HomeMy Public PortalAbout6053 LOMA AVE_Mechanical__ ,
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°r''iherebyaffirmORhaR'haOMaEeSATcIOe'oEconsentOto self insure, 20-0046 DPW 9/8 A ���LIC�T:1.01�6 ®, .�EYlM�T
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r-"'cc tificate=of.Worker's Compensation Insurance or'Ia certified
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copy thereof,(Sec.3800 Lab'.cJ.P t ; . ,
t HEATING -VENTILATING.-AIR CONDITIONING .:�
Policy No " Company C,OUNT'Y OF LOS'ANGELES "DEPT OF,PUBLIC WORKS ,BUILDING AND'SAFETY DIV _s
�+ Certified•copy,is hereby furnished.,,
,a
BUILDING
FOR APPLICANT•TOFILL IN
Gertified,copy is filed with the county building inspection` ADDRESS .. rp'�'��
department
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(PRINT OR TYPE ON
' I LY)
Date Applicant t NO: TYPE.OF APPLIANCE OR EQUIPMENT FEE
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. .« NEAREST
.,CERTIFICATE
i
CERTIFICATE OF EXEMPTION FROM:WORKERS': CROSS.ST
COMPENSATION INSURANCE
;- i'':.. ASSESSOR r
, ABSORPTION UNIT,.BTU' -
,.
(This section need not.be completed,if the work involved by the; MAP BOOK PAGE PARCEL-
eriiiit is for-one hundred dollars $100 or less.
•.- p ( � Y: ` ,:" ':,'. '.,AIR HANDLING UNIT CFM "` DISTRICT NO. PRocesseoev
ork for which:,th'is permit
I(certify that-in the performance of the>w - ,
Is issued, I shall not employ any person In'anymanrier so as io BOILER„BTU
become subject°tolthe Workers'Compensation Laws:r:� G
COMPRESSOR'BTUTURE
APPROVALS .i GATE INSPECTORSSIGNA
D ate ' Applicant VENTILATIOMSYSTEM
`NOTICE TO'APPLICANT If.; after makin this'Certificate ot:` R6UGH7: t
g '
'Exemption,'.you^should become subfect,to'the�Workers Compensation' EVAPORATIVE+COOLER.
provisions.of the Labor.Code, you must,forthwith comply with such
provisions oFthis•.permi[shall be'deemed`revoked: FURNACE: "•_ FAU 'GRAVITY
FA
AL
AL
LICENSED CONTRACTORS DECLARATION FLOOR' BTU
VALIDATION
't hereby affirm that_I am.licensed,under provisions of Chapter-9': ;,, ;SUSPENDED
(commencing”with Section,7000) of'Division 3 of the BLsiness;and HEATER-, WALL'-'-;L
Professions Code,and'my license is Iri'.full force and effect.
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License Number •Llc Class
X,
Coritracto`r Date
Plan check'fee U
am exempt under Sec. '
r ,
TO
-ISSUING FE
E$'
B&P C for this reason PERMITTAL^FEE -Date: ,
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O'Q
Slg"nature
_ - : •� PLAN CHECK APPLICANT^ , , - •`, >'•.
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OWNER-BUILDER'OECLARATION Z
_ i +I _
I hereby affirm that,I am'exempt from the Contractor's License Law NAME,Vc:
foryahe-following reason;(Section 703,1:5, Business and Professions w r
•Code). t
ADDRESS <
I as ownerof'the property,-or my employees with wages, ,
- _•' as,tFeir soley-compensation;,. will-do the work and the'"ui CITY TEL.NO
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structure.isnot intended or offeled;for sale (Sectio,n 7044,
Business and Professions Code),', OWNER
x
owner of the property; am exclusively"contracting MAIL y�
with,licensed contractors to construct'the project (Sec ADDRE v�'/��-- — r
tion 7044 Business and Professions Code). �SeqI � pl..
" ..+4 2•
CONSTRUCTION LENDING AGENCY i-7f°t'it,i
C Y EL.
]'hereby'affirm.that there is construction lending agency or �«
the perfo[mance of the'•work'for which this.permit Is issued CONTRALTO --- - t
(Sec. 3097; Civ.C:), ;.
,
r - ADDRESS 4 4
„
Lenders Namer
M CITY TEL NO.j # t
'Lender's Address, STATE`,' LIC. p s n d s9 ~
Y p i
'certify that 1 h'ave'read this application and state that the above, LICENSE NO_ :,' CLASS
information'is'
correct. I agree to comply.with all County ordinances •' '
r
and State laws,relating to building construction; d hereby authorize
"representatives'of.this County to enter upon eabove-mentioned'
qo rty for Inspectio 'purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE' ,
A URE P ICA R AGaNT. .: : .DATE,_.