HomeMy Public PortalAbout5428 BALDWIN AVE_Mechanical__ WORKERS COMPENSATION Df CLARA tION CEA B 8(2 80) A P P lL CAT 8 O 1�7 FOR P E R U�7d T
I,hereby r.fftrm that I have a certificate of consent to self
Zor a cerificate of Workers Compensation Insurance or HEATING-VENTILATING AIR CONDITIONING
ified copy thereof(pec 3800,Lab CNo _442586 Company_AAA_Cond _Air,_Inc
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy is hereby furnished ,
Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING
department (PRINT OR TYPE ONLY) ADDRESS 542S-Baldwin-Avenue
Date 4/i15/_82 Applicant_AAA COnd,_Air,_Inc_
LOCALITY c ,
CERTIFICATE OF EXEMPTION FROM WORKERS NO TYPE OF APPLIANCE OR EQUIPMENT FEE T�pI�C]tY
COMPENSATION INSURANCE NEAREST
(This section need not be Vompleted if the work involved PBSORPTION UNIT BTU CROSS ST ItV d
by the permit is for one hundred dollars ($100) or less) DISTRICT NO PROCESSED BY U
I certify that in the performance of the work for which this AIR HANDLING UNIT CFM
permit is issued I shall not employ any person in any manner / 0
so as to become subject to the Workers Compensation Laws' BOILER BTU
.. APPROVALS DATE INSPECTOR S SIGNATURE V
Date Applicant r ] COMPRESSOR BTU 20 ROUGH —� a
NOTICE TO APPLICANT If, after making this Certificate of VENTILATION SYSTEMCn
FINAL q - ' Z
Exemption you should become subject to the Workers
Compensation provisions of•the Labor Code, you must forth EVAPORATIVE COOLER VALIDATION
with comply with such provisions or this permit shall be �p
deemed revoked FURNACE FAUBg_� Y y
LICENSED CONTRACTORS DECLARATION FLOOR B—TU1A�,` �b
I hereby affirm that I am licensed under provisions of Chapter HEATER SUSPENDED UNIT
9 (commencing with Section 7000) of Division 3 of the Bust WALL
ness and Professions Code and my license is in full force and '
effect
License Number-293529— Lie Class-11220—
Contractor
lass—C20
ContractorAAA__QpnCl,_AirDate4/:15182
I am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer Plan check fee 25%of above
acting ip my professional capacity (Section 7051 Bus
mess and Professions Code) PERMIT ISSUING FEE $ � 4
iLie or Reg No Date I TOTALTEE 3646 0 A
a
HOME OWNER BUILDER DECLARATION PLAN CHECK APPLICANT #'•�•fo o • 8
1 hereby affirm that I am exempt from the Contractors NAME
License Law for the following reasor✓(Section 7031 5 Bust t '21-;- 3 8 5 0
ness and Professions Code) ADDRESS r P
I as owner of the property will do the work and the _ • o to 3a50'0
structure is not intended or offered for sale (Section CITY 1 TEL NO (J 5—$2
7044 Business and Professions Code) - ,
'
I as owner of the property am exclusively contracting OWNER Mr _a11;d_Mrs;-N@gr
with licensed contractors to construct the project MAIL a
(Section 7044 Business and Professions Code) ADDRESS 5428_Baldwin_Auenue
CONSTRUCTION LENDING AGENCYCITY emple Clty TEL NO 4448-81841 i
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is CONTRACTOR AAA Conditioned`AirInc, %
issued (Sec 3097 Civ C) a
Lender s Name ADDRESS 0I_6-0—Valley-BL
Lender s Address CITY 1 MO to TEL NO—179---1&0 r
i certify that I have road this application and state tliat the STATE LIC
above information is correct I agree to comply with all County LICENSE NO 293529 CLASS d-
ordinances
and State laws regulating Heating Ventilating and
Air -_,ndmonmg and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
Co inty to enter upon the above mentioned properO for
Ills ti n our a
Si nature of Permittee Date