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HomeMy Public PortalAbout5337 CAMELLIA AVE_Mechanical__ WORKI.RS COMt ENA I IUN t t rVLATION w: v4 ��f ��.+/`1�(V FOR PERMIT I hereby :affirm that I hnvei-.) certificate of consent to self E 813 (2 80) insure, or a certificate of ee.,38rs Compensation Insurance,or HEATING-VENT TIN AIR CONDITIONING a certified�gopy there©!(tSec- 38QGh[,ab C ) ,,,�' b �". ` Policy No.— Company--_ II ❑ Certif eeo.Copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy"isfiled with the county building inspection deparrrneptf , �. FOR�APPLICANT TO FILL IN BUILDING ? `y F ADDRESS Date Applicata#` (PRINT OR TYPE ONLY) --�- _--- LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKLRS' - — COMPENSATION INSURANCE; -"�---- NEAREST 101. (This section heed not be completed if the work involved ABSORPTION UNIT, BTU CROSS ST. C by the permit 1S for One hundred dollars. ($100) oI`less.) DISTRICT NO. PROCESSED BYUJ E ;. U _ I certify that in the performance of the work for which this AIR HANDLING UNIT,C_FM- permit is issued. 1 shall not employ any person in any manner - U_ so as to become sublect to the Workers' Compensation Laws. BOILER, BTU .—. APPROVALS DATE INSPECTOR'S SIGNATURE y Uate --�- CC 1ppliru)t _--_"--- COMPRESSOR,BTU # -.—�x—4 ROUGH _ Gi NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION"SYSTEM I AL IN F Exemption, you should become subject to the Workers' ��_ _ O Compensation provisipns, of the Labor Code,you must`torth- 0- with comply with si)t b provisions or this permit shall he EVAPORATIV''E'COOLER VALIDATION• t2 - -— -- --- - - ___� deemed revoked FURNACE. FAU GRAVITY • I 1- LICENSEA3CON,TRAC"TORS DE:CLAPATION FLOOR. _____ BTU--_ -_ ass I hereby affirm that I am licensed under provisions of Chaptcr 1 HEATER: SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the'Busi- ness and Professions Code, and mN license is in full force and, effect. a l License Number " Lic.C lass_ _ k Contractor_ Date_ -- ❑ I am exempf:,from the licensing requirements as I am a _-_ -.- _ licensed architect or a registered professional engineer Plan check fee 25% of above. acting in my-pf fusional caj:.,:it% (Section 705J, Bus- iness and Pr6fes!,;ions Code), PERMIT ISSUING FEE $ Lic.or Reg.No:• _-_ -� Date__.-- —-- TOTAL FEE p HOME QWN'ER-BUILDLR Di'C:LARATION PLAN CHECK APPLICANT I hereby affirm.Afiat I am exempt from the Contractor's N,01"E -- --�� LicensJ Law for the follow'tag reason (Section 7031.5r Busi- ness usi ness and Professiops.t?de): TRESS` at . 4' j ❑ it's ----- I, as owner of the properly x,'!11 do the work_an( t))e � structure is not intended of u d ,for 'Sall& (Sectio'); S Cl TEL. NO. 7044, Business an,, Professions C., r. c ❑ I, as owner of the property,,•um exclusively contr4cting with licensed contractors 4?i'construct the project MAIL - ; ` a 0 (Section 7044, Business and Professions Code). ADDRESS" TEL. NO. CONSTRUCTION LENDING AGENCY GIT._Y N- I hereby affirm that thereis a construction lending agency for the performance of the work for which this permit is CONTRACTOR - . issued(Sec. 3097,Civ.C.). ) $ . Lendet ,D[ -- ADDRESS Fender's Address °t'.w r ::-0 d#) TEL. N O. I certify that I have read this application ani( State that tpe -SJAtELIC. above information is correct.'hagree to ign)p1',with III Ciiunty L' NSE NO. N CLASS ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby:-authorize representatives rif this SEE REVERSE. EOR EXPLANATORY LANGUAGE: County to enter upon the..-above-mentioned property for inspecticIn pui pCyses. Signature of it rmitt ?5"0*� Drat