HomeMy Public PortalAbout6343 TRELAWNEY AVE_Mechanical_7/16/1986_compressor, furnace 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
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