HomeMy Public PortalAbout9641 VAL ST_Mechanical__ sK)H hLRS COMPI ,e a CONDI CLARAiION a CEA 888 (280) APPLICATION FOR PERMIT
1 insure
r o a firmcert that 1 have a ca rtificatempen of consent to xlf
msure or u py thereof
of Workers' compensation Insurance or HEATING-VENTILATING-AIR CONDITIONING
a'certlfieJ:opy thereof(Sec 1600 Lab C ) I
Policy No Company
I ❑ Certified copy is hereby furnished COUNTY OF OS ANGELES BUILDING AND SAFETY
❑ Certified copy Is filed with the Lounty budding inspection
department FOR APPLICANT TO FILL IN BUILDING Qp_ �' E.- vAL S�
Date Applicant (PRINT OR TYPE ONLY) ADDRESS Cf(v M
CLRTII ICATF OP EXLAIPTION PROM WORKF RS NO TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY Tuln,PeLF Cf r
COMPLNSATION INSURANCE NEAREST BAkE�
(This section need not be completed if the Work Involved ABSORPTION UNIT BTU- CROSS ST Cllr 1
by the permit Is for one hundred dollars (SIBO) or IeSs) DISTRICT NO PROCESSEi9ty 0
1 certify that In thL p,rformen„ of the work for which this AIR HANDLING UNIT CFM- U
permit is issued I shall not employ any person in anv manner ��Q ^ cc
O
so as to become subject to the Workers COMPLO3at1Un Laws BOILER BTU
Ua[e 4pphcant �.�100a / APPROVALS DATE INSPECTOR S SIGNATURE COMPRESSOR BTU 11 ROUGH V
NOTICE IO APPLICANT If after making this Certificate of _IZI N
Ixemption you should beeomL subject to the Workers VENTILATION SYSTEM FINAL Z
Compensation provisions of the Labor Code you must forth EVAPORATIVE COOLER
with comply with such provisions or this permit shall be VALIDATION
deemed revok,d
FURNACE FAU GRAVITY f
LICENSED CONTRACTORS DF CLARA f10N FLOOR TU il7CJ pbtp V
I hereby affirm that 1 am licensed under proYtsions of Chapter HEATER SUSPENDED UNIT
9 (comm,nemg with Se,41on 7000) of Division 3 of the Bust WALL
ness and Prof,ssions Code and my license is in full force and _
effect
License Number LIC Class
Contractor Date
❑ I am exempt from the licensing requirements as 1 am a \
licensed architect or a registered professional engineer Plan Check fee 25% of above
acting in my professional capacity (Section 7051 Bus PERMIT ISSUING FEE $
mess and Professions CodL)
Lie or RLg No Date TOTAL FEE
HOME OWNER BUILDI R DFCLARATION PLAN CHECK APPLICANT Q WNIM
Q 1
1 hereby affirm that I am exl.mpt from the Contractors NAME 5.OAUEL MA&L-vYA
Lncens, law for th, followmg reason (SeLtion 7031 5 Bust �` A, Sr
�nesss and Professions Cod..) ADDRESS �7"L-
1p
IXC I as owner of the property will do the work and the
struvture is nji Intended or gff&ed for sale (Section CITY T-MPLE Q r f TEL NO +46 4.715
7044 Business snN Professions Cud,)
❑ - OWNER SAMUEL MAG"YAN ;91811A
I as owner uF ;he 6rop ftya ,xtlusrvely contracting
with lic,nsed_ mntraLlttos 'to Lotlilruct the �prnjeLt MAIL
(Section 7044 Business and Professions Code) ADDRESS :S,4mf" # 0 0 *I- 41
CONSTRUCTION LENDING AGFNCY CITY TEL NO 445, *-WCJ 2 * 9 2 7 0 O If
14reby affirm that there is a Lonslruction ILndmg agency . . . 27005
for the performance of the work for which this permit is CONTRACTOR
issued (SLc 3097 CiY C) 0620-80
LLnder s Name ADDRESS
Lender s Address CITY TEL NO
1 certify that I have read this application and state that the ��'y
above information is correct 1 agreL to comply wdh all County LIC
LICENSE NO V CLASS
ordman,es and StntL laws regulating HLating Ventilating and
Air Conditioning and h,ruby authorve repres,ntatives of this SEI: REVERSE I OR EXPI ANATORY LAN G7J AGL
Cu ty to enter upon the 4bove mention,d property for i
ICI ,.cuon pur^ s
IgnaturL of I'erm _
itt, Dote
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