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Home My WebLink About1727 SILVER RAIN DR (3) i �.. - I � WORKERS'COMPENSATION DECLARATION �ppLICATION FOR PERMIT ' � I hereby afferm thaf I hava a certificate of consent to self ins�re,or a certificate of Workers'Compensation InsoronCe, �� H6ATIRiv - VENTItATING - AiR CONDITIONING or a cer�ified copy�hereof(Sec.3800,Lab.C.� CE-818(REV.10/91) P❑olicy No. Company Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY � Certified copy is filed with the county b�ilding inspec- FOR APPLICANT TO Flll IN Bui�niNG r� s .�s /J lion departmenf. AD�RE55 l/j. ♦ ' �,Q"J (PRIN7 OR TYPE ONLY) �ate Applicanf LOCAUTY � NO. TYPE OF APPLIANCE OR EOUIPMENT FEE CERTIFICATE Of EXEMPTION FROM WORKERS' NEaREST � COMPENSATION INSURANCE CROS557. ABSORP�ION UNIT,8TU DISTRICi NO. GROCESSED BY (This aectlon nead not 6e complefad It thQ work involved by fiw parmit Is for ona hundrad dollors(5100)or leis.) !D p AIR HANDLING UNIT,CFM I tertify that in the performance of Ihe work for which this �� permit is issued,I shall not employ any person in any manner so as to become subjecf to the Workers'/Co+mpensafion laws. B ER,BTU �d� qpppOVAlS DATE INSPECTOR'S$IGNAiURE Dpte`�*�pp��canf��S�U��/G7J COMPRESSOR,BTU ROUGH NOTICE TO APPLICANT: If, after making this Certificafe of VENTIIATION SYSTEM FINAL � �� Exemption, you should become subject to the Workers' Compensation prorisiona of tbe Lo6or Code,you must forfh- EVAPpRATNE COOIER VALIDATION with comply with such provisions or this permit shot� be deemed revoked. FURNACE: FAU_GRAVIiV � LICENSED CONTRACTORS�ECLARATION FIOOR B7U I hereby affirm that I am licensed under provisions ot Chapter 9 SUSPENDED UNI7_ � '(wmmen�ing with Secfion 7000)of Division 3 of ihe Business HEATER� WA�� and Professians Cade,ond my license is in f�ll force and effect. >' d License Number lic.Class � V CC Contrada Dote � ❑ I om exempt under Sec. W Plan check fee 4 N e.Bv.C.for this reason pERMlli ISSl11NG FEE S � .�d ? Dare: Signatu�e TOTAL FEE j� �+� �7 6 6.5 A OWNER-BUILDER DECLARATION PLAN CHECK APPIICANT I herehy affirm that 1 am exempt from�he Contrador's License � �• • • • •� low far the following reason(Sec�ion 7031.5, Business ond N�wt�tE Professions Code): � • •3 Q 5 Q � f, as owner of ihe property, or my employees with aDDRE55 _C 5�� wages as their sole compensation,wili do the work and � � °� � the sir�cWre is not iNended or offered for sale(Sedion CITY 7Ei.NO. 7044,8usiness and Aafessions Code). � - Q�L 1—fi� OWNE �(/�� ❑ I,os owner of the property,om exclusively contracting �� (� A wilh licensed contractors to tonstru[f the projec�(Sec- qDORE55 2 �Z��!'C ) �C, tion 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY CiiY /�/��S/� � TEL.NO.��-'x � I hereby affirm that there is a construciian lending agency for , the parformonce of the work for which this permit is iss�ed CONTRACiOR �� (Sec.3097,Civ.C.). � ADDRE55 Lender's Name CITY TEL.NO. Lendei s Address STATE LIC. 1 certify thot I have read this opplication ond sta�e that the LICENSE NO. C1A55 above informatian is ca .I o ree 10 comply with all Co�n�y ordinances ond 51at aws mg to building construcrion, an hereby authori e re se atives of ih' ounty�o enter u m rhe abo i d operty for' crion puiposes. SEE REVERSE FOR EXPLANATORY LANGUAGE d-�z�3 Siqnature of Applicant or Agent �afe �v1�S � N 41� H !" C .�'b � t, �� O O d� C V U �' p � I I N .. w3mo �n,°' � ov � ca-��a o � o �, o_;c c a-`o � � _ � . c'� '� °m "c �'aSH�-C c � ao `ov os`o �� ao � ; '' ' Z occ� co �� .� v v " �m� -sd � � O U° � � �.�+'� a�i o c ° � � ro°�ti ° p w d °-e+`�_' � ° u a u� y ' oo 'oE '" ° od'z � o mr �zE � °i � d � ►- � y o ° � � E �, E � c o � 3 w �°, >„ u � a� � ° � � E � .� ��;� m° � Oo�� .°oo-aoa`>oao Ecoo '� � O O �' ' ,n O .'�-.` �N � ='O V c C `a > 6 0 lJ c� � Q �. • ,� o, m ' r ` �4 a� ti ° E °' oom oc-- ' V a v ¢ ^ o ;•. o d ^',.w c ` ° ',�.�-,°7- o ° c o i, m °a �.o ° Q °N . W a .. E � -� m E o N_ O�t v� � a� � '�_c � � � rn�; , moo'y a< a Q a� �...: c > > oo� aoo . - � x c � � o a�s o E o o a `o w a a, � - o.c a � n,v � p �, o u � a j 'U`� � °° � Q� o o'=.�o F�'= a'c � °r � � �� " a� a` I � E- � N a3 � „ iiw ° s-°b °c m '^ � � ov � '_ o � a p � �" 4 $ .`�,� m-' � m � os °' a v o w o � o` o� o � > o � `n o I - m a� '� o � c o '>-c x � o o c o v v_ a, ry� � o o a, w o Ei r'-` .��' .. 2 o u co o �na�i -a`, o "m�° E o m h- ° c c dT� a� � -° � � . � Z E,° i � >.a" uo� rn �a . o � �o � a� = � E o� �,° � 3-� s . �i "= 3 c a c o s�o°� o �6 ' v m v N m ° y� � a s m � ° u � � o O o 0 0 0 � w o�a ° �.o� ° � .' �v '^ o E •� ° _•3v ev w o >- � �p�� o .o =u v � •� E v m.a b v m . o= x V � w c d o y o . �c m � • rn o � � c� � C C = 0 N C � O�-'C- �? U C'�� ti!n O` C � C'� ❑ C �. '^ O-C V E d. � C . , -C J ] y L � � O Ol 0 p O O O s N O t � C E 3 O O � O t �L � � 8 �i " _ � m O O'E U cn N 1� U�O 3 3 � O C � 3 N — LL� � O • � W � z � � � , a - � , W � � � I I ' ei � j • I NW . F� � Z y �G � V . W , � d N , Z