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HomeMy WebLinkAbout1010A "'°RKEas-`°'"`E"SAT�°"°E"AR''T'°" APPLICATION FOR PERMIT I hereby offirm tha�I hove a certlfka�e of consenr�o self . � insUe;=or o certificate of Workers'Compensa+ion Insurance, �aAse<c HEAiING - VENi1LATING - AIR CONDIiIONING or a certified copy thereof(Sec.3800,La6.G) . CE-818(REV.ID/BI) � �- � � -�- - ��y No. F 21926�omPo�y Fairmont Ins. ' Cerrfied copy�s he�eby fumished COUNTY OF LOS ANGELES BUILDING AND SAFETY � Certified copy is filed wilh Ihe counly buiid�ng inspec- FOR APPLICANT TO FILL IN -- eUiLOiNG 1'1' � 1� _ tiOndeparlmen�. (PRINTORTYPEONIY) ADDRE55'2µµlyO E. (`TOI.C� oint Pl. LOt l4 - Da�e 5/29187 APPi;�o„� Rancho Air. Inc. �ocnuTv NO. TYPE OF ApPL1ANCE OR EOUIPMENT� . FEE � CERTIFICAiE OF EXEMPTION FROM WORKERS' NEAREST � . COMPENSATION INSURANCE � . CROSS ST. �(This s�cfion n�ad nof ba compl�f�d if the work fnvolved by ABSORP7iON UNIT,BTU 06iRiQ NO- . VROCESSED 8V Ihe pe�mif If(or one hundrod doliare(f100)or lass.} qIR HANDLING UNIT,CFM I certify Ihot in the performonce of the work for which thiz �� � �C..'fi• permif is issued,I shall not employ any person in pny monne� BOILER,BTIJ � so os fo become sobjecl to the Workers'Compensation Laws. nvvaOvnGs oait INSPECiOR'S SIGNATURE ��p�� 1 COMPRESSOR,BTU � 27 e BOO �.O OO ROUGH 'Q nPP� ICE TO APPLICANT: If, after making ihis Cerlificafe of VENTILATION SVSTEM FINAL Exemplion, you should 6ecome subject 10 Ihe Workers' ' � Campensation provisions of the labor Code,you must fonh• EVAFORATIVE COOLER VALIDATION � with comply with such provislons or this permif shall be deemed revoked. � � - FURNACE: FAU_X2LGR vITY . LICENSED CONTRACTORS�ECLARATION �. F�OOR e7U ].O 00 � I here6y aHirm that I am licensed under provisions of Chapter9 HEP.iER: � SUSPENDED UNIT_ � � �� ��.�A '(commencing wi�h Sacfion 7000)af Division 3 of Ihe Business ' wA�� . � and Professions Code,ond my license is in full force and effecL � � � � � � - ���''' ' ' •8 a �' O 380543 c-2o I ••4 Q 2 5 � . license Nomber- Lic.Class . ► V Rancho Air,Inc 8/15/87 �� •4 G P 5� O conrrocror Oa�e - � � F� a _ � I am exempt onder Sea Plan CI7eCk fe2 . D E.2 O".II 6 N 6.BP.C.far this reason PERMIT ISSUING FEE S �' Date: Sgnature TOTAL FEE �y( 'Z OWNER•BUILDER DECLARATION . � PLnN CHECK nPvuGANT � ' , I here6y affirm 7hat I am exempt from ihe CaNroctor's License-- . � � � law for Ihe following reosan(Section 7031.5, Business ond NAME..� � , � �essions Code): , , - � u I, as owner of Ihe p�operfy, or my employeei with� AODRESS woges as�he�r sole compensation,will do the work and � the strucfure is not intended or offered for sale(Section Giv TEL.NO. 7044,�Business ond Professions CodeJ. . � � , ' O'NNER A r U ❑ I,as owner of 1he properly,om exdosively contracting � MArt wifh licensed mnfraCtors to tonsfrucl the projec�(Seo- qDORE55 10 4 Parkview Drive �r20�. " � � �ion 7044,Business ond Professions Code). ' CONSTRUCTION LENDING AGENCY -- Citv � : "� �� - " TEt.NO. `� 4� �� � I hereby a(firm Ihat there is a consiroction lending agency for — � � the performonce of Ihe work for which this permif is issued CONTRAROR ' � � � � �� -- - � � (Sec.3097,Civ.C.). . . _ . .. .... ._.... . . .. � . � AD�RE55 - . . . ... � . _ . .. • _ _. . . � Lender's Name � � . . . CITY . TEL.NO. � lender's Address � — � � �- � - '- --� STATE 1' UC. � � I cerlify thof I hove reod Ihis applicotion and slate thaf the LICENSE NO. Q µ -�CLA55 (,'-2���-�- � - �- � � �-.- . .-. . . . . � above informolio�is mrrect.I pgree 10 mmply with oll County � . � � ordinances and S�ote lows reloting to building conslruction, , _ � ' and hereby authorize representatives of this Couny to eNer - � �� � ' ���. ' - � . -" '� -- �on i" he above-menrion�d,plQperty for Ins euion urposes. � , SEE REVERSE FOR EXPLANATORY LANGUAGE . .._ . . . - . _ . . S'�.