HomeMy Public PortalAbout9441 1/2 - 9445 1/2 LAS TUNAS DR_Mechanical_1/23/1989_air handling unit and oven hood DECL
TION
WORKERS'
that 1have a TION cafe of corse APPLICATION -FOR PERMIT
1 he�ebySptfitm that 1-have a certificate ofconsent to self
insure, or a certificate of Workers' Compensation Insurance, 7eAsbnc HEATING - VENTILATING - AIR CONDITIONING.
or a certified copy thereof (Sec. 3800, Lab:C.)
(� +} `y � CE-818(REV. 10/81)
Policy No. I Company t /�C /^ I v
Certified copy is hereby furnished. COUNTY OF LOS ANGELESBUILDING AND SAFETY
❑ Certified copy.is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING
tion department' ADDRESS ' ' TVrv!U' •'^•
/Ad (PRINT OR TYPE ONLY) DA
Date -Applicant y✓` �r `� �`�" LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST /rbn�
COMPENSATION INSURANCE CROSS ST. ``70 '' ��
(This section need not be completed if the work'involved by ABSORPTION UNIT, BTU DISTRICT NO. PROCESSED BY
the permit is for one hundred dollars.($100)or less.,)
AIR HANDLING UNIT,CFM VV ✓ •(/ (J
I certify that in the performance of the work for which this
permit is issued, I shall not,en mploy any persoin any manner
so-as to become subject to the Workers'CompensatiBOILER, BTU APPROVALS DATE INS TORS.SIGNATURE
c Yj fyJ/
Date /Z3 Applicant COMPRESSOR, BTU ROUGH
NOTICC T�T: If, after king this Certificate of VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Workers' gy� . V
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATI N
with comply with such provisions 'or this permit shall be
deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
(commencing with Section 7000) of Division 3 of the Business WALL
and Professions Code,and my license is in full force and effect. CL
. 210 a2-o c q3 N �ri-� �/ 0
License Number- Lic. Class - V
L2.3 S ,
Contractor �r^Date
❑ 1 am exempt under Sec.,'T '1 UA
Plan,check fee H
B.&P.C. for this reason
Date: PERMIT ISSUING FEE $ 2-
TOTAL FEE
Signature
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason(Section 7031,5, Business and NAME ,. ^
Professions Code):
ADDRESS. H`. I 'ir _
❑ I, as owner of the property, or my employees with
wages as their sole compensation,will do the work and •=r'='0 -4.50
the structure is not intended or offered for sale(Section CITY TEL. NO. r_
7044, Business and Professions Code). 3 I�- '=
OWNER, _ 0
❑ I, as owner of the property, am exclusively contracting MAIL a I I ��
with licensed contractors to construct the project (Sec- ��/ '
IH
ADDRESS IVG !/� t_t s;;(;_ 5.0
tion 7044, Business and Professions Code). ' -:HECK
''
CONSTRUCTION LENDING AGENCY CITY 'TEL. NO.
I hereby affirm that there is a construction lending agency for CHANGE
the performance of the work for which this permit.is issued CONTRACTORWI �GS 6 � POT X440
(Sec. 3097, Civ.-C.).' _ j
ADDRESS / 3.
(I( t 11 I I' 1..i�./39
Lender's Name ' • t t ( ff
CITY TEL. NO. '1r f?•b. 3 )��� IDU (
Lender's Address J
I certifythat I have read this'a lication and state that the STATE :0111/\ LIC.
pp LICENSE NO. .J(! I V CLASS ,
above information is correct. I agree to comply with all-County
ordinances and State laws relating to building construction,
and hereby authorize representatives of this County to enter '
upon t above-mentione pr rty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
AIpo �49 L2_�3 1,vwtvr
Si n Lure of Applicant or Agent Dote