HomeMy Public PortalAbout5032 SERENO DR_Mechanical__ ER S
WORRtIhave Certificate of
�,Y91� r APPLICATION FOR PERMIT LIME GREEN
784'iB4C
I hereby affirm that I here a certilicete of consent to self Insure
or a certificate of Worker a Compensation Insurance or a certified HEATING-VENTILATING-AIR CONDITIONING
COPY thereof(Sec 3800 Lab C)
POS'140Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
❑
Certified copy Is hereby lumiahad
❑ CendaRl mpy Is flied with the county building Inspection FOR APPLICANT TO FILL IN' BUILDING `J—o3a
depertmem (PRINT OR TYPE ONLY)
Date ApplicamLOCALITY
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS CROSS NEARESTST
COMPENSATION INSURANCE ABSORPTION UNITBTU ASSESSOR
(This section need not be Completed If the work Involved by the . MAP BOOR f A PAOEQ�a PARCElQ,3
permN Is f«one hundred dollars($100)(1100)or It ) AIR HANDLING DNR CFM
owrncT ro PAGE ew or
I certify that In the performance of the work for which this permit
IS Issued I Shall not employ any person In any manner to as to BONER BTU
become subject to the Workers Compensation Leen
COMPRESSOR BTU MAW oaasxYu
NO Appecenl VENTILATION SYSTEM -
NOTICE TO APPLICANT If alter making this Certificate of _ ROUGH
Exemption you should become subject to the Workers Compensation EVAPORATIVE SER FINAL
provisions of the Labor Code you must forthwith comply with Such
provisions«this permit shall be deemed revoked FURNACE FAU_ORAVFTY
LICENSED CONTRACTORS DECLARATION FLOOR BTU VALID ATI N
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED UNIT_
(commencing with Section 7000)of Division 3 of the Business and WALL
Professions Code and my license Is In full force and effect _
' ACC•T.:
Liceroe Number Lic Claw
contractor ' Data I ITEM-
Plan check feec c
El am exempt under Sec I OTAL _ 2 . O _ CC
B BP C for this reason PERMIT ISSUING FEE$ .115 0Y
T(U
Data .. TOTAL FEE �Z LHANl7E 'f:L 1L
Signetun PLAN CHECK APPLICANT Z
DINNER BUILDER DECLARATION r n
I hereby affirm that I am exempt from the Contractors License Law NAME ► �I J�I�`IQ�I 17+'-��"h
for the following reason (Section 7031 5 Business and Professions
Code) ADDRESS J!I
❑ I as owner of the property or my employees with wages
as their sole compensation will do the work and the CRY TEL NO
Structure le not intended « offered for sale (Section 7044 <
Business and Professions Code)
1 as owner of the property am exclusively contracting MAIL T
with licensed contractors to construct the project (Sec ADDRESS C]
tion 7044 Business and Professions Code) CITYA CJ-TJ
1 TEL NO
CONSTRUCTION LENDING AGENCY /`
I hereby affirm that there la a construction lending agency for , r
the performance of the work for which this permit s issued CONTRACTOR _
(Sec 3097 Cm C) '-
ADDRESS
Landes Name
CRY TEL NO r
L9ndBr a Address STATE LIC
I certify that I have read this application and state that the above LIC94SE NO CLASS
Information is correct I agree to comply with all County ordinances
and State Iowa relating to building construction and hereby authonze
representatives;Opts County to enter upon the above mentioned
p party lolr I/nsp hon purposes SEE REVERSE FOR EXPLANATORY LANWAOE
1V CFAP VIT A EM CA� Q� -