HomeMy Public PortalAbout5248 SERENO DR_Mechanical__ affirm
that I have a certificate
DECLARATION to 400odeDPW a/em APPLICATION FOR PERMIT LIME GREEN
I hereby affirm that I have a certllicete of consent to Bell Insure
70,0048
or a certihcate of Worker a Compensation Insurance or a certified HEATING-VENTILATING-AIR CONDITIONING r
copy thereof(Sec 3800 Lab C) '
QNo Company COUNTY OF LOS ANGELES DEPT OF�PUBLIC WORKS BUILDING AND SAFETY DIV
Certified copy is hereby fumlehed '
❑ Ce m Oleo w+al Ow county wudng IlwppCdOn FOR Al P�PILIDCRAET«OaFlLL IN
BUILDING
ADDRESS
Date Applicant LOCALITY C
NO TYPE OF APPLIANCE OR EQUIPMENT FEE f
CERTIRCATE OF EXEMPTION FROM WORKERS NEAREST'
COMPENSATION INSURANCE ABSORPTION UNIT.BTU CROSS ST'
(This section need not be completed If the work Involved by the MAP BOOK
ASSESSOR PM3E PRC
AEL
permit Is for one hundred dollars(3100)or less) AIR HANDLING UNITCFM
omrlem mcc®
I certify that In the performance of the work for which this permit so a.
Is issued I shall not employ any person In any manner ea as to SCALER BTU
become subject to the Workers Compensation Lowe OC20 DP
COMPRESSOR BTU
Data 7 Q3 Applicant VENTILATION SYSTEM .rnrnus M11xnwalon°alaannxe
NOTIC TO PPLICANT If eller making this Certificate of ROUGH 7/L
Exemption you should become subject to the Workers Compensation
provisions of the Labor Code you must forthwith comply with such EVAPORATIVE COOLER FINAL
provisions or this permit shall be deemed revoked FURNACE FAU GRAVITY
LICENSED CONTRACTORS DECLARATION t FLOOR BTU VALIDATION
I hereby affirm that I em licensed under provisions of Chapter 9 NEATER SUSPENDED UNIT_
(commencing with Section 70110) of Division 3 of the Business and WALL
Professions Code and my license Is in full face and effect (�
License Number 5 to 6 Q Llc Claes G-ac,
a
to to-3t-g3 8
❑ I am exempt under Sec Plan Check fee
Q
B aP C la thla reason PERMIT ISSUING FEE f G U
-Date TOTAL FEE .s LU
Signature '
OWNER BUILDER DECLARATION PLAN CHECK APPLICANT r Z
1 hereby affirm that I am exempt from the Contractor s License Law NAME ►
for the following reason (Section 7031 5 Business and Professions
v
Coda) ADDRESS
❑ I as owner of the property or my employees with wages WCT.AT
as their sole compensation will do the work and the CITY TEL NO vvK.J3 Lu s'•=I
structure Is not intended or offered for eels (Section 7044 JJV
Buelneea and Professions Cede) OWNER L lam, 1 ITEMS
❑ I as owner of the property am exclusively contracting ^ l '
r with licensed contractors to construct the project (Sec MAL
RESS 3 / E ' TOTAL 122_25
tion 7004 Business and Professions Code) CITY TEL NO -W 4 t,+>t�t 172.25
CONSTRUCTION LENDING AGENCY 7.L�����
I hereby affirm that there Is a construction lending agency for CONTRACTOR
bfP� .01I
the performance of the work for which this permit a issued(Sec 3D97 CN C)
ADDRESS ndk _
Leer°Name 0000-0001 7/26/93
Lenders Address CITY TEL NOq 0918 1 API 8:0S
STATE LIC
I certify that I have read this application and stets that the above ucENae NO CLASS
Information is correct I agree to comply,with all County ordinances
and State Tawe relating to building construction,and hereby authorize
representatives,of this County to enter upon the above-mentioned
Me a for s cUon purpose° SEE REVERSE FOR EXPLANATORY LANGUAGE
Tu Asru R ort Dort w '