HomeMy WebLinkAboutNo Permit Number (86)DECTION
WORKERS' affirm,
- I hereby affirm that I have
that I have certificate of consent to self
cafe of corse
- APPLICATION
-
'
FOR PERMIT n
r
insure, or a certificate of Workers' Compensation Insurance,
or a certified copy thereof (Sec. 3800,/U,•b. t.)
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7eA364c ;.. HEATING - VENTILATING - AIR CONDITIONING
. - P❑Policy"No.. Comlwn y 7udrrW�f6ZVfIYlIY1CcE-els(aty.
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Certified copy is hereby furnished.
- COUNTY OF LOS ANGELES
BUILDING AND SAFETY
Certified copy is filed with the county building inspec-
FOR APPLICANT TO FILL IN
BUILDING
tion department. -
(PRINT OR TYPE ONLY)
ADDRESS ac/��V QI'�
0'1 3.83
Dale Applicant__
CERTIFICATE OF EXEMPTION FROM WOR RS'
IN TYPE OF APPLIANCE OR EQUIPMENT -FEE
-
LOCALITY2_
✓✓44-
COMPENSATION INSURANCE
-
NEAREST _'
CROSS ST.GC.GLG7 1pl
(This section need not be tom PAted If the work Involved by
ABSORPTION UNIT, BTU -
-
the permit Is for one hundred dollars ($100) or fess.)
- -
DISTRICT NO,
-
P CESSED BY
1 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, LOWS..
BOILERS BTU
.,
gppxaVAts DATE INSPECTOR'S SIGNATURE
'Date - Applicant _
COMPRESSOR, BTU
ROUGH 1*4271V3
NOTICE TO APPLICANT: If, after making this Certificate of -
VENTILATION SYSTEM
'06 44 It r 42
FINAL
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
EVAPORATIVE COOLER
V LIDATION -
Voked. -
FURNACE: � FAU_._GRAVITY- �''-
LICENSED CONTRACTORS ION
commBerrieenc
- FLOOR BTU 0 [�
I hereby offirm that lam licensed under provisions of Chapters
HEATER: SUSPENDED- UNIT_ "
I
-- ( g Division of the Business
WALL
-
and Professions Code, and my license Is in full force and effect.
Q ..
,
,.
License Number q L Lic. Class
15 Lf `•-✓
- -
`
I
..Contractor ate
❑ I am exempt under
B.BP.C. for this reason --
Plan check -fee _.
- -
Date:
PERMIT ISSUING FEE $
:2.9 4 2 3 A z
1
Signature
TOTAL FEE
# e .,e .,. g
- . OWNER -BUILDER DECLARATION
hereby
PLAN CHECK APPLICANT'
f e 049.7,5
I offirm that I am exempt from the Contractor's License
"
law for the following reason (Section 703T.5. ,Businessand
--'-Professions Code): - - - -
NAME - -
- - -
® '>t .. 4 9 % Jr,'
❑ 1, as owner of the property, or :my employees with
'
ADDRESS
_ 1 a 0 JS y 8 3
wages as their sale compensation; will do the work and
-
-- the structure is not intended or offered for sale (Section -
CITY TEL. NO.'.
7044, Business and Professions Code)..-
❑ I, as owner of theproperty,v ..
' am exclusively contracting
OWNER / TiW►
-
--
with licensedcontractorsto construct the project (Sec-
' tion 7044; Business Professions -
MAIL hn'"
ADDRESS r1V
and Code). - -
CONSTRUCTION (ENDING AGENCY. .- .. ..
rm
affithat there is a construction lending agency for
:he
CITY' ✓fes. .-... - TE[. NO.
-
the performance of the workfor which this permit is issued
- -
(Sec. 3097, Civ. C.),
.. ..
CONTRACTOR — --
NameLender's
Address
LADDAIESSLender's
_..TEL. NO..
certify that i have read this application and state that the -"
// LIC.nI
- (p - CLASS • l: -r✓
-
above information is correct. I agree to comply with' all County
pr
-- - -- ,
ordinances and State laws relating to building construction,
eby authorize seniotivea of this County to entere
above- a onepro ry for Inspection purposes.SEE
kgn.t..
REVERSE FOR EXPLANATORY.LANGLIAGE
--Dote
of Appllw orA nr.
IN PECTO S NOTES
QWN R-WiDO DECLAWON
t
- .t }tereby affirmlthot`4 aMre.empt from -the Contractor's
License Law for 'the,, following reason. (Section i01.5,
SCode)QAny jit yorV _...
Bch
and ia -
pePirilf+sslon
eu9fness
demolish,
1 - -
,'\ pp r. any structure, riot to lfa lssuante, also fe-
or
t
fha� applicanRforsuch. ned state-
tot taeprovisionsn dsta e-
if sed pursuant ofthe
(
Ivisan (Cho fe BusinessandPro ncing with
os•Cotdgn fes-
.,
't F es
the tp x f the f m nd the basis
s to 00prcha e, e
viola
for the alleged a em tion, Any violation Se
Section
7031.5 6 do a flc nt, fora "ermi't sub'ecfS the'e
p 4 l
.;
h.,
nail of n t more t on five hundred
Y Q
i
d°�ars IS500olwner of the property will do the work,
rk, and
- 3 S ' - "'- - ,
r i i '_ ' ,
tha structure is hot intended or offered forsple
1 . <.' y ._.. _ _ 6 �,
_ (Sec. 7044 Business and Professions Coal The 4orttrac-
_
t
Iol,s License, L_aw des not apply 19 pn owner ro ell y
-.
.of
buildswho pr.lmprgves thereon, and. who does such
_.`
work himselfprovided that such improvements are not
intended or offered,,fo"r-salb; If, -.however, 'the building or
improvement isr;old within* ne. year . of completion, the
bwner,builder will have the burden ofprovtng that he did
of improve for the purpose of'aale.) �
"n build or
l,.osowner.of`li :roe ,am
O ,p
1 � p tty exclusively con-
`tracting
with licensed camractori 10 constfdct the project
($b P,14) Business Ond�F sston{ Code- The Confmc-
1 for''s ifcense Low does not pp�ply Toon owner of property
who builds or improves,thereon, And who conlrgcts for
- £
s nse
.. projects contractor(s) _ d pursuant to
Ucense
.._.,,. .: , ` .. -_ .. ....
h , Y Q :._
L'av,)tor
_. , :,.
_._. the Contractor's
p a • •' 1 - -
r
I am exempt under Set..'
;..
B & P, C. for this reason