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Home My Public Portal About9725 WOOLLEY ST_Mechanical__ ' WOA3646CPW9/89 APPLICATION FOR PERMIT LIME GREEN I hereby affirm that i have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec.3800 Lab.C.) Policy No.730CompanyCOUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished. ruol Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING department. (PRINT OR TYPE ONLY) Date4-0&0Applicant IiZ LOCALITY �6, NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' r CROSS ST. COMPENSATION INSURANCE ABSORPTION UNIT,BTU (This section need not be completed If the work Involved by the ASSESSOR 5100 or less. MAP BOOK PAGE PARCEL permit is for one hundred dollars ( ) ) AIR HANDLING UNIT,CFM DISTR:Ci No PROCESSED BY 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 become subject to the Workers'Compensation Laws. I-a COMPRESSOR,BTU APPROVALS DATE INSPECTO 'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Z Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code,you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business and HEATER: WALL Professions Code,and my license is in full force and effect. License Number 'PALic.ClassOL Contractor Date C ❑ I am exempt under sec. Plan check fee a D B.&P.C.for this reason PERMIT ISSUING FEE$ V1175 I- Date: TOTAL FEE LL Signaturea PLAN CHECK APPLICANT.--- Cl. OWNER-BUILDER DECLARATION d G I hereby affirm that I am exempt from the Contractor's License Law NAME , �• for the following reason(Section 7031.5, Business and Professions Code): ADDRESS ' °4 ❑ I, as owner of the property, or my employees with wages _� as their sole compensation, will do the work and the CITY TEL.NO. 33- structure is not intended or offered for sale(Section 7044, Business and Professions Code). OWNERrne ❑ I, as owner of the property, am exclusively contracting MAIL I I j'Kt ,_jam•+_'o fir i with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). I CONSTRUCTION LENDING AGENCY CITY -C a TEL NO. �7= ` 'i a r'- I hereby affirm that there is a construction lending agency for �H'{' I performance of the work for which this permit Is issued CONTRACTORhelm ° a4S ► (Sec.3097,Civ.C.). ADDRESS -_I.'_-r I 52 6�•�''— ti Lender's Name , CITY TEL' NO, Z CZA",t; y p,r' :°r(= Lender's Address I certify that I have read this application and state that the above LICENSE NOA 3 OLCA$S 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 prope action ;QOqAs. SEE REVERSE FOR EXPLANATORY LANGUAGE -Z.A � SIGN TU F APPLICANT OR AGENT DATE WORKER'S COMPENSATION DECLARATION th46DPW9/69 APPLICATION FOR PERMIT LIME GREEN 76A3 I hereby affirm at I have a certificate of consent to self insure, 76A364C or a certificate of Worker's Componsation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec.3800 Lab.C.) policy No. ' Companys� COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished. Certified copy is tiled with the county building Inspection FOR APPLICANT TO FILL IN BUILDING q717 W ADDRESS department. (PRINT OR TYPE ONLY) LOCALITY Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS ST. COMPENSATION INSURANCE ABSORPTION UNIT,BTU (This section need not be complotod if tho work involved by the ASSESSOR permit Is for one hundred dollars(3100)or less.) AIR HANDLING UNIT,CFM MAP BOOK 45 � PAGES PARCE DISTRICT NO PROCESSED BY I certify that in the performance of the work for which this permit y� is issued, I shall not employ any person in any manner so as to BOILER.BTU become subject to the Workers'Compensation Laws. �L GG COMPRESSOR,BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALI®AT ON I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED-UNIT- (commencing USPENDED UNIT(commencing with Section 7000)of Division 3 of the Business and HEATER: WALL Professions Code,and my license is in full force and effect. License Number / Lic.Class / Contractor ` Date ��sy L ❑I am exempt under Sec. Plan Check f@@ ❑I a B.BP.C.for this reason PERMIT ISSUING FEE$,,'lC �[+ �. C Date: TOTAL FEE r S `�`'�� aJ°'/'' U n Signature PLAN CHECK APPLICANT i U, OWNER-BUILDER DECLARATION 1 1(Ella 1 hereby affirm that I am exempt from the Contractor's License Law NAME n Ind` for the following reason (Section 7031.5, Business and Professions ifft�L L_sm Coe): ADDRESS CHECK iV P.IL I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the CITY TEL.NO. C+H011 °UZI structure is not intended or offered for sale (Section 7044, Business and Professions Code). OWNS ff F1 1, as owner of the property, am exclusively contracting MAIL ,.sem � iJtJ' JL/1 9/ 1/52 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CITY TEL.NO. CONSTRUCTION LENDING AGENCY + LJ� I hereby affirm that there is a construction lending agency for ° the performance of the work for which this permit Is issued CONTRACTO (Sec.3097,Civ.C.). R ADDRESS IF Lender's Name CITY ®G° TEL.NO. ° Lender's Address I certify that I have read this application and state that the above LICAENSE NO. CLASS 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�toe ter upon the above-mentioned proper nspection o . SEE REVERSE FOR EXPLANATORY LANGUAGE 2��'Z SIGNAT Re-01F APPUCANTVZAGENT DATE