���� ��rv Signature of Applicant or Agem. Dafe . . . . . . . .. .... . . .. . - ". -. . . . ....- . .. . .. , . � �, . i' . . .. . .. �.��. , .. ,. ..... . ,� ,, . � � . � . ....:... . ....�..., , . .. ._ . ...... . ' , . . . - ' ' � - •• � INS�EC70R'S NOiEs OWNER-EUILDER DECLAR�ATION" � . .. .... .,. .- ...; .. . . ,.,, .�. _ ..,... .. . . . � I hereby affirm that 1 am e:empt from Ihe-Com.ncror's � ��"��� ' ' ' ' -'� ' � License Low for Ihe foliovaing re.ason (Sec�fon 7031.5, � �...._ . __.__.._ _".__... .. .,_'.' _..'.'_'. ._.. . .. .._..�... _._.._.._.._ ..__. .. ..... . _.. _. _ ._..� ., uslnessandCro(essionsCode):Anycflyormuntywhich B . � - , : � � � ���requirei�dpermit locons«uc4 olfer,Improve,demolish, �_. ..-..- �'. ��-- "-... "'...� -' � ' �..�� �. . . .._ � .�.. � . � .. or repair any sfrutlure. prlar��o lfs Issuance, also re- � ���' � � �� qufrez tho oppllcanf for sucb permft lo flle a slgnod stote- ,. ...---'.-...".'...:..._..�.'` -�....� .. . .. -.- " ' . � ,. ' . . ..�. .' �� � ment Ihot fie is UconsedpursuaN fo the provlsions o!the < < � �� � . Con/racrori Licensc Law Cho �er 9 cin i�h ( p (commen g w ' '_..""'."•......"".-;'` '�".-.'.... ..... . '..�.' '.. ..' � '. � . � . Secilon 7000J of.Oivision 3 0l fhe Business and Proles- ' . . __ ._ .. .' . ' � � � . . �, � sions Code)or thal he Is exempf Iherelrom and fhe b�osls -h + �'�' 1 � . J03,Sb�lle ed exempllon. Any violation�al Setllon � l_.____ .._ _._ .. . .___- . -s . . _ .�. .. ....... I. y any applicant for a�permif subJecfs fhe vppli- ; .. . ,.• .,. . . . '., ' . -.. .-._. . ... __ . _ ' ,can! �o-a civil penalty of not more.�han fivn hundred �-�-— -. _ �_ ._. .. ._ _ _. ._, .". . . dollars(S500J.: � � � � ` -' � � . , � • . . � , ,� � .. . -.,.,...' ' . _. :_ . ; - -.- . -- . -. � �� � ❑I,as owne of rhe opert will do Ihc wo and '-�. ; � ���.i � � � � � '� ; ; ._ � " the slructure's noff iNendedror,oifered for sale: ���� _ rk, '--� -'=' �' �'��� `� �� - ' � � � � � (Sec.7044,Eus�nessandProFesslonsCode: TheC...rac � � - ��� . ,, . � ror's Llcense Lov+does nolapply to an ownerof property :..,'; ;•,. _ , . , . " "-� " -� '. _.... !.. - � who builds or lmproves thereon, and�wfia does such � � , ,_ . . . .. . � work bfmself providrd thaf such Impravemenfs arc not ' �������� '� -�-� .�-��- � � � infenaed or o/fcred for sole.�,If,however,Jhe bvlldfng or � � • - . . _ ._ _ . . . , , � �,improvemenl is sold wilhin one yoar of mmplefion,Ihe _ : ' - �--� - � - '`` '� - � ownenbuilderw111hovrlhc6urdenofprovingihafhedid . I . � � ' . � ' , � � '- not build or Improve far the purposo o(sofe.J��� � --��� --�- - -- - � �-- � - � ��� -� ' �� . ❑I,ps owner of Ihe property,om exclusively con- ' � .. � -- troclin9.vilh licensed conirac!ors Io con;irucr thc p}oject � . '' --�'�-- �-- -�- - � ��- - - - �--�' ��Sec 7044)Buslness and P�ofessions Code:ihe Conlroc- � � � . � - �or's Licrnsc Low does no�opply to n awner af prop�erty : ; a . .. � ---- -'� � - -' -�� ---- - --� --���� who builds ar Improves therecn,.ond who contracts lor � �� � �>'"�-� '�'� such projccfs w(1h o mntracfor(s)Iicrnsed pursuant to � . ._ _ , __ __.._.. . .. . . . .. . .. .. .. . . ' - � � -fha Coniradorz Uccnse Law).' � � � .__. . .. ._ . _ _... .._ � . ' � � ' �� I am exempt�undcr Sec:" � . � � . . . - � 8 8 P.C.�for this reason � � _ � _ � '--. . .---- ---- - . . , . . . .__. .___.__ .. ._-_.--- - - � � � . ,. Date ' ! --- -- � , __ : , � Owner ', INSPECTOR'S NO7E5 ��-----� --- �- . �. . �. '. . ��� . . . . . �� � .. . . . .. , . . . t _ . . � _ . . , , 1 ````� /� _C;,':'` .G���.�'.'��. ' y.�'V� ? �J_-w..,l.l�/ 1