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Home My WebLink About1502A (8). r, w Ut(AARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, Fp(.Q,xlij cppy-Meof (Sec. 38 Lob. C ) ❑olicy No. 'Y� 7 Company I! F 1 /Certified copy is hereby furnished. I X Certified copy is filed with the county building inspec- ��""""�" tion department. Dote 10-16 "V 7 Applicant CERTIFICATE OF EXEMPTION FROM WO KERS' COMPENSATION INSURANCE (This section need not be completed If the work involved by the permit is for one hundred dollars ($100) or less,) I certify that In the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. Date.4ppiicant NOTICE TO APPLICANT: If, after making this Certificate of 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 deemed revoked. LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 '(commencing with Section 7000) of Division 3 of the Business and Professions Code,, and my license is in full force and effect. License Number -16 I y%� Lia Class (!_ 7-0 Contract Date ❑ lam exempt under Sec. B.&P.C. for this reason Signature OWNER -BUILDER DECLARATION. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Code): ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sole (Section 7044, Business and Professions Code). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby offirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. 1 agree to comply with all Count' ordinances and State lows relating to building construction, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. Signature of Applicant ar Agent Dare APPLICATION FOR PERMIT J/,3 7/ 76A364C HEATING - VENTILATING - AIR CONDITIONING CE-818(REV. 10/81) - COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN (PRINT OR TYPE ONLY) BUILDING --s-46757 OF APPLIANCE OR EQUIPMENT FEE LOCALITYTYPE Lam'" NEAREST CROSS ST. ^ ABSORPTION UNIT, BTU DsiPicr NO. PROCE5510 ev L� rNO. AIR HANDLING UNIT, CFM BOILER, BTU APPROVAIS DATE INSPECTOR'S SIGNATURE COMPRESSOR, BTU ROUGH J11_57v" VENTILATION SYSTEM FINAL . (sc . y EVAPORATIVE COOLER ► VALIDATION - -- -- ;C 15 Q 2 A 4 e • • • • 8 1--74,75 • • •74.75 1 Q2 1— 8 7 - - FURNACE: FAU_GRAVITY/�� FLOOR BTU HEATER: SUSPENDED - UNIT— WALL 3/ Plan check fee PERMIT ISSUING FEE $ /O S TOTAL FEE 17Y 7.S PLAN CHECK APPLICANT NAME - ADDRESS CITY TEL, NO. OWNER MAB. ADDRESS e CIT 1 TEf. NO. CONTRACTER ADDRESS - CITY TEL. t0. ?� $TATE ��Jf LIC. - --r LICENSE NO.,r( CLASS SEE REVERSE FOR EXPLANATORY LANGUAGE iNSPECTOWS NOTES OWNER -BUILDER DECLAP,ATION _ I haieby'affirm 1ha' 1 am a empt from the Contractor's License Law for the following reason (Section 7031,5, - - - -' Business and Processions Code): Any city or county which permit to construct, filter, -Improve, demolish, or repair any structure, prior to ffs-Issuance, also re. quires the applicant for such pe}mit to Woo signed state- ment that hats licensed pursuant to the provislons of the Contractor's License Low (Chopfer 9 (commencing with ""- Section 7000) of Division 3 of, the Business and Profen sions Code) or ihol he Is'exempt therefrom and the basis for the alleged exemption. Any violation o/Section 7031.5 by any applicant for apermit subjects the applf. cont to a civil penalty of net more thon five hundred dollars (SS00).: ❑ I, as owne• cf the property will do the work, and the structure is at inlepded ar offered for sale. — — - - -- — - (. - - - (Sec. 7044, Business and Professions Code The'Controc. ' for i Llcensc Law docs not apply to an owner of property whobuilds or Improves thereon, and who does such work himself provided that such improvements are not intended or offered for -sale. If. however, the building or _ - - improvement Is sold within one year of completion, the owner, builder will have the burden of proving That he did not build or Improve for the purpose of safe.) ,\ 0 (, os owner of theo pr peat', am exclusively can - tracing with licensed contractors to'co""uct the project (Sec. 7044) Busfness and Professions Cohe: The Contrac- _tar's License Lave doesnotappfy, to an'owncrof property - _who builds or improves thereon, and who contracts for _ - such projects with a eonlraetor(s) licensed pursuant to the Contractor's License Lanj n e 1 am exempt under Sec. B & P.C. for this re=on - Date_ Owner