HomeMy Public PortalAbout9834 HALLWOOD DR_Mechanical__ y firm that
I haE a certificate
of corse A0 l�l�LS�CG�111 M FOOD PLSIII�NT
;,I`nereb,,y dffifm�tl•lat I haves a certificate of consent to self � '
insure, or'a certiFicafe of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
CE-818
or a certified copy thereof (Sec. 3800, Lab. C.)
CE 81 B(REV. 10/81) -Policy No. " Corfipan
Certified copy is hereby furnished. .
COUNTY OF LOSANGELESBUILDING AND SAFETY
❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING
tion department. ADDRESS �3
(PRINT OR TYPE ONLY) � ,
Date Applicant LOCALITY -�� G1 1
NO. TYPE OF APPLIANCE OR EQUIPMENT .� FEE
CERTIFICATE OF EXEMPTION FROM•WORKERS' CD NEAREST //�=� r
COMPENSATION INSURANCE L - OD CROSS ST.VZ� _jDJ_ t..• S1
ABSORPTI NUN T, BTU DISTRICT NO. PROCESSED BY
(This section need not be completed if the work involved by
the permit is for,one hundred'dollars ($100)or less.) (j)
certify that in the performance of-the work for which this AIR HANDLING UNIT, CFM 1\
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers"Compensation LOWS. BOILER, BTU h' APPROVALS DATE IN SP T •s SIGNATURE
LJO
Date k-7 Applic COMPRESSOR, BTU �� �V ROUGH
NOTICE TO APPLICANT: If, afterm this Certificate of VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Workers' /
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDA I N
with comply'with such provisions or this permit shall. be
deemed revoked. FURNACE: FAU GRAVITY '
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT(commencing with Section 7000) of Division.3 of the Business WALL
.and Professions Code,and my license is in full force and effect. CLCL
O
License Number Lic:Class U
0
Contractor Date
❑ . I_am exempt under Sec. w
Plan check fee H
B.&P.C. for this reason
PERMIT ISSUING, FEE $
Date: z 8 37.4 A
Signature TOTAL FEE i 9177 # 0.0 0 o•o 8
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor's License D I ° ° 4'9..7 5
Law for the following reason (Section 7031.5, Business and NAME / _
Professions Code): 0.0 0 4 9.7 5 5
1:1I,'as owner of the property, or my employees with ADDRESS
wages as their'sole compensation,will do the work and 1 ,1A 7_ 87
the structure is not intended or offered for sale(Section CITY TEL. NO.
7044, Business and Professions Code)..
OWNER
I, as owner of the property, am exclusively contracting v 3 t
with licensed contractors to construct the project (Sec- MAIL +,
tion 7044, Business and Professions Code). ADDRESS 3 f q r
CONSTRUCTION LENDING AGENCY CITY Cq; TEL. NOt�,$tj' / Ow
I hereby affirm that there is a construction Fending agency for
the performance of the work for which this permit is issued CONTRACTOR D
(Sec. 3097, Civ. C.). -
ADDRESS .. ,
Lender's.Name
CITY.. --TEL. NO.
Lender's Address r
STATE LIC.
I certify that I have read this application and state that the iICENSE NO. CLASS
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
upon the above-mentioned property for inspectiio7n puurr(poses. SEE REVERSE FOR EXPLANATORY LANGUAGE
1. / "' V 7
at e of Applicant or Agent Date -