HomeMy Public PortalAbout10607 FREER ST_Mechanical__ ION
♦� WORKER'Shave a certificate
of consent to 76A346DPW9,69 APPLICATION FOR PERMIT LIME GREEN,
76A364C
hereby affir.;i that I have a certificate of consent to self insure,
or a ce tificate of Worker's Compensation Insurance, or a certified HEATING - MTILATING AIR CONDITIONING
copy thereof(Sec.3800 Lab. C.)
�
cy No. WCP1275f>company CITATION COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
Certified copy is hereby furnished.
® Certified copy is filed with the count building in ection FOR APPLICANT TO FILL IN BUILDING 1 0607 E. FREER ST.
department. (PRINT OR TYPE ONLY)
ADDRESS
1119 - LOCALITYTEMPLE CITY
Date 4/23/92 Applica NO. TYPE OF APPLIANCE OR EOUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
CROSS ST.
COMPENSATION INSURANCE 1 ABSORPTION UNIT,BTU
(This section need not be completed if the work involved by the ASSESSOR
MAP OK PAGE PARCEL
permit is for one hundreddollars($100).or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU
become subject to the Workers'Compensation Laws.
' COMPRESSOR,BTU '
Date Applicant N/A APPROVALS DATE INSPECTOR'S SIGNATURE
VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH t
Exemption,you should become subject to the-Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL
provisions or this permit shall be deemed revoked. FURNACE: FAU VIT
LICENSED CONTRACTORS DECLARATION1' FLOOR BTU �bffU--- 23.75 VALIDATION
I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT
(commencing with Section 7000) of Division 3 of the Business and HEATER: WALL
Professions Code,and my license is in full force and effect.
License Number 468609 Lic.,CCllas�-e 20 }
IL
Contract , �/ Date "/23/92 -^
O
Plan check fee _- — U
I am exempt under Sec.
BAP.C.for this reason PERMIT ISSUING FEE$ 24 .75 _ _ 'I OO
Date: TOTAL FEE 7 2 5 O !I_j_s" ', �;- 0
`'.�. _..i fw
Signature N/A - !1
�T� PLAN CHECK APPLICANT :I`!C!•F? �� 'c: !(n
OWNER-BUILDER DECLARATION _£ -
hereby affirm that I am exempt from the Contractor's License Law NAME
for the following reason (Section 7031.5, Business and Professions
Code): ADDRESS
I, as owner of the property, or my employees with wages
as their sole compensation, will do the work and the CITY TEL.NO. '
structure is not intended or offered for sale (Section 7044, € P ) 'f=«'?
.A '.I�'.c...-
Business and Professions Code). OWNER EDITH NELSON
I, as owner of the property, am exclusively contracting MAIL
with licensed contractors to construct the project (Sec- ADDRESS 10607 E. FREER
ST-
tion 7044, Business and Professions Code).
CITY TEMPLE CITY TEL.NO. (818) 968-8541
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for CONTRACTOR ,
the performance of the work for which this permit Is issued IRVINEWEST HTG. & A/C
(Sec.3097,Civ.C.).
ADDRESS . 638 -SOUTHERN AVE.
Lender's Name
CITY ORANG TEL.N1714) 921—
714 921—0 8 0 '
Lender's Address
I certify that I have read this application and state that the above
LICENSE NO. 468609 CLASS C-2 O
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 the above-mentioned
property for insp tion poses. SEE REVERSE FOR EXPLANATORY LANGUAGE
4/23/92
A URE OF APPLICANT OR AGENT . DATE