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HomeMy WebLinkAbout0918A (4) .v�Rr.eKa'COMPENSATION DECLARATION � ` APPlICAT10N FC1R PERMIT� - � I 6ereby atf rm ihal I have o�certificate of conseni to s f � - irFsure,.or.a cerrificate of Workers'Compensd,ion Insuronc�`:-��� - . ,;_. . HEATING - VENTILATING - A1R CONDIt10NING � or a cert�fied copy thereof(Sec 3800,Lab:G�� CE-ei&(REV.t0i81) � � . _ . � P�_ol�icy No. Company . . . . - ... . - . � Ce�tff�ed cepy rs hecehy furnlshed. COUNTY OF LOS ANGELES BUIIDING AND SAFESY � Certified copy is filed wiih�the munty building inspec- �F�R APPLICANT TO�FILL IN . � Bu1LOING n�,,,`� p�,,�y� tion department. �.� - - qoDRE55 i�iJ��YI/""��r��' � . . � - (PRIM OR 7YPE ONLY� Dote � - ApPlicanl . .. - : .. � � � LOCALI7v ���� - . � - NO. TYPE OF APPUANCE OR E4U PMENT FEE CERTIFICAiE-OF EXEMIPTION-PROM WORKERS' - --'-� - NenREST � . � COMPENSATION INSURqNCE � "- . � - CRo55 Si. � f+�-�- � 4 � ABS;7RMION UNIT,BTU � (This seation need noT ba complefed if fhe work imolved hy . .. oisTaicr rva� aaocess/eo-sv� . � the permit is for one hondred dollars(5100)or less.) - A�R HnNOUNG uN�T,CFM � j �� � I cerfify Ihat in the perFormonce of the work for which ihis � �f'� - pErmif�is issued,I shall nat employ qny person io ony manner '- ' 1�� so as to 6 come sub�ect to ihe Workers' m�ensafion Low BOILER,eiU / I R /�S- � A9FR0`JAIS OkTE . INSPEC?0�2'$SIGNATUFE � DateC���Applica .. � 'L�'"' COMPRE550R;BTV ROUGH %`{7c�U� ����� NOTI TO APPUCANT: If, afrer�makmg t6is Certifimte of� VENTLLATION SYSTEM . . FlNAL y S i� �^j Exemprion, you should�become su6ject to the VJorkers' . ���' U Compensatiort provisions of the Lsabor Code,yoo musr fo��h- EVAPORATIVE COOLER -� VALIDATION with�comply iih such p.ovisions or fhis permit shall�6e - � � �� - � deemed re�oked. � - - . . �� puRNAce�- Fnu_.;.cenviry � � ` �'�' '�`�-F1� � � I�CENSE�CONTRACTORS DECLARATION . FLOQR � � BTU �-- - � � � .�� - . I hereby�affirm thpf I am licensed unde�Provisians of Chapter 9 HEATER�. SUSPEN6E6- - UNIT� Y� � �(mmmencing with Section 7000)of Division 3 ofJhe Business -W/+�� ; n s � �,�',i � and Professions Code,ond my lieense is in full force and effect. � ' ��- - T� - T �� � ,ll�I'oi'�K�i�r✓,J"o�t/ /�'i6n U f' � o t � Licensa Number�� Lic Closs � �� o `n � V _. �' • c� ,z:A,v. � � �- � Coniract �Doie;� , . - o ❑ u I am exempr unde�Sec. � Plan check fee B.&P.C.for this renson � � . _ - -" - � �� . � Date: PERMIT ISSUING FEE S S�gnoture TOTAC FEE � - QVJNER-BUILDER DECLARATION - - - PLAN CHECK APPLiCAN7 . .. - �� -- � - . I hereby offirm rhot 1 om exempt from the Contrador's License -�� - ► Law fo/ihe following reason(Section 7�31.5, 8usiness and NAME - .. . - � Professions Codej: � . . ❑ I, os'owner of ihe p�operty, o� my employees with ADDRESS � . . . -�. - w ages as their sole compensation,will do the woik and CITY � � 7EL NO. � the sirucYure is noi infended or offered for sple(Section __ ..._.. - 70A4,Business and Professions Gode). - . � � � OWNER�Gfjrf�.� ���� ❑ �,as owner of the property,am exdusively conlrotling MAIL ��� ' � �- wifh.lirensed mnirac�ors to conslruct ihe project�Sec- qDDRE55� 7/ �'�[�.'f"�"� � . . fwn7044,8usiness and Professions Code). , _ . CONSTRUCTION LENDING AGENCY a�ry� �J'���� 7Ei.NO��� f�' I here6y affirm that there is a consirudion lending agenty for (� , � . �he performance of the work for which-rhis permii is issued .GONTRACTOR (Sec.3097,Civ.C.).