HomeMy Public PortalAbout6207 RENO AVE_Mechanical__ �ccerfiflcate
I ho,ENS cerci DECLARATIONAPPLICATION FOR PERMIT
I h � t I have a certificate of consent to selfinsu`, of Workgrs'Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
or o certified copy thereof(Sec. 3800, Lob. C.) 76A364C
I CE-818(REV. 10/81)
Policy No. Company
Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING // /-^� f
V
tion department. (PRINT OR TYPE ONLY) ADDRESS ig 7 /�/ AV
Date Applicant LOCALITY A�/+4 C
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST.
(This section need not be completed If the work involved by ABSORPTION UNIT,BTU DISTRICT NO PROCESSE Y
the permit is for one hundred dollars($100)or less.) _
I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM � /]
permit is issued, I shall not employ any person in any manner BOILER,BTU (J�
so as to become subject to the Workers'Compensation Laws.
APPROVALS DATE INSPECTOR'S SIG TORE
Date 7 Applicant�` a- /0,7_:L-Zn COMPRESSOR, BTU ROUGH
zo
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER /V TIO
with comply with such provisions or this permit shall be l/
deemed revoked. FURNACE: FAU AVITY Q
LICENSED CONTRACTORS DECLARATION FLOOR BTU D Q
1 hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
'(commencing with Section 7000) of Division 3 of the Business WALL
and Professions Code,and my license is in full force and effect.
O
License Number Lic. Class ® %7
Contractor Date 2 7 7 A11—
F-1 # 0 0 0 0 0 8 W
I am exempt under Sec. Plan check fee IL
B.BP.C. for this reason Iaa2050 U)PERMIT ISSUING FEE$
Date: TOTAL FEE �Gl a 13 .' y v r
Signature
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and NAME
Professions Code):
I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and
the structure is not intended or offered for sale(Section CITY TEL. NO.
7044, Business and Professions Code).
p�j/� OWNER
I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec- MAIL
tion 7044, Business and Professions Code). ADDRESS
CONSTRUCTION LENDING AGENCY CITY TEL. NO.
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued CONTRACTOR
(Sec. 3097, Civ. C �
/qA �j2�� ADDRESS
Lender's Name � _[ �./Y" `�
Lender's Address A I �} /� CITY TEL NO.
� Ts`i ( iV /r
STATE LIC.
I certify that I have read this application and state that the LICENSE NO. CLASS
above information is correct. I agree to comply with all County
ordinances and State lows relating to building construction,
and hereby authorize representatives of this County to enter
upon aborn;�d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
. f�tl_sz //-� 4 - 97
Signature of Applicant or Agent Dote