HomeMy WebLinkAboutNo Permit Number (88)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,��{'b_. t.)
.i
7eA�64c ;.. HEATING - VENTILATING - AIR CONDITIONING
. - po y /VBF�Xic1�iZVfIYINJCcE-ela(Rty.
Policy "tJo.. Comn
TOM) _
_
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. -
ADDRESS
0"'1 3.83
(PRINT OR TYPE ONLY)
Dale Applicant__
CERTIFICATE OF EXEMPTION FROM WOR RS'
IN TYPE OF APPLIANCE OR EQUIPMENT -FEE
-
LOCALITY
✓✓
COMPENSATION INSURANCE
-
NEAREST „,��,w_'
CROSS St GC.GLG71pl
(This section need not be Completed If the work Involved by -
ABSORPTION UNIT, B7U
DISTRICT NO,
the permit Is for one hundred dollars ($100) or fess.)
- -
-
P CEssEo 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 #QA4 0RO1031,1
UGH 1
NOTICE TO APPLICANT: If, after making this Certificate of -
'Exemption,
VENTILATION SYSTEM
FINAL
you should become subject to the Workers'....
IM I
Compensation provisions of the Labor Code, you must forth-
with comply with such provisions or this permit shalt be
EVAPORATIVE COOLER
VALIDATION -
revoked. -
FURNACE: � FAU_._GRAVITY- �''-
LICENSED CONTRACTORS ION
commed
- FLOOR BTU D [�
I hereby offirm that l.am-licensed -under provisions of Chapter 9
�(
HEATER: SUSPENDED - UNIT_ "
I
-- enc g Division
) of the Business
WAIL
-
and Professions Code, and my license Is in full force and effect.
,
_. -
License Number q L
" Lic. Class
Lf `-✓'
O
- - .. .. ..
`
®
..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 TEE
# e e,. e,. a
- . OWNER-BUILDER DECLARATION
hereby
PLAN CHECK APPLICANT
49.75 e
f 49
I offirm that I am exempt from the Contractor's License
-
Law for the following reason (Section 703T.5. ,Businessand
---Professions Code): - - - -
NAME - -
- - -
,'
® '>t e *49,756
❑ 1, as owner of the property, or :my employees with
'
ADDRESS
_ 1 a O JS y 8 3 j
wages as their sale compensation will do the work and
-
-- the structure is not intended or offered for sale (Section -
CITY TEL. NO.'. - -
- r
7044, Business and Professions Code)..
I, as owner of the am exclusivelycontracting
'property,
OWNER
/ TiW►
-
with licensedcontractorsto construct the project (Sec-
' tion 7044; Business Professions -
MAit
ADDRESS
and Code). -
CONSTRUCTION LENDING AGENCY. .- .. ..
I affirm that affithat there is a construction lending agency for
�I7Y'.. ✓fes. . -... - ..TEL. NO.
-
the performance of the workfor which this permit is issued
(Sec. 3097, Civ. C.),
CONTRACTOR - - --
Lender's Name D-Yl.�...i _
-'-.�
ADDRESS
Lender's Address
CITY _.. TEL. 1,10 /5l i�
I certify that i have read this application and state that the -"
STATE // 7r�r
LICENSE NOLIC.
: - - (p - CLASS • l:
-
above information is correct. I agree to comply with
pr-v
ordinances and State laws relating to building construction,
an ereby authorize seniotivea of this County to enter
n the above- a one pro ry for Inspection purposes.
SEE REVERSE FOR EXPLANATORY.LANGLIAGE
--Dote
�• Signature of Appllw or A nr.
Ear t,
IN PECTO S NOTES
QWN R-WiDO DECLAWON
t
- .1 hereby affirm!thot`4 aMre.empt-from -the Contractor's
License Law for 'the,, following reason. (Section �01.5,
Beu9fnessand ia Professions SCode)QAtruCt,ny city orV _...
-
pePirilf Can demolish,
1 - -
,'\ pp r. any structure, rior to lfa issuance, also fe-
or
t
ned elate-
fha�app$ic=tforsuchtothearovl9 edstae-
licensed pursuantt ons of the
s i ll
- se Law (Cha to 4" co mencln with
ivislo oT�he Su!Irtess and Pro
e
i
e3
s••Cotd 00nroha Me osis
he Is
11
for the alleged' exempilonm Anyevolotlan of Section
".'. __ ..__ _ -. .l.. '.
.4 a aQPll_.
_ ub-ectti th p.
1 by any aPPflcgnt fof.a perm�i s
-.-
.___- .. _.._ •h I
.
cont penalty of nq! more thon five hundred
daham ($500)il:�
El I as owner of the property will do the wok and
the structure is not int"cled or offered for"le
_ __ -_' '' 1 + I ' : <.' i y -_.. _ _ _..., , `
-_ . (Sec. 7044, Business and Professions Code: -., The (;Ontrac-
0 t
loris License Law dIll— oes not a f l gn owner of ro eN
buildswho pr.lmprgves thereon, and. who does such
work h mself provided that such improvements are not
intended or offered,fo"r"salel If, -.however, 'the building or
improvement iso;old within* ne. year . of completion, the
bwrier.builder will have the burden of.provtng that he did
`
build
not or improve for the purpose of sale.) ' : '
owner. of jKj,;propetty, am exclusively con-
--- �-fretting with licensed camractors io constfdct the project
_
($b P,14) Business Ond Fotessian{ Code- The Contrac-
l - for''s ifcense Low does not ppply To an owner of property
who builds or improve;,thereon, and who cantrgcts for
s license
such projects (J. _ d pursuant to
License
A ,
L'ay.)tor
the Contractor's :,.
p a • •' 1 - -
r
I am exempt under Set..'
- .
B & P, C. for this reason