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HomeMy Public PortalAbout10529 BOGUE ST_Mechanical__ WORKi.RS Co:%it`F�SA ;(,N :}_:: ARATiON 76As s(2-sol ' FFUCATT ON FOR PERWT I hereby affirm that I have a; certificate of consent to self insure, or a certificate ( Workers'Compensation Insurance,or HIZA�j MIG-V[�NTILATIG�'G-ABG GOND ONONG a certified copy thereof(Sec. 3800,Lab. Lzh.C.C_) Policy No. Company Certifiedcopy is hereby furnished. COUNTY OF LOS ANGELES BUILDQNG AND SAFETY Certified copy is filed with the county building inspection FOR APPLICANT TO [SILL 0-NBUILDING �1 � O department. ADDRESS 7 Date Applicant (PRINT OR TYPE ONLY) — — — LOCALITY CERTIFICATE OF EXENi?T ION .FROM WORKERS' I NO, TYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE NEAREST (This section need net be cers,a:ed 'rte wee: nvoiveci ABSORPTION UNIT, BTU CROSS ST. a by the permit Fe: c:-.z I:Id:L"'eL' tic."__X $(PjOC) CY ieSS.D DISTRICT NO. PROCESSED BY O I certify that in the performance of :fie work for which this AIR HANDLING UNIT,CFM permit is issued, I shall not employ uny person in any manner cc so as to become subject to the Workers' Compensation Laws. BOILER, BTU � 0 �_ / p ' APPROVALS DATE INSPECTOR'S SIGNATURE V Da%=�P=✓ teApplicant _ — _-_ 2COMPRESSOR,BTU`��0 ROUGH 'e?O (t-��-� W i:n tl NOTICE TO APPLICANT: if, after making this Certificate of eCn Exemption, j VENTILATION SYSTEM FINAL Z p you should become sub ect to the Workers' _ Cam Compensation provisions of-the Labor Code, you must forth- S D with comply with such proEVAPORATIVE COOLERVALIATION visions or this permit shall be II - deemed revoked. I FURNACE: FAU AVITY LICENSED CONTRACTORS Di-,CLARATION FLOOR: BTU k _ I hereby affirm that I am licensed underrovisions of Chapter p p I HEATER: SUSPENDED UNIT 9 (commencing with Section 701,0)of Division 3 of the Busi- I WALL ness and Professions Cude, and my license is in full force and effect. [ License Nu— V-�Z, i_ic.C+zss oi! I am exempt from t�c liccns:ny rcdu;rements as I am a ! licensed architect o: z registered professional engineer Plan check fee 25% of above. acting in my profess:ona'. capt:ci:v (Section 7051, Bus- iness and Professions Code). PEff$MOT OSSUING (FEE$VQ Lic.or Reg.No. Date TOTAL (FEE I� HOME OWNER-BUILDER DECLARATION j PLAN CHECK APPLICANT '- 2050, 1 A I hereby affirm that I am exempt from the Contractor's NAME #.0o o o o 8 + License Law for the follov,ittg ••eason (Section 7031.5, Busi- 2+0 ° 3 0.5 ness and Professions Code): i ADDRESS + I, as owner of the ?ropert}, will do the work and the o o o 30,5030: structure is not intended or offered for sale (Section (CITY. TEL.NO. + , + 7044, Business and.Professions Code). 0 Ll, 1 '6—8'4 ❑ OWNER�.� , ^ I, as owner of the properly, am exclusively contracting with licensed• contractors to construct the project MAI L (Section 7044, Business and ?cnfessioi:s Code). AppRESS CONSTRUCT!ON LENDING AGENCY jCITY G _ TEL. NO. — I hereby affirm that there is a construction lending agency for the performance of tate work for which this permit is CONTRACTOP issued (Sec. 3097,Civ.C.). Lender's Name ADDRESS�4© Lender's Address 1 ITY -CTEL Nr-'—r i _ ,j T I certify that I have read This application and state that the STfa,ELIC. above information is correct.I agree to comply with all County LLI :ENSE NO ��. �Z CLASC.2 ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to •nter upon the above-mentioned property for inspection _urpose' 7/K gnat ire or Permittee Date