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Home My WebLink About1005A W��-`°""°E"5°'T'°"°E"AR"T'°" APPLICATION FOR PERMIT j� I hereby nffkm that I have o certifica�e of consen�to salf insu�e,o�a c�rtifiicate of Workers'Compensarion�nsurance, ��A3�C HEATING - VENTILATING • AIR CONDITIONING Z� or a ceriified copy thereof(Sec.3800,Lab.C.) . CE-SIB(REV.10/el) � � P❑olicyNo. F `c�],.926Company Fairmont Ins. � Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUIIDING AND SAFETY � Certified copy is filed wifh the county building inspeo FQR APPLICANT TO FILL IN BURDING tion(leparfinent. (PRIM OR TYPE ONLY) �+DDRE55 1� 2 Armit P �� oa�e 5/29/87 a.�,Pr,�o�r Rancho Air, Inc.. �OCAL1TV Diamond Bar CA 42 6 NO. TYPE OF APPIIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST � COMPENSATION INSURANCE � CRO55 Si. (Thi�seetion need nof ba eomplefed I(the work Involv�d 6y ABSORPTION UNIT,8TU oisraia No. vrsocesseo ev . fhe permif is for ona hundrod dollors(5100)or Ios�.) qIR HANDUNG UNIT,GFM �� 1 certify Ikof in the performance of Ihe wark for which this r � permi�is issued,I�shall nb1 employ ony person in ony manner BOIIER,B7U . so os io become subject ro the Workers'Compensation LOWS. . APCROVAIS on*e INSPECfOR'S SIGNATURE ,s . . �- �MPRESSOR,BTU 27a yOO ZO OO ROUGH �„ �P" APPIiwM ICE TO APPLICANT: If, after making rhis Certificate of VEMILATION SYSTEM FtNAt � y Exemp�ian, you should become subject to the Workers' Compensotion provisions of the Labor Code,ya�muat forih- EVAPORATNE COOLER � VALIDATI�N � � with comply with such provisions or fhis permit shall be � deemed revoked. 1 .FLOORCE: FAU�_GR T�Y�� O o0 LICENSE�CONTRACTORS DECLARATION �SS�L�L_ � I hereby affirm fhoi I am licensed under provisions of Chapler 9 HEATER: SUSPENDED UNI7_ - �(commencing wifh Sec7ion 7000�of Oivision 3 oF fhe 8usineu � �'a�� ond Professions Code,and my license is in full torce and effect � , _ d L�ce�se Number 380543 ua Clas: C-20 Re ist rs 1. �1 � �°'100.�A � Rancho Air,Inc S/15/87 " ' 0 Contractor Date � #' � �8 H ❑ I om exempt�under Sea � '� °��5 Q .W Plan check fee d B ev.c.for rhis reason pERM1T ISSUING FEE$ 10 0 � tl(;4 r�� o�1e C8P0'-8b sgnat�re TOTAL FEE OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT � I hereby af4irm that I om exempt from the Comractor's License ► . �A. for the�fallowing reason(Section 7031.5, Business and NAME F Fessions Code)r . L,J I, as owner of�he properly, or my emplayees with AD�RESS � ages as Iheir sole compensalion,will do the work and � . �he siructure is not intended or offered 4or sale(Sedion CITY iEl�No. 7Q44,Business and Frofessions Code). pydryER ❑ I,as owner of the propeny,om exclusively mniratling yqR . wilh licensed confrocfors fo consirud�he projec�(Seo- pDDRE55 10 4 Parkview Drive �cQl lion 7044,Business and Professions Code). � � CONSTRUCTION IENDING AGENCY CITY TEt.NO. � � � I hereby affirm rhallhere is o consiruc�ion lending ogency for ' ► . . ihe performance of Ihe work for which ihis permit is issued CONTRACiOR Raneho Air zI1C. (Sec.3097,Civ.C 7.- . ADDRESS 12 2 W, tYl St. Lender's Name " cirv lan TEL.NO. 1�fy Ol Lender's Addreu � STATE LIC. . I certify that I have read this application a�d state ihat�he uceNse No. 3805�3 anss C-20 . . . . above informpfion is mrrect I ogree to comply wilh oll Counly � ordinances and State lows relaling io building constroction, � . ond hereby outhorize represeniatives of this County to enfer upon the obove-mentioned property for in pection purposes. SEE REVERSE FOR EXPIANATORY LANGUAGE ��°�i.��— � Signature of Appliwn�or Agent Date - � � , y 1 R' O OWNER-L'UILDER D�CLARATION � . - 1 heleby affirm thai I am exempt from-ihe Contractor's License Law for thm following reason (Sedion 7�31.5, .. . . � Business nnd Frofessions Codc1:Any city or countywhich � . . . requires.a permit to consfruct,okr,improve,demol7sh, � � � � or repcir ony sfrucfure,prior to ifs issuance, olso re- � �. � � _ � . quires tha applicont for sucb permif to 1Ae a signed sfote- - . � menf ihat he�is licens�d pursuant to the provisions o/tbe - � , Canfractor's License Law(Chop�er 9(commendng with � � - Section 7000)o!Division 3 of fhe Business ond Profes- sions Cods)or ihot he is exempt lherefrom and ihe basis . , � � � �or the ollege•d exempfion. Any violafion of Socfion � . - � . . . 703L5 by ony opplicanf/or a permit subjecfs the appli- � � �� - � � canf to a civrf penalry of nof more than live hundred "� � � � � - � � dollars(b500j.� � . . . ,. ❑I,as nwn=r of the properfy will do�he work.4and � . , . � � , � the sfructure Is not inte,nded or offered for sale. ; ' - � � � . � (Sec.7044,Business and Proiessions Code: 7he 4....,roo- , � . }or's Ucense Law dcr nof epply to an ownsr of property who builds or improves thereon, end who does such . . work himselt provided Ihaf such improvemeMs nre nof intended or b/fered for safe.If,however,the 6utlding or . - . improvement Is sold wifhin ona year of.compfetion,ihe � owner-6uilder�wif!heve f6e 6urden olproving thot he dtd � ' , � � nat 6uifd or"rmprove for the purpose of sa(e.) � . � � ❑I,ps owner of ihe property,am exclusively mn- � � � ,iocting v.�ith licens^d ccnircctors ro con=�ru<t�he project . .� (Sec�7044)Buslness and Proleuians Code:ihc Contrao � ror's License Law docs not apply to an'owner ol property who builds ar improvQs theraorr,an�who contracfs for � � su[h proje[ts wilh a confra[ior(s)lirensed pursuont to � � - ihc Confracters License Law).� - � I am exempt under Sec. � B&P.C.for fhis reason _ Date � - � ' . Owner INSPECTOR'S NOTES �t ,'� : s � ;�,. r,. .0. .