HomeMy Public PortalAbout5522 SARA MAR LN_Mechanical__ WnjIF US CO%1PFNSATiON DI CLARATION 76A364C -
I,�Sbv, affirtn that I hese a certtflcate of consent to self CE 818 (280) APPLICATION FOR PERMIT
mSure or a certtflcate of ROrkera Sompcnsabon Insurance or HEATING-VENTILATING-AIR CONDITIONING
twC..6;-en0'�thhertof(Se, 3300 Lab C) /� t�
Policy *1. _II 1A0-CompanI-S P�O PL-•-r~L
Ctrtdlcd copv is hlo,by turmshLd COUNTY OF LOS ANGELES BUILDING AND SAFETY
J i erhfnJ cap) Is filed with thL nounn hwlJing vsp` FOR APPLICANT TO FILL IN FOR �Tffr��
i car' myv OaCC aY7,Yd /'W�
2ppireant l� (PRINT OR TYPE ONLY) ADDRESS //-
LOCALITY `/- l-!Ole/I•L of
CLR iII ICATL 01 EXI hIPI ION FROM WOR EERS NO TYPE OF APPLIANCE OR EQUIPMENT FEE / L^�V C_ !(//j
LO%1PLNSAf10N INSURANCE NEAREST }
CROSS ST a
(Tins section need not be completed If the work Imoived ABSORPTION UNIT BTU O
b) the permit IS for One hundred dollars (SIBD) or less) DISTRICT NO ` / PROCESSED BV r-)
L o
I Le-tIf) that In the perform ui f the work for which this AIR HANDLING UNIT CFM 5f. �q W
PLfmn Is Issued, I shull not Lmplo)_any pirson In anv manner Va O
so as to become suhjlct to the 1VOrk LfS Cump,.nsauon Laws BOILER BTU UUUC
.•7 APPROVALS I AD�ATFI�PCTOR• IGNATURE WDmc Applicant COMPRESSOR BTU-3 kr _QUROUGH Do
WNOTICI TO %PPI ICANI If after mtkuig this Certthcate of VENTILATION SYSTEM FINAL
Facmptton )au should bLLame SLbjtel to the WorkLr,i
Compansmon prusnwns Of IIIL Lubar Code you must forth EVAPORATIVE COOLER VALID ON
with eompl9 with such provisions or this permit Shall he
d Lcmed resoked
FURNACE FAU_ GRAVITY
LIC( NSI D(ON[RACTO RS UI LLAR ATION FLOOR BTU
-
I herehv affirm that hint licensed under provisions of Chapter HEATER SUSPENDED UNIT _
n (cummcncing wuh SLLi Ion 7000)of Doision 3 of the Bust WALL
ne5s snd Profeseiuns Code and In) IICLnse Is in full farce and
effl,t 1 'S ( Y
IICLnse Number VJ7�.+ LIL Clux e�sr g7e)'p
Cuniraltor Cp N_N o2 UaR �—�3 �( -
I am ecelnpt ITOM Ilil hLLItSint, requirements as 1 am a
hccnsed architect of a registered proflsstonal engineer Plan check fee 25%of above
ittiny in my profes%tun d e.,pacny (Section 7051 Bust R 7 45 2 A
mess and Pro6SSlons Code) PERMIT ISSUING FEE $
Lw or Rep No Date TOTAL FEE
HOME OS1'N1 R BUILDER DLC( ARATION PLAN CHECK APPLICANT
1 hereby affirm th7l I am LZLmpt from the Contractors NAME 1 *y2050
Ltc,r Law for the fuflo,smg rcaSon (SLCtIOrv7031 5 Bust
neSs and I'rofeSvons (ad;) ADDRESS • • 2 a 5 0 5
I is foiner of the propuly wIll do the cork and the
structure is not mtLLnded or offered for sale (Section CITY TEL NO _ s Q 7� 3 8•�
7044 Busoteu and Pror ssiolls Code)
I is owner of the property am LellusrymUOWNER 2
ely cuntcng
with licensed contractors to construct the project MAIL ��•� �L. y,QN!
(Stenm
on 7044 Bus ,.%i and Professions Codc) ADDRESS rad '/"
CONSTRUCTION LLNDIN(,A61NC) CITU `�A�.( /O�-(J/ 5/ TEL NO
I hereby uifirm that Ihcre Is , construction lending agency
fur thL perforrnm a tit 7hd work for ssbi,h this permit is CONTRACT R
I[pned (SeL 3097 Lay C)
Lender s Name ADDRESS �(��� �j Fre/N/ ///`
Lender sAddress CITY �t, �y "7✓�� TEL NO a9_G�.31.f
1 clr ify that I hau rLad thus appllcallon and stale that the STATE ( 9 LIC /1
abou m/ormatton Is cnrrc CI 1 agreL In comply with all Counts LIC NSE NO 027 1 CLASS` SC. O
urdmancas and Since Ides regulating Ilcatins Vcnidatmg and
Air Cund.h.ning and hlrehs authortrn repms,.ntatues of that SEE REVLRSI. i OR EXPLANATORY LANGUAGE
If
to Lnt,r u�tn ubaSementmnld property tui
nnAIms.S �1 V ,
e of 1'ermrtteL Otte _ _ ,