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HomeMy Public PortalAbout9021 EMPEROR AVE_Mechanical__ 76A364C WpAKEKSthat IYc ire P' c,`. cate of CE-818 (2-80) Q p p[��C Q T O Oo �l FOR P f�R ] 0T I hereby affirm that I have � cutis'icate of consent to self insure, or a certificate oI NVori.ers'Compensation Insurance,or HEA70NG-V ENTIL.AT'ING-ABR CONDITI®NONG a certified copy thereof(Sec. 3800, Lab. Q.� Policy�uq?O_��Company—r� El Certified copy is hereby furnished. COUNTY OF LOS ANGELES ' BUILDING AND SAFETY Certified copy is filed with tho county,building inspection - —F®L� APPLICANT i O FILL IN ADDRESS BUILDING department. P/ 4v Date Applicant (PRINT OR TYPE ONLY) ` ^ LOCALITY CERTIFICATE Or L--XEIMPTION PROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE fG'i h r COUPENSAYICN iNSL'RANCE NEAREST CROSS ST.RarVl/O+a��p� a (This section need no': bccm e ;ase_ed i." the work involved ABSORPTION UNIT, BTU ' ��'� by the perm^ N ;'or Cre ??v^d ec. eail" (fit^3) or iess.) DISTRICT NO, PROCESS'D BY O I certify that in the performance of the wort, for which this AIR HANDLING UNIT,CFM0 permit is issued, I shall not employ any person in any manner rJA cc so as to become subject to the Workers' Compensation Laws. BOILER, BTU 0 yAPPROVALS DATE INSPECTOR'S SIGNATURE U Date Applicant 11� COMPRESSOR,BTU—JDrOI� (! ROUGH PA- 7 a NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM Exemption, you should become. subject to the Workers' FINAL Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER ALIDAT ION with comply with such -provisions or this permit shall be _ deemed revoked. �� FURNACE: FAUX_ r RAVITY �) /O,-r/� P LICENSED CONTRACTORS DECLARATION FLOOR: �- - — I hereby affirm that i am iicenscd undo:provisions of Chapter i HEATER: SUSPENDED UNIT 9 (commencing with Section 7CC0) of Division 3 of the Bus' - WALL ness and Professions Code, and my license is in full force and effect. «� AA J License Numberdgq 1419 =-ic. Class r Contracto �e%w.✓ Date, IfI I am exempt from the licensing requirements as I am a 0 licensed architect or a regis+.em6 professional engineer Plan check fee 25% of above. acting in my pro;ess'unal cap2ciiy (Section 7051, Bus- li iness and Professions Crde). ' PERilfIlT ISSUING (SEE $ l[f Q 0 6 5, VA Lic.or Reg.No. -_—Date I`®TAd FEE (�� Ji o"0 0 0 0 HONE OWNER-BTUiLDP.R DECLARATION .PLAN CHECK APPLICANT ' ' 2 3,7 0. 50 I hereby affirm that 1 am e_empt from the Contractor's NAME _ License Law for the fol!owing reason (Section 7031.5, Busi- J o o' ,7 0,5 0 6 ness and Professions Code): II ADDRESS El1, as owner of the property, will do the work and the O �I 2 0'_8'4 structure is not intendd or offered for sale (Section I CITY TEL. NO. 7044, Business and Pro' ssions Code). OWNER E/�� •20�2. � 2�Op.1S I, as owner of the property, am exclusively contracting with licensed contradWrs to construct the project MAIL (Section 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY CITY ��w TEL. NO.49yS) 470 I hereby affirm that there is a construction lending agency for the the performance of the work for which this permit is CONTRACTOR_K�_�o issued(Sec. 3097,Civ.C.). Lender's Name ADDRESS v res`I �T L'ender's Address _ it CITY b©e.yu - TEL. NO.gq ��a+ 1 certify that I have read this application and state that the rSTATE p LIC. above information is correct. I agree to comply with all County LICENSE NO.�=/ CLASS EJ^ ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter upon the above-mentioned property for 0'u" ,w Nv les.of Permittee Date