HomeMy Public PortalAbout6322 GOLDEN WEST AVE_Mechanical__ ^_.Z �rF ")t.iPi NS1T10N DECLARATION 78A364C
I hcrTI-o, CE -818 (2-80) APPLICATION FOR PERMIT
��m rt•u 1 `tai.• .i rerrlficata of consent- self
iri9�7_,t•: nr u ?'e of lt,,rkcrs• Cvm n6etlon Insurenca,cr HEATING-VENTILATING-AIR CONDITIONING
;• c::rel , I Sar3tt00.
• Certille-d copy u hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY
�jCorti d co y is
will t building Inspect n
FOR APPLICANT TO FILL IN BUILDINGZ��ZZ
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-'a n (PRINT OR TYPE ONLY) ADDRE33
CtRTIFj(ATE OF EXEMPTION FROM ORKERS'
NO. TYPE OF APPLIANCE OFA EQUIPMENT FEE LOCALITY -7 P[ gr 17`
COMPENSATION INSURANCE NEAREST Lo(Thi3 !action need.not be completed 1f the work invotved ABSORPTION UNIT, BTU CROSS ST.
by the permit is for one hundred dollars ($100) of lea.) DISTRICT No. PR o-
I certify t118 in the performance of the work for_whlch this AIR HANDLING UNIT CFM
permit L3JuUod, I shall not employ any person in any manner �-V', O
so as to become subject to the Workers' Compenastlon Laws. BOILER BTU
.APPROVALS DATE INSPE SIGNATURE W(W1,,
Date Applicant COMPRESSOR BTU ROUGH N
NOTICE TO APkICANT: If, after making this Certificate ofVENTILATION SYSTEM Z
Exemption, you should become. s4bject to the Wori(ers' FINAL —
Compensation pr6vision's of the Labor Code, you must forth- EVAPORATIVE COOLE VALIDATION
with comply with. such provisions or this permit stall'be
deemed revoked.-
FURNACE: FAU FY
LICENSED CONTRACTORS DECLARATION J FLOOR BTU (/
I herolry affirm that 1 am 1lcemed under.provisions of Chapter HEATER: SUSPPNDLD UNIT t
9 (commencing with.Section 7000) of Divlilon 3 of the Bull- WALL # '� i
ness and Profeasions CoUe. and my license is In full force and l 2 a O
effect. Q • •!•
Licca•,Numbe c. Class a 0'6
data �T�-S oa26 -85.
1 um orempt from the licensing requirements as lam it
licensed architect or 'a registered professional engineer Plan Check fee 25% of above.
acti-hr in my professional capacity (Section 7051, Bus-
in.ess and Professions code). PERMIT ISSUING FEE $ ,jQ
Lic.or Req No.' Date TOTAL FEE D
HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I herebv affirm that I am exempt from- the. Contractor's NAME
Licenso Law for the following reason (Section 7031.5, Bull-
ncss and Profeszlons Coda): - ADDRESS
F1 l,'as Pwner of the property, will do the work and the CITY TEL. NO.
structure is not intended or' offered for sale (Section
7044, Business and Professions Code).
1, owner of the es a OWNER
w
property, am exclusively contracting
th licensed contractors to eorlxtruct the project MAILpe-
'
(Sactk,n 7044,Business end Professions Code). ADDRESS 3
CONSTRUCTION LENDING AGENCY CITY TEL. N0. 7
I hereby affrrm that there is a cmrstruction lending agency
for the performance of the work for which this permit Is CONTRACTO
issued (Sec. 3097,Ciy.C.), {y
Lender's Name AIDDRE5� , r�
Lender's Addres CITY )
I certify that J hese read this appllcetion and state that the gTATE LIC. '
above informarlon is correct:1 agree to comply with all County E N CLASS 1
ordinonee-K and Stutd laws regulating Heating, Ventilating and r
Air ndltinning, anti hereby authorise reprmentettves of this SEE REVERSE FOR EXPLANATORY LANGUAGE'
C nt a r upon the above-mentioned property for
'gout ere of 1'er [ee � ate