HomeMy WebLinkAbout1020A (5) . WORKERS-�oMPENSAT�oNOE��ARA,�oN ApPLICAT�IpN FOR PERMiT � I hereby aff,irm�hot I have a cenifica�e of consent ta self � insure,'or a cEnifimre of Workers'Compensoron Insuronte, �aA�� HEATING - VENTILATING - AIR CONDITIONING or a certi(ied copy�hereof(Sec.3800,Lab.C.) . , . . GE-818�REV.10/81) � . - . .. .. . . ,. � P❑olicyNo. F 9"�,�Q9hGompany�'a.irmnnt TnG_ . . . . . Certified copy is hereby furnished. COUNTY OF LOS ANGELES : BUILDING AND SAFETY � Certified copy is filed with the couroy 6uilding inspec- ,FOR APPLICANT 70 FILL IN � - � 8wioiNG . . . tiondepartment. , ; (PRINTORTYPEONLY} ' /aDDRE55 24k�1 E. Gold oint Pl. L t �Dale 5�29�87 Applimnt Rancho Air. Inc. � tOCA'"ry Diamond Bar CA Tract 42 NO. TYPE OF APPLIANCE OR EOUIPMENT . 'FEE CERTIFICATE OF EXEMP710N fROM WORKERS' NEARESi COM7ENSATION INSURANCE � � � CRO555T. - . (Thii�ection a��d nof ba complN�d if Ih�work tnvolved by ABSORPTION UNIT,B7U ' pi5laiCr No. vROCEssE�Br ��tha permtf ts for one hondrod dollan(5100)or less.) AIR HANDUNG UNIT,GFM - ' I cenify thm in 7he performonce of the work for which rhis� ' � r� � � - permif is issued,I sholl not empioy any person in pny manner gOIIER,BN � I ,so as fo become subject lo the Workers'Compensalion Laws. , � avvaovais DATE �INSMOOR'S SIGNATURE . � 1 COMPRESSOR,BTU �51y OOO IO OO ROUGH � �D� �,6 �l"'��j epplicant � . � �ICE TO APPUCANT; Ii, ofter making this Cer�ifimte of VENTILATION SYS7EM FINAt Exemption,�you shoufd become subject �o ihe Workers' , , Compensation provisions of the labor Code,yw�musf forfh- EVAOORATIVE�COOLER VAL DATIO�V With comply with suth provisions or Ihis permit shall be � . deemed revoked. � - FURNACE: FAU XX GR ITY - � LICENSED CONTRACTORS DECLARATION Z FLOOR eTu lO OO . I hereby affirm fhat I om licensed under provisions of Chopter 9 HEASER: SUSPENDED UNIT__ � '(commencing with Section 7000)of Division 3 of ihe Business WA« and Professions Code,and my Ifcense Is In(ull force and effeU. ��� � � �' 11 Re isters @ l. 1 °" titense Numbar 380543 lia Closs C-20 =1 0 2.0 A u Rancho Air, IN 8/15/87 ► �� ° � ''$ O � Confractor �ote ❑ I am ezemp�under Sea .. _ .. . �w a Q 0.'�5 W � Plan check fee a B.87.C.for ihis reason� �a a f1 9,/J�o z PERMIT ISSUING FEE S 10 0 a 8,2 0"8 6 �afe: Signature TOTAL FEE jy ' OWNER-BUIL�ER DECLARATION PLAN CHECK APPIICANT � , � I hereby affirm thot I om exempl from Ihe Confrador'S Litense � � for the following reason(Secfion 7031.5,Business and � NAME . � � '. °essions Code): � - - . LJ I, os owner oi the property, or my employees wilh ADpRE55 � � wa9es as their sale compensation,4.ill do the work pnd _ , � the st�uc�ore Is no�7ntended or offered for sale(Seuion ��TY �7Et.NO. - , 704G,Bosiness and Professions Code). � � � � � ' . OWNER The Anden Grou ' ❑ I,as owner of the properfy,om exclusively contracting hw'i with licensed�o�r�o�io.s io�o�:�rou rhe P�oie�r�se�- o.00Ress 1074 Parkview Drive #201 ' tion 7044,8usiness and Professions Code). . CONSTRUCTION IEND�NG AGENCY � - a7Y - - Tei.No. - � - I hereby affirm that there is a construction lending agency(or — ► , tbe performonce of the work for which this permif is issued CONiRnCtOR . � - �� - I � (Sea 3097,Civ.C.). � . - . .. .. . _ .._.. __ . . � ADDRESS _ . _ _ . :.. , . .,... .. . lender•s Name 1232 41, th St. - ieoders nddress an U land _ Tei."o. g1-4$Ol I cerlify ihot I have read ihis applimtion and state thaf Ihe IICENSE NO. -C A55 , . .. . . above informotion is correct.I ogree 10 comply�yith all County . � � ��. ordinances and State lows reiating to building wnstrucfion, . _ . _ . and hereby ou�horize�epresento�ives of fhis Coumy�o enter � � � � - � � � � �� � - - � �n ihe obove-memioned property for i specti n porposes, � SEE REVERSE FOR EXPLANATORY LANGUAGE .