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HomeMy WebLinkAbout1379AI hereby affirm that I am licensed under provisions of Chapter 9ATER: SUSPENDED -UNIT - HE '(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effec ( t.' License Number Lit. Classrc` - � O Contractor "n'�" ate 0 1 am exempt under Sec. Plan check fee B.&P.C. for this reason Signature OWNER -BUILDER DECLARATION PLAN CHECK APPLICANT DEC WORKERS' TION APPLICATION FOR PERMIT that a certificate t I have cafe of corse I hereby otikm Ihat I have a certificate of consent to self ❑ I, as owner of the properly, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Section CITU OWNER insure, or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING or a cerci ted copy thereof (Set. 3800 b. C.) + 76A364C - CONTRACTOR the performance of the work for which this permit is issued /J -7 -y P�l�2/ Company CE • 818 (REV. 10/81) Lender's Name C ITY t2ry Q COUNTY OF LOS ANGELES above information is correct. I agree to comply with all County BUILDING AND SAFETY Certified copy is hereby furnishe . Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING ADDRESS /� do d pa menf. (PRINT OR TYPE ONLY) r /r Date • �� Applicant 11 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' - NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST CROSS ST COMPENSATION INSURANCE (This seetlon need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRiCI NO, ROCESSED BY the permit is for one hundred dollars ($100) or loss.) I certify that in the performance of the work for which this AIR HANDLING UNITCFM 16, ,�/y\ t Q permit is issued, I sholl not employ any person in any manner so as to become subject to the Workers' Compensation Laws. BOILER, BTU APPROVALS DATE INSPECTOR'S SIGNATURE COMPRESSOR, BTU Z rOUGH Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deemed revoked. - '- FURNACE: FAUG 11fAY )T� /� LICENSED CONTRACTORS DECLARATION FLOOR Biu I hereby affirm that I am licensed under provisions of Chapter 9ATER: SUSPENDED -UNIT - HE '(commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effec ( t.' License Number Lit. Classrc` - � O Contractor "n'�" ate 0 1 am exempt under Sec. Plan check fee B.&P.C. for this reason Signature OWNER -BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License NAME Law for the following reason (Section 7031.5, Business and - Professions Code): ADDRESS ❑ I, as owner of the properly, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Section CITU OWNER 7044, Business and Professions Code). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- - tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY MAIL i- ADDRESS CITY - I hereby affirm that there is a construction lending agency for CONTRACTOR the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). - ADDRESS Lender's Name C ITY t2ry Lenders Address certify that I have read this application and state that the STATE l yf LICENSE NO. -f t above information is correct. I agree to comply with all County - ordinances and State lows relating to building construction, PERMIT ISSUING FEE $ TOTAL FEE TEL. NO. (X) TEL. NO. 3 3U4 A55 e�ZD C1 and hereby authorize representatives of this County to enter upon a abov -mentloned property for inspection purpos . SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date } O ;2137.9A #.e...fj 0- f f ..53.25 a e�•52.5Z x207-88 t , Lo ,I 1 to in - N O ° c 0 S �:vrti30©m. ,i ���"O t]�fO O - SC.�O'f�9� rV���OO-.°o VO�tOw S ° tr G 0 _ . Q1 ° O n < T ?' ° O v' ' CO .°' . . O T O C O �. O . 0-0 TO 3 N ate. O p n o (D-0 yO r..b ^< 3 O m. Cl °� a©� C) t°CD I• cno -C30 0 �'^ .u3p 7 Q n x m'd H'� T'o ° �. 0 .G< H f y� v Q_o n N n. p a O O N o r W n° 2* N°+ O C °. O' -• '� xS <C O C O j 0 0 r - - a f 3i Naa o=O aIL 11 j O �33-o °.,1 'SL 3 0 .,0 --'O x w'�'� ?gyp ^,0- N 'a S..O o M a^ <°'O"` CL � 1 on'N�,n� oto�n=�°v)- o0n.^ oSc��-?oo3...a . CL �� o 43 --u o0 0 00 fl �, o o p Toa a vm�v vD. 11 5- � S p '17 O Q' O C % Y. O O N ,. VC C Q." n° O K o to .O p '? ovNov n SS�a'of o c 3 o na = u o o -o w -c. p v s 0 O- .OQ.- y?. Mo '•o 0 in CL CD 3 s.m. o a° o n t m p n m O f - �' w CL ° -..� 1° "p o- ? CL — 0 0 .S O • N ° 'O l0 p, N p � S O R.S. �' O O F ' O n a- o£ 0o a�°c` a?�° N3-