HomeMy Public PortalAbout10952 FREER ST_Mechanical__ I•, .erelS, ffh-m that�I have a cwllfkate of coruent to self HrrLl%.A I Burr rvK rCK1V11 1
Insure, or a cerpfkate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
iL
or a certifl c y they (Sec. 3600, Lab. C.) Ca^
r�j CE-818(REV. 10/81)
Pollcy �,,,,�-7 No.� mpany� �
Certified oopy is hereby furnish COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certffled copy is filed with the county building Inspec- FOR APPLICANT TO FILL IN o�
tl departm (PRINT OR TYPE ONILY)
Dah Applicant LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPAYMFEE
CERTIFICATE EXEMPTION WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST.
(This sectt=owed not be cowWWted H the work Invahed by ABSOUTION UNR,BTU DCS rRICTI NO. PROCESSED BY
the permit Is for one hwtdred dollars($100)or less.) �V
I certify that in the performance of the work for which this AIR HANDLING UNIT, CFM D
permit is Issued,I shall not employ any Person In any manner
so as to become subled to the Workers Compensation Laws. BOt►EFt,BTU �rvaovus DAZE CxRS sx,r+r RE
Date Amlkant MVPRESSOR, BTU ROUGFI / �jyJ
NOTK:E TO APPLICANT: If, after making ihls Certificate of Ve•ITILATION SYSTEM FINAL �� ���^�
Exemption, you should become subject to rhe Workers'
Compensation provlslorts of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAVTTY
LICENSES CONTRACTORS DECLARATtGN FLOOR BTU O d
I hereby affirm that I am Ikensed under provisions of Chapter 9 HEATER.- SUSPENDEDUNrr
`(commencing with Section 7000) of Divislon 3 of the Business WALL
and Professlorts Code,and my license Is In full force and effect.
License NumberY37d `(ic. Class <f— J-0 �} , ►
Contrapct0k,:Jr C_
❑ 1 am exempt UrowPion check fee
B.BP.C_ for this reason
PERMIT ISSUING FEE $Dow—Signature TOTAL FEE
1 OWNER-BUILDER DECLARATION PLAN C-IECK APPLICANT
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Boniness and NAME p 1
Professions Cade):
ElI, as owner of the property, or my employees with ADDRESS AMA V
wages as their sole compensation,will do the work and TEL NO. =775200
the structure Is not Intended or offered for sale(Section
7044, Business and Professions Code). OWNER 1 ITQ�
❑ I, as owner of the property, am exclusively contractingS / /�L 00
with licensed contractors to construct the project (Sec- � �,v (�� IS ! 00
Non 704, Business and Professions Code). yn .W
CONSTRUCTION LENDING AGENCY CfTY S� /ry/ TEL NO. � �r�
I hereby affirm that there Is a construction lending agency for LYe /Y� •01 01
thb performance of the work for which this permit Is issued AOR � �� dD r
(Sec. 3097, Clv. C.}.
ADDRESS / J>4' a !/`d'- 0000-0001 U 16M
Lender's Npme C T n /qC• TEL. NO. ,�, 4014 1 Ali 8129
Lender's Address
ATE L!C
I certify that I have rood this application and state that the 5T NO. 70 CLASS
above Information Is correct. I agree to comply with all County
ordinances and State lows relating to building construction,
and hereby authorize representatives of this County to enter
upon e a e-mentioned property for Ion pu les. SEE REVERSE FOR EXPLANATORY LANGUAGE
Sip App lcont or Agent Doti
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