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Home My Public Portal About8712 WENDON ST_Mechanical__ V,1ORKERS'COMPENSATION DECLARATION 7GA36646C(a 80) f�Ian p'"�� '�®fAN ®lid I� f�f1L1 �� , I hereby affirtri that I have a' certificate of consent to self Ir Ir LLQ 1 �I R P 5 Ifs 11 711 insure,or a certificate of Workers'Compensation Insuranc ,or HEATING-VENTILATING-AIR CONDITIONING t er (Sec.3800 .) om.pany Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY /�� - ti rtified copy is filed with eco b ilding inspection FOR APPLICANT TO FILL IN BUILDING Date Applicant (PRINT OR TYPE ONLY) ADDRESS LOCALITY CERTIFICATE OF EXEMPTION FROM WORKER 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. 0a by the permit is for one hundred dollars ($100) or less.) DISTRICT NO: PROC SED By 0 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 so as to become subject to the Workers'Compensation Laws.' BOILER,BTU .. APPROVALS D 04SPECTOR'SSIGNATU T Date Applicant COMPRESSOR,BTUROUGH. « j y NOTICE TO APPLICANT: If, after making this Certificate of VENTILATI.ON SYSTEMZ FINAL Exemption, you should becomesubject to the Workers' Compensation provisions-of the Labor Code, you must forth- EVAPORATIVE COOLER /�� VALIDATION with comply with such provisions or this permit shall be (y deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR: BTU I hereby affirm that I am licensed under provisions of Chapter HEATER:. SUSPENDED. UNIT 9 (commencing with Section 7000)of Division 3 of the Bus!- WALL ness and Profes ' Co a d y license is i full force and effect. / AA License, tuber c.Clas r , Contrac 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). Lic,or Reg.No.' Date TOTAL FEE HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I-am exempt from-the Contractor's NAME License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): ADDRESS ❑ I, as owner of the property, will do the work and the. -9.1 8 5 9 A. structure is not intended or offered for sale (Section' CITY TEL. NO. '7044,Business and Professions Code). #+9 40 0 9-0 8 OWNE E] I, as owner of the property, am exclusively contracting •2 0-027.00 with licensed contractors to construct. the project MAIL (Section 7044,Business and Professions Code). ADDRESS .0 9.0 .27.0.06 CONS TRUCTI N LENDING.AGENCY TEL.NO. I hereby affirm that th is a construction lending agency I. 1f.Ga_ 1 , for the .performanc o he work for which this permit is CONTRACT issuedSSec.3097,Ci .C) Lender s Name ADDR V-f� Lender's'Address ly CITY TEL.N I cerrify that I have read this application and state that the STATE �1 LIC. above information' o ect.I'agree to comply with all County LICENSE N CLASS ordinunc nd St e 1 ws.regulating Heating,Ventilating and Air dition' g,'and ereby authorize representatives of this SEE REVERSE•FOR,EXPLANATORY LANGUAGE C n to te� u on the above-mentioned property for i. pec i ur , Sign re of P mittee I Date. WORKERS'COMPENSATION DECLARATION 76A364C I�I� �-fi`�-�®fes� FOR lid E R� �T , CE-818(2-80) APPUC — H II II�1 Ifs li—LS I herebyyaffirm that I have a' certificate of consent to self ' insure, or a certificate of Workers'.Compensation Insurance,of HEATING-VENTILATING-AIR CONDITIONING a certified 'copy thereof(Sec.3800,Lab.C.) f t Policy NCompan Xy ❑ Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is filed with the c ty building inspec ' BUI LOING yt �� Way _ r-� de artment. FOR APPLICANT TO FILL'IN I (,(J Date��pplicant (PRINT OR TYPE ONLY) ADDRESS 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 I ABSORPTION UNIT, BTU CROSS ST. v�� ' d b DISTRICT NO. PROCESSED BY y the permit is for one hundred dollars (5100) or less.) - T 'U I certify that in the performance of,the work for which this J AIR HANDLING UNIT,CFM ; cc O. permit is issued, I shall not employ any person in any manner I' .so as to become subject to the Workers'Compensation Laws. : BOILER, BTUV APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant COMPRESSOR,BTU �Ja �_•�'�� RDUG"H NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM v Z Exemption, you should become subject to the Workers' FINAL . Compensation- provisions of the Labor Code, you must forth- EVAPORATIVE COOLER I • VALIDATION with comply:with such provisions or this permit shall be deemed revoked. FURNACE: - FAU- G A ITY LICENSED CONTRACTORS DECLARATION FLOOR: BTU a I hereby affirm that I am licensed'under provisions of Chapter- H,EATER:. SUSPENDED _NIT 9 (commencing with Section 7000)of Division 3 of the Busi- WALL ness and Professions Code, and my licbnse is in full force and effect. License Number, WLic.Class ) Contractor S/e,�I�/� Date� �^�Z• I ❑ I am exempt from the licensing requirements as I am a j 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). ,i Lic.or Reg.No. Date j TOTAL FEE HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT ' I hereby affirm that I am exempt from-the Contractor's NAME License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): ADDRESS ❑ I, as owner of the property, will'do the work(Section the CITY TEL. N �2 + x;2,7 9,'9 A structure is not intended or offered for sale Section t. 7044,Business and Professions Code.). .� i #'o o'a a a ❑ OWNER• / 1... .. . I, as owner of the property, am exclusively contracting with licensed contractors to construct the project MAIL "O,° 38.5 0 (Section 7044,Business and Professions Code). ADDRESS ° ° '° 3 8 5 = CONSTRUCTION LENDING AGENCY CITY TEL.NO. r D c� I hereby affirm that there is a'construction lending agency for the performance of the work for which this permit is COJ4TRACy—CIti-4 i issued SSec.3097,Civ.C.). � r Lender.s Name ADDRESS f�— • �" ' Lender's Address CI-uY I certify that I have read this application and state that the STATE LIC. above information,is correct.I agree to comply with all Count; LICENSE NO. CLASS �.. ordinances.and State'laws'regulating Heating, Ventilating and Air Conditioning,and hereby authorize representatives of this" SEE REVERSE FOR EXPLANATORY LANGUAGE CountY,oCq enter upon the ®above-mentioned property for. inspe Signature of Permittee Date