HomeMy Public PortalAbout5043 SULTANA AVE_Mechanical__ 76A364C W�475, -
WOR KhRS COhIPhON DI CLARATION DE 6,6 (260, APPLICATION FOR PERMIT
I hereby stoiisrm that I hove e a a certificate of consent to self
Insure or a certificat,of workers Compensation Insurance or HEATING-VENT ILATI NG-AIR CONDITIONING
a cerllfiLd copy thereof(Sec 3900 1�yIh C)) 0 (n'
Policy Nc5RX40 Compan>- 5r e ��r COUNTY OF LOS ANGELES BUILDING AND SAFETY
nCertified copy is hereby furnished
XCertified copy is filed with the county budding inspection BULDING
department , FOR APPLICANT TO FILL IN ADIDRESS 5043 N'5A
Date Applicant (PRINT OR TYPE ONLY) 7—/,i
LOCALITV•TY}eA/PL£ /y IT(J�
CERTII IC ATE OI LX EAI PT ION FRO\I WORKERS NO TYPE OF APPLIANCE OR EQUIPMENT FEE ` V'�•' �/�, I ,
COMPLNSATION INSURANCE NEAREST
(This Section need not be completed if the work Involved ABSORPTION UNIT BTU CROSS ST 1
by the permit Of for one hundred dollars ($100) or less) DISTRICT NO PRocess Dar U
1 certify th it in the performance Of Phi. work for which this AIR HANDLING UNIT CFM
permit Is issued I shall not emplos any person in any manner S i0 Q O
so is to become subject to the Workers Compensation Laws BOILER BTU
APPROVALS DATC INSPECTORS SIGNATURE U
Date Applicant ' COMPRESSOR BTU ROUGH LU
NOTICE f0 APPLICANT If atter making thisCastltieate of N
1 vemptron sou should become subject to the Workers
VENTILATION SYSTEM FINAL 3 Z
Compensation provisions of the Labor Code you must forth VALIDATION
with comply with such provisions or this permit shall be EVAPORATIVE COOLER
deemed revoked FURNACE FAU—I_\. G AVITV h
f ICLNSED CONTRAC90RS LII CLARATION , FLOOR _�_ BTU_ZO_ �_V /lL a,
I hereby dfirm that I am licensed under provisions of Chapter HEATER SUSPENDED UNIT r
9 (commencing vstth SLetion 7000) of Division 3 of the Busl WALL
/ ness and Professions Code and my license Is In full force and
_ feet yw '� //-� 1
Lattnse Number 1,_-2^41 " - Lit Class v / y
CO ntractor_12 F �f/fis all
1 am exempt from the licensing requirements as I am a
licensed architect or a registered professional cngmeer Plan Check fee 25% Of above
acting In my professional capacity (Scelmn 7051 Bus
mess and Profi.sflons Code) PERMIT ISSUING FEE $ 'D
Lac or Reg No Datc TOTAL FEE
HOMI OWNLR BU11 DLR DI CLARATION PLAN CHECK APPLICANT
1 hueby affirm that '1 am exempt from the Contractor's NAME
License Law for the following reason (Section 7031 S Bust 0 9 2 4 A
nes,and Professions(ode) ADDRESS
I as nastier Of the property will do the work and the CITY TEL NO 9'e •I• • • 8
structure Is not intended or offered for sale (Section
7044 Busmeas and Professions Code) I 1 pyC�. - 21• • 3 0 50
exclusively
-
1 as owner of the property am dxcluvely contracting OWNER ry 5
with IILLnsed contractor, to construct the project MAILG L' y •a• 3 0 50 v
(Section 7044 Busmess and Professions Code) ADDRESS 504 3 ,J LL4n7 N
CONSTRUCTION LLNDING AGENCY CITYTG�� ./GeeArY TEL NO Q.0 1,-83
1 hereby erfor that then. as a construction lending agency / {„TOR ��
for the performance th rhe work for which this pcnmt as CONTRACTOR x0L7
issued (Sec 3097 Civ C )
Lender Name ADDRESS
Lender s Address CITY EL NO
,
T
¢_5, 814 RirO4' —4431
I certify that 1 hasc read this application and state that the STAT( 114fLIC
• above information Is wrrect 1 agree to comply wrth all County LICENSE NO 7 CLASS s
ordinances and State lass regulating Huang Ventilating and
Air Conditioning and hueby auihorare represeptahses of this SLI RI_VLRSL 1 OR EXPLANATORY LANUUAGL
Counts a enter upon the above mentioned property for
uaspc
Sgnaposes
u rL of ;i ee �r�/•/ Da�te