HomeMy Public PortalAbout10950 FREER ST_Mechanical__ DEC
vl -�=that CI have °c'°"cate of c"°" APPLICATION FOR PERMIT
I have a certificate of consent to self
I Insure, or a cergflcate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
or a certlff co ther (Sec. 3800, Lab. C.) 76A364C
CE-818(Rev. 10/81)
P❑ollcy No. a .mpany
Ce fled copy Is hereby furnish COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy Is filed with the county building Inspec- FOR APPLICANT TO FILL IN BUILDING
I tlo departm (PRINT OR TYPE ONLY) ''D°�
DateApplicant LOCAIY
NO. TYPE Of APPLIANCE OR EQl11PAtiENT FU CERTIFICATE F�CEMPTION WORKERS' NEST
COMPENSATION INSURANCE CROSS ST.
(Thls.sectfon need not be completed IF the work lnvotved by ABSORPTION UNIT, BTU ouTO-7 NO. PROCESS®BY
the psrmtt Is For one hundred dollars (;100)or Is".)
I cerltfy that In the performance of the work for which this AIR HANDUIVG UNI,CFM cX
penult Is Issued, I shall not employ any arson In any manner ((,
so as to become subject to the Work" Compensation Laws. BOILER, BTU ,,PpROVAiS DATE �
Date Applicant COMPRESSOR, BTU ROUGH /
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATTVE COCU R VALIDATION
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU O O tj
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNI
`(commencing with Section 7000) of Division 3 of the Business WALL
and Professlons Code,and my license is In full force and effed.
IL
License Number74V
Ic- Class r 7' e U
Contractror,JT
❑ I am exempt under Sec.. W
Plan check fee w
B.BP.C. for this reason PERMIT ISSUING FEE $
Date:
Signature TOTAL FEE
OWNER-BUILDER DECLARATION RAN 01ECK APPL"NT a
I hereby affirm that Faro exempt from the Contractors Llcanse ,
Law for the following reason (Section 7031.5, Business and NAME
Professions Code):
❑ I, as owner of the property, or my employees with
ADDRESS ACCT.T
wages as their sole compensation,will do the work and
TEL.the structure Is not Intended or offered for sale(Section CITY NO.
7044, Business and Professlons Code}. . C / 1 ITE]�S
❑ I, as owner of the property, am exclusively contracting �J TOTAL _��
with licensed contractors to construct the project (Sec- MAIL 75ADDRESS �,� I�� ; �.y 75.WIlan 7044, Business and Professions Code). CWLK 75■
CONSTRUCTION LENDING AGENCYNo.
I hereby affirm that there Is a construction lending agency for Cm � � TEt �J ' ■
the performance of the work for which this permit Is Issued AOR
(Sec. 3097, Clv. C_)_
Lenders Name Am"Ess / 'd I00r1=1 6/16/89/1A//09
OTY D o TEL NO.
Lender's Addressit 1 8:29
STATE
Ll r_
I certify that I have read this applrcatlon and state that the LICENSE NO. (LASS
above 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
upo e a vo-mentloned property forIon pu SEE REVERSE FOR EXPLANATORY LANGUAGE
Stgnatu Appllcont or Agent Dot.