Loading...
HomeMy WebLinkAbout1013A rvSnuON DECULRATION I hereby afljrm�bat`I have.a certifica�e of�o�,a��,o,e�� � APPLICATIDN FOR'�PERMIT � insure,-or a cenifimre oi Workers'Compensorion Insura�ce, ���� HEATING - YENTILATING - AIR CONDITIONING . or a certif'�ed copy thereof(Sec.'3800,Lab.C.) _ „ - . CE-818(REY.10/81� � � �� -' - �� �- �-- , PolicyNo. F P192F)Compony Fairrnont Ins. � Cerrified copy 1s hereby furnished. COUNTY OF LOS ANGELES -. - IBUILDWG ANDSAFETY , � Certified copy is filed wiih�he counry bollding tnspeo- - , FOR APPLICANT TO F{Ll IN� � suaoiNG � ' r�on de rfinenL ADDRESS 2kk1 E. Gold oint Pl. ot 21 � . (PRINT OR TYPE ONLY� � Dole 5,�, J�7 qpP���a�} Rancho Air,Inc. � � LOC""'Y Diaraond Bar CA Tract NO. TYPE OF APPl1ANGE OR EQUIPMENT - FFE CERTIFICATE OF EXEMPTION PROM WORKERS' NEAREST � - COMPENSATION INSURANCE � CR0.555L � � (TI�i�s�cflon nwd nol bo tomplatrd IF Ihe�work involved hy ABSORP710N UNiT,eTU �ISiVICI NO. GRp�ES$ED BY tha parmit 4 for one handred dollar:(5100)or loss.) A�R HANDUNG UNIT,CFM ,( � � I tertify ihot in fhe performonca of fhe work for which Ihis . ..ro �L}� �, permit is issued,1 shpll not employ any person in any manner BOILER,B7u _ so as fo becomt subject to the Workers'Compensation Laws. arvaovai5 �AtE INSVEC10R'S SIGNATURE - C�/'�'+ applicdnf COMPRESSOR,BTU ROt1GH � g�,'� r� . � ICE TO APPLICANT: If, ofler mok(ng�his Ce�tifitare at VENTILATION SVSTFM F�NnL , Exemprion, you should become subjen �o the Workers' , � Compensorion provisions of�the tabor Code,you mus�forfh- EVAPORATIVE COOIER � �' VALIDATION , with comply wBh such provitians�or Ihis permit aholl be - � deemed revoked. � FURNACE: FAU��GR TY - , � � LICENSE�CONTRACTORS�ECLARATION � ]. FLOOR B7U ]_Q OO � I hereby oifirm fhpl l pm li[ensed under provisions af Chop�er 9 NEATER: SUSPENOED � UNIT_ . � '(commencing wilh Seciion 7000�of Division 3 of�he 8usiness wALL �. ond Professfons Code,ond my Ifcense is in fuli force ond eifeU. � � � � - �. � �' - Re isters L 1. 1 �1 O 1,3 A o License Num6er 380543 Lic.Closs C-20 � , �� V Rancho Air,Ine. 8/15/87 #9� �x �8 � ConfmUar Date . ❑ I am exempt under Sec, plan checic fee �' � � f •a��2 5 x W � � 8.8P.C,for this reason� "'��-4 d c 5 c� z PERMIT ISSUING FEE S l� o e B 2 0—8 6 Date: Signawre 70TAL FEE �y OWNER-BUILDER�ECLARATION PLAN CHECK APPLICANT �' I be�eby affirm thpl I om exempt from Ihe CoMrotlor's License � . � ', -� for the following reoson($edion 7D3L5,Business a�d NAME `essions Code): . , LJ I, as owner of Ihe properly, or my employees with ADDRE55 , - � aqes as their sole compensa�ion,will do ihe work and� CITY TEL.h0. � fhe strucWre is noi iniended or ofFeredlor sole(Seciion �704a,�Business ond Professions Code). � -- � � - � �. owrvee The Anden Grou ❑ 1,as owner of the propery,am exdu:ively tontmtting wifh li<ensed conlmctors to consfrucf�he projett(Sec• � ��� � �- �- -� � ' , - � fion 7044,Business ond Professions Code). . A�ORESS , CONSTRVCTION LENDING AGENCY - atr � �iet.No. � b ^ �+1 ' I here6y affirm thaf there is a mn:tcuclion lendiog ogency for ► �� . - ihe performante ol Ihe work Ior which this permif is Issued CONTRACTOR - � - - - (Sec.3097.Civ.C.). . - . . . - � - - AODRESS ' �.232 W. J�Yl S't. . . .. . _ . � � ..._ _ . , . . � Lender's Nome � � CItY . .. . .TEL.NO. _� . . , .... . � . . tender's Address STAiE LIC. '� I certify rha�I have read this applicaiion and smre ihot the LICENSE NO. - 8O !1 CtASS C-20 � . - .... . ... .. . . . .. . . . . __. abave infarmolian is mrreU.1 agree 10 comply with oll County � - ordinonces ond Sto�e lows relming to building construtlion, , , � ond hereby puihorize represeNatives of this County to eMer � - � - � � --" - � upon the obove-memioned properfy for�nsped�on purposes. SEE REVERSE FOR EXPLANAiORY LANGUACE � �lL��-,e� � '�0 -• �.