HomeMy Public PortalAbout5112 AGNES AVE_Mechanical_3/31/1982 -a r
WORKE RS'C01\1PFN,,ATI()'� i�1 i A'-
APPLICATION FOR PERMIT
I herehv affirm that I have a
insure, or a certificate of Worker,' HEATING-VENTIL&X41SIG IR CONDITIONING
a certified copy thereof(Sec. 3866, 1,tr,
Policy No.-Compan-,-
F] Certified copy is herehy furniv r, , COUNTY OF LOS ANGELES BUILDING AND SAFE!
0 Certified copy is filed with the
F(I"RAPPLICANT 'rO FILL IN BUILDING
department ADDRESS.
Date- Applicant_..--_ N r P Y P E ON'L,Y
LOCALITYf--' CL
:IPMENT :
FEE0
CLARTI 1 ICA YF OI F XEMPI'll": 0
COMPENIS"A"FIO11
N 1%' � NEAREST
Cix�-
ST. W(This section need not be completed f ('J CROSS —j
-----r -7n
by the permit is for one hundn-4.1 J,A! s 777ICT NO PROCESSED BY LL
T; F
I certify that in the performavc,, ,f d V,
permit is issued. I Shall not emplio, I),f%1) 1 1 Ifl,
so �ojPecPme,§Uj)ject to tll,z U
APPROVALS DATE INISPECTOR'S SIGNATURE <
Date_ Applicant r
M P 1 1 Bi U----- 0
ROUGH
NOTICE TO APPLICANT: If. G
Exemption, you Should hec,tii,t -FINAL LU
Compensation provisions of If P
with comply with such prr,%
deemed revoked.
L1CI-*.NSED CON FRA(-T OR 01 L.\:? lf)"�
I hereby affirm, that I am licensed Lino,
,-{E,,- UN
FL D UN!T
9 (commencing with Section 7000) W h, B", A A L L
ness and Profecions Code, and rriy li, is In all for ,I,)I I
effect. 7
-- t, �Z.
LerreN�u m is,
Contractor----.-
El -1 am exempt from th-, I
licensed architect or L r,--i
-)ec E) of ,,Dove.
Ji f 2
acting in In%- !)n,fc, 1 1
mess and Profes,wns PERmrr ISSUING FEE $;
Lic.or Req.N�) JOTAL FE
herehc
1ACCIISO 11%�, ?,Ir Ij,L
nesT,and Prorev,i,,,Il f
D 1, as
strucur,� 1, ;1,",
7044
with lac ers
(Section 704: . Bit,;
fj
CONSTP 1;C1 ION f 0
irm that there is "i
I heieby aff �1)1 'I''I I
for the pert)rtiianco of the 1
(Sec.
issued 3097,Civ.C.
Lender's Name---
)
Lender's Address
TE L4*40.
I certify that I have lead !hi ATE 7 LIC
above information is orrect. I U,I o j LICENSE N 01 CLASS
ordinances and State I-%,. rc
Air Conditioning, and !-1F I R I X P I N T(-)1:Y 1,k N 6 1 A G 1:
County th,--
Y
Signature of Permittee
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