HomeMy Public PortalAbout10554 DANBURY ST_Mechanical_5/6/1993_Compressor 46
1N that I have a certificate
DECLARATION 763640 W 9/89 APPLICATION O PERMIT LIME GRE
0-00 4C
I �?eby affirm that I have a certificate of consent to self insure, •f -'
ENiL
or a certificate of Worker's Compensation Insurance, or a certified' HEATING- VENTILATFNG-.Al CONDITIONING
copy ther/�/gf(Sec. 3800 Lab. C. -
PClicy Nr� py m�UNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
E Certified copy is hereby furnished
Certified copy is filed with the county bu�Inacti FOR APPLICANT TO FILL IN ADDRESS
dep a (PRINT OR TYPE ONLY) /✓�`"' ��
/p_r9�eJ% LOCALITY
Date Applican NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EX PTI FROM WORKERS' NEAREST ,y
CROSS ST.
COt be co NSU RANGE ABSORPTION UNIT,BTU ASSESSOR
(Thisperm section need noted comps(S1 0 the work involved by the MAP BOOK PAGE PARCEL
permit is for one hundred dollars(5100)or less.) AIR HANDLING UNIT,CFM
OISrRILT NO. PFOCESSEO BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU [!
become subject to the Workers'Compensation Laws. I
COMPRESSOR,BTU
_
hIIC0 PLS DATE aPECTOfl'S SIGNPTURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers' Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL
provisions or this permit shall be deemed revoked, FURNACE: FAU L ,D DATION l
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT_
(commencing with Section 7000) of Division 3 of the Business and WALL
Professions Code, and my license is in full force and effect. I' Z`Q 8 / •"!>"w"4J r. -
License Number C/ Lia Class`-� � �' ��'(-I!T '
a.
OW
ConVacto ate _ q
❑ Iam xempt under Sec. Plan check fee - 4(�Q �(p, "6'D 1 ITEM` e e
B.BP.C.for this reason PERMIT ISSUING FEE �• TOTAL =a m _r O
CHECKDate: TOTAL FEE ' {�,G` � 715.45 V
Signature CHANGE]E •��{ N
PLAN CHECK APPLICANT -'
OWNER-BUILDER DECLARATION - � Z
I hereby affirm that I am exempt from the Contractor's License Law NAME DnI}IjIJI]-1�I�L 1 / G/��
for the following reason (Section 7031.5, Business and Professions
Code): ADDRESS -
❑ I, as owner of the property, or my employees with wages ...
as their sole compensation, will do the work and the CITY TEL.NO.
structure is not intended or offered for sale (Section 7044,
Business and Professions Code). OWNER -
❑ I, a$ owner of the property, am exclusively contracting MAIL - /'�-7Y`�' /I✓✓`�� -
with licensed contractors to construct the project (Sea ADDRESS ��—
tion 7044, Business and Professions Code). -
CONSTRUCTION LENDING AGENCY C V TEL.N
I hereby affirm that there is a construction lending agency for / �. D
the performance of the work for which this permit Is issued CONTRAC RAll
-
(Sec. 3097,Civ.C.). ,L' •'••',:
ADDRESS
Lender's Name
cl7 I TEL.NO.
Lender's Address
I certify that I have read this application and state that the above LCENSE NO, CLASS
information is correct. I agree to comply with all County ordinances
and State laws relatin o building construct, and hereby authorize - -
r entativ f th' Cou ty t enter u n ito e-m tioned
rope r spec On p s', SEE REVERSE FOR EXPLANATORY LANGUAGE
eIG AE OF APPLICANT OR AGENT DATE