�� Signaivre o1 Applicani or Agenr ' Dare . .. . . . .... _ ...__ . _. ._ .. . . . . ' � • " ' � ••� INl�6cio►.�s NOTes OWNER-QUILDER DECLARA710N� � , �.� ---�� I hereby affirm�thaf 1 am exompt from the CoMrocfor's �}��� ���� � � "" " License law for the following-recson(Secllon 703I.5, ,.. _.._.__._...___...�._.... .... ..-.�.-............__....... __ ._...___..._.._. . ...._... .__._.. .._.__._.__..._ - . �,� ... ,, . ., ., ,.. .� . . . . , 8usine:s and Pralessions Code)�Any Ntyor coonty whlcM1 ' . � ' . . : � � � • . . � requf es e permft fo consfrud,aleer.Improve,demofisfi. • . �-� �--� .. -`:..�. .. .. `.'� '� �..�. . �- . ..�. . . or repair ony sirucfure,prlor to i�s Issuance, afso re� ' '� '�. , � � --. . ' � "- . �. . � � :. quirostbo.applicontlorsuchpermi�fefileo,s�gnedsto�r �""- - -.:..'. _..- .'. �.- .'� �..." . �� . ... �� . �� � . .•.� : � � ". . .' menf thal he is Ilcensedpursucnf to fhe provlslons of Ihe + � - � � Conirecfor's�Lfcensc Law(C6aptc��9(commoncin�with . ,...._........ .......... .._ ...._. ..." '._..,-. I . . : .' I . . '� � � � � sions Code)or ihal he ls exempt Ihemlrom artd�(�Profes- _ _Section 7000 af Divis�on 3 of the Bus�ness and , ' - � � e basis . � , , . � . '� .��-� . � �� . 7or�ihe olfe�jed exemptfon_f�ny�viofaffon o(Secfion ; ' ' . I�, ' . • . . . _ ' _ _ . �" , .. . . . . ._.. .__ .___. ._......._ ___.. _.. _.._ _.. . . . . . , - .7031.5 by any appfimnf ior o,permii subjccfs!fio oppll- . . ..�. ,�� - . . . . � i _ , . -. . .._ . ._ . � .cant fo a�civ�7 penalry o(not mare fhan fivo hundred ,_.. .______. ..___.. . ._ _- _ _. ....... .. _._' dollars(E500).: � � ._ _`._ . �-._ . _ �__� ;. . ' . - ,..'.. ...:_. - . �- . .�. - ' - ❑I,as owncr of ttie roperl will do the wock,`and . . .. . '__ ��...' �� F Y � � �'� � �r.', �-� ' - � .. . . . "�the-struclure is noi intended or.o(fcred for salo.:� ...._,. , . ; �. ��� �' ����' � '� ��� - � � �� ,� (Sec.7044,HusinessandProfessionsCodr TfieC�...rao , _ _ . . . _., . _ .__. . . _. .. �' ���'� '��' ' � � ��Vor's Ucense low does naf apply fo an awner o!property � �� �� ' __. '�.__.� __ . .. _ .. .._ _ � ` .-who bulids onlmproves Ibereo2 and who does sucb � � . . _ � . .. _ � . . work hlmse((provfded that such fmprovements vre not � �._- � ' - _ � -- �-�� _ infended or ofleredlor satc.ff,howeveq ihe bulldfng or . . .-__ _.. . ..-_ � � . �.�. improvemanf Is sold wtlhin onc ycor of complelton,the - - - -- � �.owner•6ull�erwf(I hove Ihe 6urden oiproving fFot he did � " . . � � � nol build or/mprove for Ihe purpose of so1e.)'�� - .•- - � �- - - � . � ❑I.as owner of ihe property,am exclusivety con- .. .�- _ .. ,. .. ., . �� • � " �-�" Iracting vrith li2ented coMraUors ro conslrott the prcjem i �- '-��� �- --- - � -- �,�Sec.7044)Buslness and➢rolesslons Codc 7he Con�roc- , � . . � - -1or's Cicense Law does not opply fo an owner�o�property ' ---- - '�- �� --� �--- -- --- � - � -- _who builds or Impraves Ihcreon,and who conlracfs ior _ � - �___ ' �� "' � �-��� such projecls viifh v controc�or(s)licensed pursuvM to ._.. .. _ ._... ._.. . . ._. .... .. . __ . - - -�- -ihe Con�rector's l�cense lawJ."` � � ' . . _..,-.... .. , , . 9_-- .� .- . . _ . _ _�. _ . . .. . ._. ... . _ e': . . ; . . .{ _ ....___ .. � . . � � � �' � 1 am exempt under Sec.�' �R-� � �B S�P.C.for this reason � � , � . . . ,. �. ... . . . , ,.. ..__. _.__. _._ _.... . .. . . .._--.._.___._ ._.___... . . i � , � Datc � . . : . . . , . . - -� --_ .. ...�_ ...'..'�.�. � �.:...-...' �'-� . _ � . .,' �Owner '., .. .. .. . . , . . . � . . . � . _ -� . � • .. .. INSPECiOR'S NO7E5 " � --� --. . � .. . .� � .. . . . � � ' .. � . .--.._--.. ._ ._- � �----.�... . �. .. . ,. ;.. . ..- _.- _ .. _ .. .. _. __ .. �. � .... , 41:��c�.l��?,_ . •.r�:.�i,,1...�...� �?r.,.ti,j' )