The URL can be used to link to this page

Home My Public Portal About6132 SULTANA AVE_Mechanical__ WUKRCKJ I.VMrrNZI-11KAM UCI-LMKM 11-4 9AFF LATI®N FOK PEKMIT I here!y.rofflrm that I hove a certificeteoof coHsent to self insure, rvr d certificate of Workers' CompensoAion Insurance, HEATING - VENTILATING - AORCONDITIONING oft certified copy thereof (Sec. 3800, Lab. C.) 76A364C j. 20-0046 DPW 9/88 Policy No. '__Company ❑ Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING ti n (PRINT OR TYPE ONLY) ADDRESS L S Date f Applicant�`u y` ��`` � LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ' CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST /.� COMPENSATION INSURANCE CROSS ST. ��1.6nv /✓ (This section need not be comp)@}ed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO./ PROCESSED BY the permit is for one hundred dollars($100) or less.) AIR HANDLING UNIT,CFM 7� 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 become subject to the Workers Compensation Laws. BOILER, BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant COMPRESSOR, BTU ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM V FINAL Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER SAL ATION with comply with such provisions or this permit shall be deem- ed revoked. FURNACE: FAU BTU RAVITY LICENSED CONTRACTORS DECLARATION �J �! I hereby affirm that I 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. -z—o CL License Number Lic. Class d C 3u Contractor ate l ❑ 1 am exempt under Sec. V Plan check feeCL w B.&P.C. for this reason ,.� 1A PERMIT ISSUING FEE $ Date: Signature TOTAL FEE 3Q f J OWNER-BUILDE CLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and NAME Professions Code): ❑ 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and A4CCT the structure is not intended or offered for sale(Section CITY TEL. NO. �� 04 7044, Business and Professions Code). OWNER Le�)3 ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- MAIL g ITEM tion 7044, Business and Professions Code). ADDRESS ray 4 i I :30 0 CONSTRUCTION LENDING AGENCY CITY TEL. NO. t;� — Ihereby affirm that there is a construction lending agency for ® ;.1 t' 5"J, the performance of the work for which this permit is issued CONTRACTOR (Sec. 3097, Civ. C.). Clrte..i�'*.r .03 ADDRESS Lender's Name CITY TEL. NO. Lender's Address STATE LIC. � I certify that I have read this application and state that the LICENSE NO. CLASS :tv V0 S L above information is correct. I agree to comply with all County fU7 1 rr;X111° 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 I' nt or Agent Date KERS'COMPENSATION DECLARATION A •J hereky!iffirm that I have a certificate�tof-co"sent to self APPLICATION FOR PERMIT insure, mi'd'certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING oft certified copy thereof (Sec. 3806, Lab. C.) 76�64C No' , Company ;;-._1• 20-0046 DPW 9/88 pcy No.�_ Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING / ti n ep rtment. ADDRESS Z (PRINT OR TYPE ONLY) Date Applicant LOCALITY I NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. PROCESSED BY the permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this AIR HANDLING UNIT, CFM 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 INSPECTOR'S SIGNATURE Date Applicant COMPRESSOR, BTU U ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL , j ----•--•—----- Exemption, you should become. subject to the Workers' Alb Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VAL ATION withcomp with such provisions or this permit shall be deem- Ft ed revoked. IFURNACE: FAU BTU RAVITY I LICENSED CONTRACTORS DECLARATION -FLOOR �J v 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,andmy license is in full force and effect. I IL License Number 44312 Lic. Class G , O Contractor O '❑ • I am exempt,under Sec. F- Plan check fee ,V„ B.BP.C. for this reason PERMIT ISSUING FEE $ �' Z Signature Date: � _ - TOTAL FEE 3d .J'6 OWNER-BUILDE CLARATION PLAN CHECK APPLICANT I hereby affirm.that I am-exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and NAME Professions Code): ADDRESS I, as owner of the property, or my employees with El +�+ wages as their sole compensation,will do the work and � G'�Afi the structure is not intended or offered for sale(Section CITY TEL.NO. 7044, Business and Professions Code). OWNER r4 ! 30.50 ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- MAIL 1 ITEMS tion 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY CITY TEL.NO. TOTAL 30 o 50 1 hereby affirm that there is a construction lending agency for CHECK .50 the performance of the work for which this permit is issued CONTRACTOR (Sec. 3097, Civ. C.). CHANGE .130 ADDRESS Lender's Name ' CITY TEL. No. 00W—W i 6I 1/889 Lender's Address 1 certifythat I have read this application and state that the STATE LIC. PP AM10: i 'above information is correct. I agree to comply with all County LICENSE NO. CLASS 3707 1 r7!1 V�•.6 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.A&rjWnt or Agent Date