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Home My Public Portal About5702 OAK AVE_Miscellaneous_1/10/1991_I WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self .insure, or a certificate of Workers' Compensation Insurance, qr a certified copy thereof (Sec. 38 Lab. C.) 76A36 C �/ 46 DPW 9/68 Policy Nd. P 9%3 ompan �� n` Certified copy is hereby furnished. �``�Q' Certified copy is filed with th county building inspec- t1io dep tment. 11 Date Applicant APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES FOR APPLICANT TO FILL IN (PRINT OR TYPE ONLY) NO. TYPE OF APPLIANCE OR EQUIPMENT CERTIFICATE OF EXEMPTI FROM WORKER ' COMPENSATION INSURANCE (This section need not be completed if the work involved by ABSORPTION UNIT, BTU 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 so as to become subject to the Workers' Compensation Laws. BOILER, BTU COMPRESSOR, BTL%F/---OOto Dat- Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- with comp )y with such provisions or this permit shall be deem- ed revoked. LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force ands ffe;t. License NumbOp9e'ft (7s / Lic. Class Contractor ❑ 1096 B.&P.C. for this reason note: Signature OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Code): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Nom - Lender's Addr... I certify that I have read this application and state that the above 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 upo hh�ov ntloned property property for in 1pe ion urf--F— Si ure of Applicant gent Date VENTILATION SYSTEM EVAPORATIVE COOLER BUILDING AND SAFETY IBUILDING JnoOADDRSV? FURNACE: FAUL LOCALITY FEE FLOOR. NEAREST CROSS ST. USPENDED UNIT—W HEATER: SUSPENDED—UNIT— DISTRICT NO. PROCESSED BY ba 11 APPROVALS DATE INSPECTOR'S SIGNATURE ROUGH FINAL VALIDATION Plan check fee PERMIT ISSUING FEE $ TOTAL FEE PLAN CHECK APPLICANT NAME ADDRESS CITY OWNER MAIL ry Tom{/L MAILADDRESSVs/ Fa? CITY // r Z CONTRACTOR �E ADDRESS //�//��rr•3 S'6 f CITYi�!/�� LICENSE LIII ATE EENNSSEE1INO.?pZ 17S-6 TEL. NO. vv/, TI TEL. No� �/ / D 88f) poll r �/ TEL NO.41 —JJsF--/ LIC. -2 Jf CLASS , --d SEE REVERSE FOR EXPLANATORY LANGUAGE Il AC'C_T.a r.07 56.iIG I iTEEMS .41 Ci, J.ili NF id'GE . LCL' 010011':-1.14101 1/ li. V: 1 4946 1 ANIi:tl° FURNACE: FAUL L1� f FLOOR. USPENDED UNIT—W HEATER: SUSPENDED—UNIT— WALL LL J a Plan check fee PERMIT ISSUING FEE $ TOTAL FEE PLAN CHECK APPLICANT NAME ADDRESS CITY OWNER MAIL ry Tom{/L MAILADDRESSVs/ Fa? CITY // r Z CONTRACTOR �E ADDRESS //�//��rr•3 S'6 f CITYi�!/�� LICENSE LIII ATE EENNSSEE1INO.?pZ 17S-6 TEL. NO. vv/, TI TEL. No� �/ / D 88f) poll r �/ TEL NO.41 —JJsF--/ LIC. -2 Jf CLASS , --d SEE REVERSE FOR EXPLANATORY LANGUAGE Il AC'C_T.a r.07 56.iIG I iTEEMS .41 Ci, J.ili NF id'GE . LCL' 010011':-1.14101 1/ li. V: 1 4946 1 ANIi:tl° INSPECTOR'S NOTES INSPECTOR'S NOTES 46 OWNER -BUILDER p.C�LARATlO�I F .... ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Code): Any city.,or county Which requires a permit to construct, alter, improve, demolish, or repair any structure,tprior to its Issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Sec®on 7000). of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per- mit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ❑ I, as owner of the property will do the work, and the structure is not intended or offered ,for sale. (Sec. 7044, Business and Professions Code: The Con- tractor's License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner -Guilder will have the burden of pro- ving that he did not build or improve for the purpose o'f sale.) ❑ I, as owner of the property, am exclusively con- tracting with licensed cont(actors to construct the pro- ject (Sec. 7044) Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a contractors) licens- ed pursuant to the Contractor's License Law). I am exempt under Sec B & P.C. for this reason DatR . Owner