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Home My Public Portal About10370 KEY WEST ST_Mechanical__ C,,ii *-,1.SAJ!�1JI DECLARATION 76A364C CE 818 (2-80) i(`- LL-,UC 19, T,�0 N F 0 R 'lam E R M 0T I heiehy u`t'rm 'zha! 1 "eve E; certificate of consent to self insure,or V Ce'tifiCftte )f W07k07S'Compensation Insurance,or HEA71NG-VEN70LA7MG-AM CON D0MOI` ONG c" 0 uLab. C,) fly COUNTY OF LOS ANGELES Fi 1'��Li�ied herd-,y furnished. QUI LDING AND SAFETY filed 1, "Ic Coun y In if irnir,!Wn"ection FOR APPLICANT TO FILL)N BUILDING e; (P RINT —ADDRESS (PRINT OR TYPE ONLY) ;icar� LOCALITY C L Rl 1-' OF TOIti FROM WORKERS' No, TYPE OF APPLIANCE OR EQUIPMENT, FEE INSURANCE NEAREST CROSS ST. (71i's sec".`cr. iieec! 74oi 4_4e work involved ABSORPTION UNIT, BTU CL by 32:T7� :.S fz- C1:7 — 0 eo1'?_1S (5lvO) or )fess.) DISTRICT NO. PROCESSE By 1 certify that in the pe.-i-ormance o?-the work for which this AIR HANDLING UNIT,CFM_ permit is issued, 1 siiail nw Lrnploy anv person in any manner , a 0 s(, as `o 1)eco— -Lbiect to saforn Laws. BOILER, BTU APPROVALS DATE INSPECTOR'S SIGNATURE D Z. LLI Dace-A/—, A,, P c-, _5 COMPRESSOR, BTU ROUGH �1 'r,13T I M M01 I 1 5 1 C/) NOTTCI�. 1 0 Ti, i.fter making this Certificate of VENTILATION SYSTEM FINAL z Exemption, o:i sl oulol subject to the Workers' Com,,)ensF,0vr, prrvisior of tae ',z:lior Code, you must forth- EVAPORATIVE COOLER VALIDATION with comp!,,, v.-,t'l such o, tris permit shall be deemed FURNACE: FAu_GRAVITY — LICs:NSI'Tl ','ON—RACTORS DECLARATION BTU I hereby alf-,.-i tfi4t 1 arr licensed under provisions of ChapterATE SUSPENDED UNIT 9 (c,)n—meric,i!, v!itli Sec' ur 7000) of Division 3 of the Busi- WALL i1rofer ions Cc I= -n y 1, ness -no license isfull force and I t. c fss I Lic,,use NIL,, CI CnX,,qc_ Date ef! C:C,:-op! f:o-,-r 'I,e licensing requirements as I am a iic2cst6 13,;- c i reg.;s-'erad professional engineer Plan check fee 25%of above. 2c in L, rr" �,OfessimizQ c.,oecity (Section 7051, Bus- I i n css ?c s,,!n,1.Q%t,4- PERMIT MWNG FEE L'ic.or 0 Date OTALFEE ja3 H Cl iV^_' OF'i,'- 13 U;L D LR DECLARATION PLAN CHECK APPLIrAN T affi-tri thE: Em c%arzipt fcorrr the Contractor's NAME LicenseI.uxv for the foilowing ;easor. ', 7031.5, Busi- `tSection ness and ProfessiMns ADDRESS T, as ov.-ner of the proper-'y, w'll do the work and the CITY TEL. NO. structure is npY irtec,ded or offered for sale (Section ;2 3 5.1,2 A 7044, Business and ,olessiwis Code). OWNER r !, as owner of the property,*ant exclusively contracting _x Wo 4o!o 0,o 8 with lice-ised contractors to constructthe project MAIL . I I . (Section 7044, Business Lnd Professicii,,s Code). ADDRESS 2'o 4'o 3 35 0 CONS TRUCT,CIN L%'NDING AGENCY CITY TEL.NO. I hereby of ,rm ;l�_ , the,.�- ;s a construction lending agency 33,50c ., L, for the. perform-,iricc of the work for which this permit is CONTRACTOR issued(See. 309 7,Civ.C ). 0LI 0 Jr;-8-2 Lender's Name--- ADDRESS Lender's Address_ CITY TEL.NO. certify that I Mwe read iiiis application and state that the STATE 1 LIC. L above information is correct. 7.agree to comply with all County LICENSE NO. CLASS ordinances and State 11WS 7CgklCating Heating, Ventilating and �'r Condition ,te REVERSE FOR EXPLANATORY LANGUAGE 'pe .. WURKERS'COMPENSATION DECLARATION CEp$68(2.80) Q)p� C Q T p O N (�OR p E R�p`� A hereby affirm that I have a' certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or HEATBNG_M[eNTILATINGi_QBR O®NOBSTIONPINIG a certified copy thereof(Sec.3800,Lab. ) Policy No.1D--3&—?,?Company.,; A� T, ei ❑ Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUIWINGs AND SAFETY ❑ Certified copy is filed with the county buil it i vection FOR APPLICANT TO FILL IN BUILDING �` r� pp ADDRESS. Date_ -2�^ Applicant L/ _J a"�1"� (PRINT OR TYPE ONLY) �. LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE NEAREST } (This section need not be completed if the work invOIved ABSORPTION UNIT, BTU CROSS ST. O by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. ,/ PROCESSE BY r U 1 certify that in the performance of the work for which this AIR HANDLING UNIT,CFM D t/ ✓x�� O permit is issued, I shall not employ any person in any manner O so as to become subject to the Workers' Compensation Laws. i BOILER, BTU F ?? / APPROVALS DATE INSPECTOR'S SIGNATURE `U Date Applicant COMPRESSOR,BTU_J�eA G / ROUGH s �,ry �• N NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL ��6`p Z Exempiion, you should become subject to the Workers'_ Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be �i deemed revoked. FURNACE: FAL �7OdGRAVITY LICENSED.CONTRACTORS DECLARATION 1 FLOOR: Z'rU I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Section 7000) of Division 3 of the Busi- WALL ness and Professions Code, and my license is in full force and effect. �y License Numbers.?—C 3 r — Lie.Glasse Contractor _ �p?� ,• Date &---2 F1I am exempt/from the licensingrequirements as I am a licensed architect or a registered professional engineer Plan Check fee 25%of above. acting in my professional capacity (Section 7051, Bus- iness and Professions Code). PERMIT MSUINGa EEE Lie.or Reg.No. Date TOTALFEE EE ;z HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from- the Contractor's NAME License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): ADDRESS `9 5 4 1,.7 A ❑ I, as owner of the property, will do the work and the TEL. NO. structure is not intended or offered for sale (Section CITY # o 0 0 0 4 1 7044, Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contractingr? 0 0 2 7 Q with licensed contractors to construct the project MAIL o (Section 7044, Business and Professions Code). ADDRESS ;o o 7 Q �z c� d. f_'.� �-_ .�!Qj ' CONSTRUCTION LENDING AGENCY CITY TEL.NO. -� 05.2.7-8 1 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is CONTRACTOR _J�_ Zp a � _z issued(Sec. 3097,Civ.C.). ��77 Lender's Name ADDRESS ��6 IV, Lender's Address CITY ��/�v TEL!NO. q / ^jfy� I certify that I have read this application and state that the STATE / above information is correct.I agree to comply with all County LICENSE NO. —_21 CLIC.ASS ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter p r :_ above-mentioned property for iusnec' �n purpo e.. Signature of Pei r.itte• Date