HomeMy Public PortalAbout5708 OAK AVE_HVAC_1/13/1982_WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers' Compensation Insurance, or
Yolicy No.°o�� thereof
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❑ Certified copy is hereby furnished. �•�—••r//
21�certifiecl copy is filed witj the county building inspection
Dateaoolicelt,du�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the work involved
by the permit is for one hundred dollars ($100) or less.)
1 certify that in the performance of the work for which this
permit is issued, 1 shall not employ any person in any manner
so as to become subject to the Workers' Compensation Laws.
Date 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 comply with such provisions or this permit shall be
deemed 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 Busi-
ness and Professions Code, and my license is in full force and
effect.
License Number Lia Cla«
Contractor Date
F1I am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code).
Lie. or Reg. No. Date
HOME OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from- the Contractor's
License Law for the following reason (Section 7031.5, Busi-
ness nd Professions Code):
V1, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section
7044, Business and Professions Code).
❑ 1, as owner of the property, am exclusively contracting
with licensed contractors to construct the project
(Section 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 Name
CEAB 8°(260) APPLICATION FOR PERMIT
HEATING -VENTILATING
-AIR CONDITIONING
7
COUNTY OF LOS ANGELES
FOR APPLICANT TO FILL IN
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RESS
(PRINT OR TYPE ONLY)
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LOCALI TY.�OLC el7y L R 9��AAd2
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
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CROSS ST L VG (/?K // 4�i
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ABSORPTION UNIT, BTII
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DISTRICT N�'
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AIR HANDLING UNIT, CFM
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BOILER, BTI(
APPROVALS DATE INSPECTp R'S SIGNATURE
17—
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COMPRESSOR, BT'I
ROUGH�S �J rl �
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VENTILATION SYSTEM
FINAL - (.�—I «[[d!lJJJffllllllhZV,�--� �'-`-�-�%
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EVAPORATIVE COOLER
I
VALIDATION
FURNACE: FAU— GRAVITY
FLOOR: BPI
' HEATER. "NIUT
e_ZL j
y
e
Plan check fee 25% of above
PERMIT ISSUING FEES �(%
S
TOTAL FEE � SO
PLAN CHECK APPLICANT(' OQ4'E. 4>. r P
NAME
ADD.R/ESSSS-9.L`f�/,
CITY / eOLF 0117 64 TEL. No#`/y _2 u'7iS.'
OWNER '
:5141;1`7E
MAIL
ADDRESS SiFM E
CITY
TEL. NO. 4 *-7 —;L47,S_
CONTRACTOR /l/
ADDRESS 7
Lenders Addr— CITY / TEL. NO.
I certify that I have read this application and state that the STATE LIC.
above information is correct. I agree to comply with all County i LICENSE NO. CLASS
ordinances and State laws regulating Heating, Ventilating and O'
Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County to enter upon the above-mentioned property for
ul ectlon purpose
ignature f Permi tee Date 1 /j 7O
260,,
2' ° 2 a 0
01,13-2'
INSPECTOR'S NOTES
INSPECTOR'S NOTES
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): Any city or county
which requires a permit to construct, alter, improve,
demolish, or repair any structure, prior 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 Contra&or's License Law (Chapter 9
(commencing with Section 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 fora permit
subjects the applicant to a civil penalty of not more than
five hu red dollars (S500).:
ffr 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: Tile 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
completion, the owner -builder will have the burden
of proving that he did not build or improve for the
purpose of sale.) -
❑ 1, as owner of the property, am exclusively con-
tracting with licensed contractors to construct the project
(Section 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
contracts for such projects with a contractor(s) licensed
pursuant to the Contractor's License Law).
I am exempt under Se,
B & P.C. for this reason
e -rt •! �j��i,
Date
Owner,s,'-��