� _ _.. .. ._ . . . �Y.=_—.�o,j�,Q B ��i �.. � . Signature of Applicani or Agenl Dv�e .. . _ . ... . . . .. .. . ..". .. - .,_ _ _. �• , , . . , . � , , � ' - - , . . . _ ._ .. . ... . . , r.. ;, .. , , • � ' ' • ' ' INStECTOR'S�iOiEs OWNER-BUILD'cR DECLARAiION� - �-��•1 here6y offlrri thot I�om exempt from4he Controctor's . . ..... .. ...�, .. ..,..,. . . , . .,.�.....� . � ' '`'� "-' � "'-'�'� � Licenso Law for Ihe following�.reoson.(SocNon 7031.5, ,_"...�.._._..___ _._._„.,.....�.�_. ..._... ...,_. _.. .,.._.._.....v,_ .._.. .. _. ._._. _...___... ...._ . __ Qusiness and Prolesslons Code):Anydty or covnty which . - ��� � . . ' . ' �� � �� �� �� . ' reqWrei'o pormlf to conslruct,alfer,�fmprove,demolish, � - ., ! � �.��- �'� .� . . . . . � . . ' _.�.__ :��._- ___...._ �:-.._ _.._ .�.. _ ..._.._. . =�.: . or repair any sfrv[fura,prlor to Ifs Issuance, also re- . . �" .� .. �. .. . � . �. .�,., ' `` � . ..�.' ._9Wrestho�applicantforsuchpermitio/ifoaslgnods�a�e- ".---. _..-. -'. _.._`. � `.�.. --�- --. -. �.�.: . I' .. . ' ... .'...� � . ment fhal ho ts licensedpursvan�to IAe provls�ons of the � � Confr6ctor's Licenie Lew(CFapter 9(commencing wfth , �,.......... ..... ...__..._.__.. ......__...............�_. . .,...� , ' . . . . . . SeUion 7000)of Division 3 of}he Buslness and Pro(es- � �, � ' sions Codz)o�1Vmf he Is exemp�.ihemfrom and Ihe basis I �I � �- �. .. ._ . . ' lor Ihe.'alleged exempfion. Any vio�fefion of Secfion , ; .� ..-___. ... . . . ��- - .. .'-�--..�- - -- �'. . .. ' ' . . �� � �. can�fobo�Wil en'affn'of not.,more�fian fWe hvnpPlJ _ . . _ . .., ; Y Y PP P°m l , . .. . ,. . .,. . , � i . _ . _. _....__._ .. . .,� "�� ' � . p Y . dred �. � �,..__._ _ _. . .. ..._ �_.. . _:_. . ..__. . ... . ' . . dollars 5500).: � - � .- �, � � -� �_._ __.��_ . • ..._... .'. . . . �I,os owncr of the properry will do the wor,�,�and .��� .. . • ,':..\ .,�����'�"_�"��� � -- �-- .� . .. - , usiness and Pro or offered ior sale. ' �,=�� - =` - - - - -- _ �_ _ �- �� , � , (Sec.�7044 B�s nor intendedfessfons Codr.'The C�...rac- \ , , . . . , � for's ilicense Law does nof apply fo an owner o(properfy ��'.::,.��.:� � . . �--'-�- �- ' ' � � � ��„ who�6Wlds or improves thereon„and who�does such ,_.. ._ . '_'. .. ._._ _ . _. . _.� � , __ . _ . _ . . � work himself provided�ha�such improvemenls ore no� •� � ' �� � � -- --- -� -�• `�� � - �- -�' � infended or ol(erod forsalc 1(,howevcr,fhe bullding or ' �,, . . . - - .- . . . . . .. im�rovemenf b sold wNhin one year of.tompleflon,�Ihe ._ � � .-� � � �--� -� . � �.ownervbuilder will havo fhe burden of proving fho}he did _ , � � not 6uifd or'Improve far fhe purpose of sole.) � � - - � � , ❑I,aa owner of the propmty,am exclosively con- � � �� � -���- irac�ing'wiih licensed contractors�o covst:uct th��projea � � . � -�� - � --- � ---- -� - �� �-� • ($ec.7044)6usiness ond Frolessions Code:The Confroc- ' � '. . - 'ror"s Ucense Low docs not apply fo an owner of property -� � ' � - � � �--�-- �- ---- �-� � _ wha builds or Improves}hereort,bnd who conlydds lor � - , �. � . � � �� such pro(ecls with a confracfor(sJ licensed pursuanf fo � � - � ��� � - � � - -- thc Controcfor's Licensc low). � ' � '. '� � - � i I am exempt u�der S�c.'� - � . � B&P.C.�for this r'eason� �� � � �"`_ ,.._._ . ------�--.....-- -------_._ ..____._ . . , . . ' � � .. ' Date � . � . . .. - .: � ,:. ._ � . ., .:� , _ . .. . ... . ...- ----- _ ' Owner INSPECTOR'S NOTES __ _ � � , - ' - ' . - '�C'_l�` r�C, . .a�'.`��..5...�...� 's��,..���t�`r��