HomeMy Public PortalAbout6314 SULTANA AVE_Mechanical__ WORKER'S COMPENSATION
certificate
of consent to
76A348DPWeles APPLICATION FOR PERMIT LIME GREEN
78A964C
-�I hereby'afilr�m mat I have a Certificate of consent to self insure,
or a•cartificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING
ppcopy thereof(Sec.3800 Lab.C.)
q-Po�i3 No 7 9 7 02—0 5 Company Fremont COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
F1Certified copy is hereby furnished.
® Certified copy is filed with the county building Inspection FOR APPLICANT TO FILL IN BUILDING
department. (PRINT OR TYPE ONLY) ADDRESS _6314 S
tana Ave-
Date 11 30 93 Applicant AAA Cond Air LOCALITY =rem .;le' Cit:"_
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE •
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. Lon den
COMPENSATION INSURANCE ABSORPTION UNIT,BTU
ESSOR
(This section need not be completed if the work Involved by the MAP BOOK PAGE PARCEL
permit Is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU O�
become subject to the Workers'Compensation Laws. /-
1 COMPRESSOR,BTU Z CO5
APPROVALS DATE INSPECTOR'S SIGNATURE
Data Applicant VENTILATION SYSTEM 99
NOTICE TO APPLICANT: If. after making this Certificate of ROUGH .(�
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code,you must forthwith comply with such FINAL �Z I
provisions or this permit shall be deemed revoked. FURNACE: FAUXXGRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU Z VALIDATION
I hereby affirm that I am licensed under provisions of Chapter 9 HEATERSUSPENDED UNIT
:
(commencing with Section 7000)cf Division 3 of the Business and WALL
Professions Code,and my license is in full force and effect. f
License Number 293529 Lic.Class C20/10
EL
Contractor AAA Cond Air Date 11130193-
❑ I am exempt under Sec. Plan Check fee L
a a
B.&P.C.for this reason PERMIT ISSUING FEE$ 2( 10
Date. TOTAL FEE ' 7 C
Signature PLAN CHECK APPLICANT V,
OWNER-BUILDER DECLARATION
G
I hereby affirm that I am exempt from the Contractor's License Law NAME ,
for the following reason(Section 7031.5, Business and Professions
Code): ADDRESS I-1i:t .7
I, as owner of the property, or my employees with wages T ;r -�r
as their sole compensation, will do the work and the CITY TEL.NO. `'f'D_ 31`15
structure is not intended or offered for sale(Section 7044, ) IE `
Business and Professions Code). OWNER Won _
❑ I, as owner of the property, am exclusively contracting MAIL g TOTAL 3 m t'5
with licensed contractors to construct the project (Sec- ADDRESS 6314 Sultana A CHECK 21.1D
tion 7044,Business and Professions Code).
CONSTRUCTION LENDING AGENCY CITY Temple Cit TEL.No. 285-0322 CH E i it i
I hereby affirm that there is a construction lending agency for CONTRACTOR ,
the performance of the work for which this permit Is issued AAA Conditionea Air
(Sec.3097,Civ.C.).
ADDRESS 10160 Valla Blvd. 0000-130101 ELS-130101 1 '135C."
0.2
Lender's Name i
CITY El Monte TEL.NO. `'!'7h 1 AM
1 9�06
-
Lender's Address STATE LIC.
I certify that I have read this application and state that the above LICENSE NO. CLASS
information is correct. I agree to comply with all County ordinances
and State laws reI tin o building construction,and hereby authorize
representatives of is unty e r upon the above-mentioned
property for inspe on r o s�� SEE REVERSE FOR EXPLANATORY LANGUAGE
Davi Cross 11/30/93
SIGNATURE OF APPLICANT OR AGENT DATE