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HomeMy Public PortalAbout6343 TRELAWNEY AVE_Mechanical__ WORKERS Ct I haveATIONDLCLARATION CE 81 C APPLICATION FOR PERMIT CE 979 (2901 1 he+Ib) affirm that 1 have a certificate of consent to xi( Insure or a certifitale of Workers Compensation Insurance or HEATING-VENTILATING-AIR CONDITIONING e bcr N d S,Qp� ihs sp( 1y1 7800 Lab eM Poles) No 6Y�L�7pL a tpanv /r—\i0',c• ONT SN ❑ Certified copy is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY ® Certlfi,d copy is filed with Ih ty budding i action BUII-DING department ._ r' FOR APPLICANT TO FILL IN ADDRESS /�y3 T12� /f�Ne Date]-/S_ ACgpphcant Lou� ,GtlYLae/ (PRINT OR TYPE ONLY) ADDRESS (O C6 RTIIlCATE OI EXEMPTION FROM WORK( RS NO TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY jj�r•. COMPENSATION INSURANCE NEAREST } (This section need not be completed if the work Involved ABSORPTION UNIT BTU CROSS ST O1 by the permit 6 for One hundred dollars (SIOO) or Iess) DISTRICT NO P8 ROCIE B� 1 certify that In the performance of the work fur which this AIR HANDLING UNIT CFM V!O V cr permit is Issued 1 shall not employ any person In any manner LJ a O so as to become subjLcl to the Workers Compensation Laos BOILER BTU 6 �D � APPROVALS DATE IN ECTO SIGNATURE yy Date Applicant COMPRESSOR BTU 36, 000 W ROUGH W NOTICE TO APPLICANT If after making this Certsf'l"tL of VENTILATION SYSTEM 0"0 ? I xemptiun you should become subject to the Workers FINAL Compensation provisions of the Labor Code you must forth with comply with such provisions or this permit shall be EVAPORATIVE COOLER VALID TION deemed revoke) FURNACE FAU✓ C�.i'yyLL�v r�ITV I ICLNSED CONTRACTORS DECLARATION FLOOR BTU—.9.]f ODD— fid 1 hereby affirm that I am licensed under provisions of Chapter HEATER SUSPENDED UNIT 9 (commencing with Section 7000) of Division 7 of the Bus, WALL ness and Professions Code and my IICLnSL Is in full toms- and effect ��,// License Number_l q S LIc Class C 3� Contractor 00W1Vt9Q Date 7=Z 4C ❑ 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer Plan check fee 25% of above acting In my professional capaLity (Section 7051 Bus #fi L Q i 4 8 .nets and Professions Code) PERMIT ISSUING FEE S 3�S • • 3(150 Ltc or Reg No Date TOTAL FEE • • - 3G505 3(1505 HOME OWNER BUILDER DECLARATION PLAN CHECK APPLICANT 07 1 6,t86 1 hereby affirm that 1 am Lxempt from the Contractor's NAME License Law for the following reason (Section 7031 5 Bust nets and Professions Code) ADDRESS I as owner of the property will do the work anti the structure Is not mlended or offered for Sale (SLCtIOn CITY TEL NO 7044 Business and Professions Code) //yy ��i1"" ❑ oOWNER 4/y� ���5 /Ve/Soni 1, as owner of the property am exclusively entraef ng /„ ' T�7 �1 , with heenud contractors to construct thL project MAIL 637/3 / rL e/�/W�"! ��- (SLelton7044 Business and Professions Code) ADDRESS CONSTRUCNON LLNDINO AGINCY CITY Tc, TEL NO Q Y I hereby affirm that there is a construction lending agency [� for the performunLe of the work for which this permit Is CONTRACTOR �oyNu2 Ail Q/✓e� issued (SetQv C) 4'9 J/ Lenders Name, ADDRESS Lender's Address CITY r1f~4. cl -7 TEL NO VY.S- j yf8 I certify that 1 hive read this application and state that the STATE I-Gro 37JJ LIC y� above Information is correct I agree to comply with all County (CENSE NO CLASS O ordinances and Stale laws regulating Heating Ventilating and Air Conditioning and hereby authonie representatives of this SFE RI VI-RSL FOR EXPLANATORY LANGUAGE County to Lnter upon �the �above mentioned property for este urpo es� 7` Slgnat re of Permitli:e Date M