm that I am licensed under provisions of Chapter B HEATER SUSPENDED UNR (commencing with Section 7000)of Division 3 of the Business and WALL Professions Code and my license Is in full force and effect 2 G'X License Number b I J Lie Class jr IL Connector Dale 8 ❑ I am exempt under Sec Plan Check fee Ir R B aP C for this reason PERMIT ISSUING FEE$ rf 7S OF Daze TOTAL FEE �� a ' Signature OWNER BUILDER DECLARATION PLAN CHECK APPLICANT Z I hereby affirm that I am exempt from the Contractor s License Lew NAME , for the following reason (Section 7031 S Business and Professions 11 T- ❑mss) ADDRESS (1tf_ 1 .a I as owner of the property or my employees with wagesr, as their sole compensation will do the work and the CITN' TEL NO +:`I-17 1�I1._5 structure is not Intended or offered for sale (Section 7044 1 iTEIS Business and Professions Code) OWNER ❑ I as owner of the property am exclusively contractingMAIL - TOTAL �_Q �_ - 89 with licensed contractors to construct the project (Sec ADDRESS b 41 y on 70Business and Professions Code) �. HE r 11i 1.r•q CONSTRUCTION LENDING AGENCY CITY TEL NO _HOGE - 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Pe issued CONTRACTOR (Sec 3097 Dv C) _ Poo. -yt • Landers Name ADDRESS / s ( I)1]fII]-1�I]I]1 _ 5/14/+2l CITY vz TEL NO Lender Address 1 certlty that 1 have read this application and state that the above LILKAr3E No 9' CUSS of/' 2Q - mlormation Is correct I agree to comply with all County orchnances and State laws relating to buntlug construction,and hereby authorize - representatives of this County to enter upon the above mentioned , property Ior In pect 0 purposes ate, BEE REVERSE FOR EXPLANATORY LANGUAGE - - /4ik 7L ' ecF oR 1geMT wee -' WORKER SCOMPENSATION DECLARATION 9189 APPLICATION FOR PERMITLIME GREEN I hereby affirm thdt 1 have a certificate of consent to self Insure or a coolllicate of Worker a Compensation Insurance or a certified - "HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec 3800 Lab C) - , - --- Policy No /2 14 2" Company :5U7E- %Wfe' COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV ❑ Cenlrodpopy Is hereby lumtehed , ❑ , dCamiled nmempy is filed with the county bulldrng Inspection FOR APPLICANTfT OR TOOLFILL IN BUILDING DRESS 6•s (q Date e ./V::�!Appllwm - LOCALfTY , l✓N^�+ NO TYPE OF APPLIANCE OREWIPMENT FEE CERTIFICATE OF EXEMPTION FROM 1[ERS 1, NEAREST COMPENSATION INSURANCE C�ST ABSORPTION a+rt eTu (Thio Section for mad not be completed($1 U the work Involved by the f�BOOK PAGE PARCEL 1 SSOR permit Is for ora hundred dollars(!f 00)or hu) AIR HANDLING UNIT DFM �rBcr Ip �e. I comity, that in the performance of the work for which this permit is issued I shell not employ any person In any manner so as to SOLER BTU become Subject to the Workers Compensation Lem ` COMPRESSOR BTU C^3 t Date Applicant _ _ - usnovws [ATE Fmeeetorlaexvunxre VENTILATION SYSTEM _ NOTICE TO APPLICANT If eller making this Certificate of ROUGH ,S Exemption you should become subject to the Workers Compensation - provisions of the Labor Code you must forthwith comply With Such EVAPORATIVE COOLER FINAL _ provisions or this permit shall be deemed revoked FURNACE FAU—GRAWLY , LICENSED CONTRACTORS DECLARATION FLOOR BTU *coo 3 VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 rt HEATER SUSPENDED UN (commencing with Section 7000)of Division 3 of the Business and WALL Professions Code and my license is In full force and effect 30 6 License Number r r Uc Cl. } Contractor Date d O ❑ 1 am exempt under Sec ' Plan check feecc U B dP C for this remora PERMIT ISSUING FEE$ 0 Dat O DataTOTAL FEE O/ a / W Signature D. OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT TA J 1 hereby affirm that I am exempt from the Contractors License Lew NAME • for the following reason (Section 7031 5 Business and Professions , hl(TJ Code) ADDRESS ❑ I as owner of the property or my employees with wages 72=117 as their sole compensation, will do the work and the CNV TEL NO r- 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 ADDRESS 7. 7 tion 7044 Business and Professions Code) - CONSTRUCTION LENDING AGENCY CITY TEL NO 1 ITE IO _ I hereby affirm that mare rs a construction lending agency for LbrrrRAcroR 11-11 AL' 1G 1 _ 89 the performance of the work for which this permit ?I Issued Circ/ _ (Seo 3097 Civ C) , '- I ,' ° 7 HECK [1 [Il. ADDRESS U //J _ Lender a Nemo / r C 4NNI]E I�1� , CRY �� Q�_ TEL NO J � �� _ _—_ Lender a Address • I certify that I have read this application and state that the above I CA NBE NO4_4 aCLASS Information IS correct 1 agree to comply with all County ordinances and State laws relating to budding comiruction and hereby authonze - represematmes of this County to enter upon the above mentioned =c C4 property for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE • ' - - - " 9aNAlllR F AP Aa WTE