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HomeMy Public PortalAbout9413 LAS TUNAS DR_Mechanical__ 3 ; WORKERS'eCOMPENS a 76A364C ATION'DECLARATION - " I hereby affirm that 'I, have a—certificate of consent to self - CE-$1$"(2-80) - P L CAT�, 0�I- r0If`� ���QC/II� U. insure, or a.certifica#e of Workers' ompen5ation Insurance;oe HfEATiWG,l1 TILTIIts=AIR GOW®1'I'IONI(r�4Ca d certified copy thereof(Sec.'38'00,Lab C-)_• 1?olicy Jvo7�7a 0 3CompanctQ 0, Certified copy is hereby"furnished., CtOUNTY'.OF LOS`,AiVGE-LES ��� BUI`LDIf1lG'Aft10 S ,FIETY: ' Certified copy is filed with the County building inspection, i BUILDING �dPpartment.` FOR_APP„LICANT"TO FILL��IN [[� _ Y}1 ADDRESS 7 /K/��S /� ��y,� -s' _ A. CERTI; IGATE OF EXEMPTIONFROM WORILERS ` NO TXPE OF'APPLIANCE OR EQUIPMENT FEE LOCALITY -COMPENSATION INSURANCE NEAREST v (This section need.not be compfeted i� the'work. involved ' ABSORPTION.UNIT, BTU C/ ���� 0 by the permit is fog type hundred dollars ($100) or less.). OCR©CS No". PRocesser sv U ; . e AIR HANDLING,UNIT CFM, ' I certify that, in the performance of_the`•work for which this• permitis.issued, I-shall not employ any person in any manner so as to becorne subjec# to the Workers' Compensation Laws-. BOILER, BTU — D �t APPROVALS, • D TE INSPF TOa,S SIGN TURF '-.L) Date_ Applicant C'OMPRESSOR., BTLU U, �i w N, NOTICE TO Lel T' after makmg,this.Certificata,of VE-NTILATION SYSIzEM Z ROUGH Exernption '`>you. should: beegrrie subject ,to th'e- Workers', FINAL Compensationprovisions of the Labor Code,'you.mustforfFi- - with,'comp'ty with-such provisions; or this permit,shall be EVrAPORATJVE.COOLER '. deemed revoked.. f.. a . V FURNACE: ' FAU GRAVITY A LIDATI N " . FLOOR: - - BTU�L pb ' / LICENSED OONTRACTORS DECLARATION ATTON / ; I hereby affirm that I'am licensed vender provisionsof,Chapter', HEATERr,- ,SUS,PNDED UNIT 9 (commencing WAili Section'7000)�¢f Division 3 of the Busi= ” :WALL " ness and Professions Code, and,my license is in full force and effect. License'Number�� 7J� Lic.'ClassC t{ Contractor E.,=f1AQAL#! —AOL Date 7 d-7 I'arri exempt,from the licensing requirements 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- ` loess and Professions Code). PERMIT fSSUINI 3 FEES .<- Lic.or Reg.No. Date TOTAL,FEE' f? � . 'HOME OWNER,-BUILDER DECLAPLAN CHECKAPPLICANT RATION ; 3 9 S,5,A I hereby affirm that 3 -am.exempt from-.the C.ontractor's NAME• h° License Law for the following reason (Section 7031.,5, Busi- 8 .ness and Yrofessipns,Code): ADDRESS [,,.as owner.,of the property, will do the work and the c Q= structure, is not intended or offered:for sale (Section CITY TEL:,NO.' �.?0°0o'3 7044, Business a'nd Professions Code). OWNER 9 0.5 84` 1, as.owner of the property, am exclusively'contracting a ` with"licensed: contractors_ to.-construct the ,protect MAIL � IT-� (Section 7044,Business and Professions Code). ADDRESS !/7� ( Q�/¢f'` CONSTRUCTION.LENDING AGENCY /e' E CITY TEL NO.� I.hereby affirm that there is a construction lending; agency '�j!� - 'for the performance of the work'for which this permit is CONTRACTOR�}' Q /�° n /� issued (Sec.3097,CiVrC.}. ��� �! l<�j Lend'er's Name ADDRESS Lender's'Address � NO. /�C ` sC;lTY TEL�PiLt��Q. r f- ��2 I ceitify,that I'have read this application and]state that the STATE'=.- LIC.. 3 C,ZA above information is,correct..I agreeto'comply with all County` LICENSE'- 0: 0373-5: ': CLASS ordinarlces ani, State_laws.regulating.heating;:Ventilating and Air'Con;.r-n,ng, end hereby authorize representatives of`this SEE REVERSE 1<OR`EkkPA ATORY LANGUAGE. Count, # nter 'u, n the above-mentioned proper#y for ' mspec.io+ pi pos s. Signa'crr .; 'er lit Date