- _ . . + �����' �' . .. . � . tender's Name � - pD�RE�-��K�/� G/�/",L'- .. . . . . . '. CITY._ /IP�/� TEi.NQ'.33 �J . Lender's Address �/ -"r�� � � STATE - LIC. �� - I<ertify ihoi I hove read 7hls applimNon and state that the llCENSE NO. CLA55 above informatlon is correct.I agree fo comply wlih al{County � - - . -- - . ordinonces and S+a?e la s relating to building construciion; . . -. -- . - and h r a or"r- presenta!ives oP3hiSCounty to enter . . �� . �- � - �� ��-�- � � --'-— � � - u ion erty fo�ins ctio purpases. SEE REVERSE FOR EXPLANATORY LANGUAGE . 7 � _. ._ Slqnarure of Ap I mn�or Aaenr Dare - - . . . - .. ... . :. ... .... ... .._:... - . -- . . . - .. . 9I�S�E�7�R`�N07EF flWNER-BUILDER D"cCt�RATiOiV . - . -. .,.. ..... - �i hereby a#irm.th6f I am�exemp:from fr�e CoMractor's - � � � - - - � �--` !i:ense Law �or rne foildwing��recson (Section 703L5, .. .-.... . . . . . .. . . _. _. ". . ... .... ....... 8u P e G d� A y<.4y o roun'y:vhi:h s. �� ° : ,, � ., � :�. - , � ' � - � - .e�-qm., o pet r-4o-cor,s.u,.t,citer,�emprove,demclish, . '�` �.... . ., , . .. . r s -a ��- � .. � � - -� - � �� �- or repoir cny strcdura:prlc to r9s�issuonce, also re ' �����•,`��` ��- - . _. ._quires she appficani for such permit tc 4i(e o signed sfcie- � �- � -- -��- " -� -� � --"��- - �� � �-� � � menfSfict.fieisilcensedpursuanttofheprov�sionsofihs ... .___.._ _ . . . . . ._ . - -- � � .. Cor.frc.tor's-Lirnnse Low�(Cfiapter 9 jcommencfng witn � -�����"-�" � � �.�. .� - - ���- � : � � .�� Se.ficn 7fAvj of D �s-ion 3 of in=3usiness ond PraEea- --- 4;�„s cade;o�rr br he:;:ex p h.��er�m��d rh�t�s-� . . ..� � - - � fo�ihe o➢eged ezem,�tic.. Any�viaiciian of Section _._ .. :__.� . ___ . . � - �. — ,. J03I.5 oy any cppiicanf for a-permif subjecfs?he app{i- . . -� _ _ , . . � . cant to a civif penafty ot no`more.thao Iive.Fundred . . .. . . . _ . ... " .� ..�._dolfprs;55001.� .��. _ : ... - - . _. . -.. . � .,. . .__ __.. .. ,-.>w.a PFOFrnekof.rh�p ,�e'y,��rill--doth ��worlc.a�d . ... . . - _,._ .-:. �. . :. . . .� . . . . - rbe` �-:ure is n ��ntended ofr,:ed:`or s�!o,. - - � � � � � � � - .jSec.-TC,4d,Hus ness and Pr�dessions Code:--7he Contrac- . � = � � tor's License Ltrw does not appfy ia.an owner of}rropeHy - � - �- - � - - ��.: who 6uilds br im�roves f6ereon, and.who does such . _ � ��- . _ . —� work himself provtded thof such'oiprovamznis ara nct � � �- ` � � inlcnded�broffered�forsale:H,hcweJer,thebu;idingor � —�' . ... is scld wi+hio one yeac of comple7ion,the . . � -.. -� rr�,oecvemer.f � --- - owaer-buifder wtll hova the-burden of p:oving that Fe did - - ��- .,,t-- �-��.^ , ' -•. ':4 � � no7 Suiid or imprbve for fiRe purpose di-snie.) - .. ...i A e. ! �- •.� . -. . � .-... �`..*;_ ❑i,as owner a'€�fhe grDpeny._am=adusi•rely con- � - - . t��. � � �o i-g vi?h iitensed cbnfrac;o�s te con tNtS'he oroiec5 �.. ��. �r , . . �- . .. . ._. .. ..�.'- �� '��-' ;.�(Sac-�ZG44)8usina�3 9nd,Qra�e3�ohs GoQe.,The Cenfroc- � � ���� 'ar s Li.-ense Law does nof appty.,tc an�owne?ot eroperty . -� .who huiJds cr;mproves thereon,ond whc conf:ccts for . . - �� � � such�rojech�,vrrh a con;raclo;fsj 1'rcen5ed pursuaM fo - - � � �� *he�ContracPors licersse LawJ. � '� � - �� � - � � � I pm.exempt�Gnder$ec. . . : � - -�B&P.C.for ihis reasan� . . . . . . .. . ,� � ._ � Cate .. :-- . . .�. . . ..;. , :-�. _....:--. ...,_ ... . _ . � - ... _ '•.� * .._ • •�, . � -OWn2r ' _ _ � . �;:. „ ..5.. ,_ �, .. .. _.,: _ . :. ;:{•:.. � -- ... ;._-,._. . INSP@C70R'S HOTES � - � � - �� �