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Home My Public Portal About9830 WENDON ST_Mechanical__ WORKERS' CI have ATION�cate ofPcons AF-1PUCATI®N FOR PERMIT I hereby affirm that I have a certificate of consent fp self ` insure, or a certificate of Workers' Compensation Insurance, •76a364C I �IA�I�G - a��NTI�ATING - AIR CONDITIONING or a certified copy thereof (Sec. 3800, Lob. C.) 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- I FOR APPLICANT TO FILL IN BUILDING S� tion department. ADDRESS (PRINT OR TYPE ONLY) Date Applicant LOCALITY NO. (TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE I CROSS ST. � (This section need not be completed if the work involved by (ABSORPTION UNIT, BTU DISTRICT NO. PR ED BY the permit is for one hundred dollars($100)or less.) f I certify that in the performance of the work for which this (AIR HANDLING UNIT,CFM , `J permit is issued, I shall not employ any person in any manner (BOILER, BTU so as to become subject to the Workers'CoompppeennsationcLaws. 1 APPROVALS DATE INSPE R'S SIGNATURE Date �pplicani��'J C' `""� ( (COMPRESSOR, BTU 6 ROUGH V ,1) r 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 with comply with such provisions or this permit shall be deemL__I - ed revoked. / IFURNACE: FAU I LICENSED CONTRACTORS DECLARATION 1FLOOR BT 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. I — ®� License NumbeP ✓�� a . O® Contracto Date 45,— } ' 6'�0 I C9 ❑ I am exempt under Sec. 0 Plan check fee u Lu B.&P.C. for this reason H Date: PERMIT ISSUING FEE $ J) Signature TOTAL FEE OWNER-BUILDER DECLARATION 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): I A F-1ADDRES S �� I, cis owner of the property, or my employees with I r, 4 s wages as their sole compensation,will do the work and CITY TEL. NO. ACC"T' the structure is not intended or offered for sale(Section i 7044, Business and Professions Code). OWNER I /1 3-31.37 �5.13(1 ❑ I, as owner of the property, am exclusively contracting 1 ! EMS with licensed contractors to construct the project (Sec- MAIL tion 7044, Business and Professions Code). ADDRESS( �l►1-fiL �-_5 l ®00 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for CITY I TEL. NO. CHECK 65.00 the performance of the work for which this permit is issued CONTRACTOR G ® CHANGE ,I�l (Sec. 3097, Civ. C.). ADDRESS r j U Lender's Name Q� , f CITY JP✓ e, EL. NO.? L�p6 LICICM0—ClUJ !i Lender's Address STATE I LIC. 7� ,; t I certify that I have read this application and state that the LICENSE NO CLA55 Z "FGA L AM 9:4-Ir above information is correct. I agree to comply with all County i ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter upon t ov ment' ned pr perty for inspection pur oses. uD i SEE REVERSE FOR EXPLANATORY LANGUAGE t Signature of Applicant or Agent Date el I76A364C p p n� WORKERS'COMPENSATION DECLARATION CE-818 (2-80) �P P LL= C AT� p�1 FOR P E R p�711 T '<I hereby affirm that I have a' edrtificate of consent to self insure,or It certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-Alla CONDITIONING; x:Ilertified copyAthereof(Sec.3800,Lab.C.) Policy No. Company COUNTY OF LOS ANGELES BUILDING ARID SAFETY ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FI LL IN BUILDING department. Date—Applicant (PRINT OR TYPE ONLY) LOCALITY Y v LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE NEAREST } CL (This section need not be completed if the work involved ABSORPTION UNIT, BTU CROSS ian-0-99 _ F O by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. I PROCE D BV () I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM I W permit is issued, I:shall not employ any person in any manner 5 O so as to become subject to the Workers'Compensation Laws. BOILER, BTU / �/�J AF ROVALS %DAT IN CTOR'S SIGNATURE d Datc)y Applicant `/,0-A— s,� � COMPRESSOR,BTU A2s�0 Oo ROUGH 1 C f to NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM Exemption, you should become subject to the Workers' FINAL Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER I AT with comply with such provisions or this permit shall be deemed revoked. ++ FURNACE: FAU V, Y LICENSED CONTRACTORS DECLARATION 1 FLOOR: BTU AVI D i I hereby affirm that I am licensed under provisions of Chapter HEATER:.- SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi- WALL ness and Professions Code, and my license is in full force and effect: License Number Lic.Class Contractor Date ❑ I am exempt .from the licensing requirements as I and a licensed architect or a registered professional engineer Plan check fee 25%of above. acting in my professional capacity (Section 7051, Bus- iness and Professions Code). PERMIT ISSUING FEE$ 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- nrssProfessions Code): ADDRESS I 114Tsi s owner of the. property, will do the work and the i TEL.NO'. r60� �e structure is not intended or offered for sale (Section CITY -- - 50 7 wN 44,Business and Professions Code). OWNER ii`` I ITEMS I., as owner of the property, am exclusively contracting •��- with licensed contractors to construct the project MAILr�1,nn►1 TOTAL 30.50 wrow (Section 7044,Business and Professions Code). ADDRESS CHECK 30.50 CITY �• TEL.NO.2&� CONSTRUCTION LENDING AGENCY �9E e . I hereby affirm that there is a construction lending agency CHANCONTRACTOR 00 for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name ADDRESS 0000-0001 12/15/89 Lender's Address CITY TEL.NO. I certify that I have read this application and state that the STATE LIC. 7 �? p� v�. above information is correct.I agree to comply with all County 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 to enter upon the above-mentioned property for .inspe ion purposes. Signature o.f.Permitt a Date.