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HomeMy WebLinkAbout0918A (4) ..�RneKa'cOMPENSATiON DECLARATION �- � � - � - � �� - � -� �' I bereby aff�rm ihpr I hove o certificate of conseni to s f `' � APPUCATION FOR PERMIT irFsure.or.o cerrificate of Workers'Campensption Insuronc - . - � � - or a cerhf'ed�oPY fne,eof rse�.saoo,�ob:c.;� ����+�c . . . . HEATING - VENTILATMG - AIR CONDITIONING � � . CE-Bi&(REV.-t0i81) - � . _ . � P�ol�icy No. Company . .. . - . � . . . Ce�rffied copy�s here6y 4u.nished. COUNTY OF LOS ANGELES BUILDING AND$AFETY � Certified copy is filed wiih rhe.munty building inspec- �FOR APPLICANT TO PILL IN . � Bu1LDING - /J� � tion deparfinent. - - � � ADDRE55 ��y ,(/����� . . - (PRIM OR 7'/PE ONLY� Dote � - ApPlicant - . ... - . . � � � LOCAt�iv �L�� - . � - � �' NO. TYPE OF APPLIANCE OR E4U PMEN7 FEE CERTIFlCAiE�OFEXEMIPTIONPROMWORKERS' - --'� - NeaREsi � CO/v1PENSATION INSURANCE � "- . - � � CRo55 Si. �� 1�-a-- �4 ABSORPTION UNIT,BTU (This seafion need no�be complefed if fhe work involved hy . .. oistuicrrvo.� aaocess/eo-sv� . � the permit is for-one hundred dollars($100)or less.� - q�R HAN�;ING UNIT,CFM � / y� I cerlify Ihaf in the perFormonce of the woFk fer which ihis � y'� � pErmi(is issued,I shall not employ any person in any mdnner . `- ' 1L� so as to b comP sub�ect to ihe Workers' m�ensafion Low BOILER,eTU I R . � APfROVAIS ❑ATE INSDE�T�2'�SIGNAiUFE �ate - � 4� Applicp . �� GOMPRESSOR,BTU RpUGH j���� �i� NOTI TO RPPUCANT: IS, af7ei making this Cert fimte of VF.N71tATION Sv57EM . . FlNAL � �,.�_ _� �^/ ExemptioA, you should�bemme su6ject to the VJorkers' . Compensai�ort provi4ions of ihe Lsabor Code,you must for�h- EVAPORATiVE COOLER �� VAUDATION with comply wilh such p.ovisions or fhis permi� shall be - � � � - deemedrevoked. � � . � � FURNACE�- FAU_GRAViTY � =�'�G�'���j � ' I�CENSE�CONTRACTOR$DECLARATION . Fu�OR . BTU �-- - � „ � ,� - - I hereby affirm thpf i am licensed�under Provisians of Chapter 9 � SUSPENISED- - uNIT� r HEATER. � '(mmmencing with Sectian 7000)of Division 3 of.ihe Business �W/+�� , r- e � �.jO � and Professions Code,ond my Ilcense is in full force and effeci. / 7� �,�/ .��¢�� - -' T �/ / .V/�r+! �l�VH�/O'{/ �I�i�//� U� 6 c1 �7;�= O Licensa Num6er�� Lic.Class � � � o n_� V . �J �/ . . �/> �/1r(/� , �(i -�1�- - �. Coniratt �Dote f� . � ❑ U I am e.empr unde�$ec. � Plan check fee B.&P.C.for this renson . --��" - �� - � - �� � PERMIT ISSUING FEE S Dote: Signat��e TOTAC FEE �, - OVJNER-BUILDER DECLARATION - - - PLaN CHECK.4PPUCAM . .. - �� -� - � - . I hereby offirm lhot I om exempt from the Contrador's License --�" � - - ► Law ior��he following reason(Section 7031.5, B�siness pnd NAME - . . - � Professions Codej: . . ❑ I, os'owner of ihe p�operty, or my employees wiih ADDRE55 � � - �� ' wages as their sole compensation,will do ihe woik ond CITY � � � � 7EL NO. � the struclure is noi infended or offered for sple(Section ..._.:. - 7044,Business and Protessions Gode). - . /�� ,��1�� OWNEk�I��J�'�..��IN���°'. . ❑ �,as owner of fhe prooerty,am exdusively coMratling �AIL .. - . . wifh.licensed contra<<ors!o consiruci-ihe project(Seo- qDDRE55� 7/ �'j�/J1lr� � . fwn 7044,0usiness and Professions Cnde). . . CONSTRUCTION LENDING AGENCY c;rv ��1 .-,�� 7ti.Nor^'���s r I here6y affirm that there is a construction lending ogenty{or �'µ� � 'X� � . �he performance of the work for which-this permit is issued .C�NTRAC70R , (Sec.3097,Gv.C.).- _ . . ���«T' �� ".s',.� .. . . Lender'sName � AD�RE���Y�� Gsry��er-., .. . Lender's Address - �. Cirv.. /��f�f� iEi.NO'33.....�.� . v AAiE � CIC �� � I certify Ihat I have read lhis applimtion and state that the LICENSE NO. CLA55 above information is correct.I agree fo comply with oll County � - - . � . ordinances and Sta(e la s relating'o building consiruciion; . . - � � �- . - ond hP� a ori�- presenta!ives of�ihis County�to enter . . . �- � � . . �"-- � .� ----�-�- � - u ion erty fo�ins ct�o purposes. SEE(iEVERSE FOR EXPLANATORY LANGpAGE . _ � S��qnarure of Ap I mn�or Acenr On!e � - . . . .. . . ... . :. ... ...... .._._:.._ -'- .. : . .. . 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 � - � � - �� �