HomeMy Public PortalAbout6267 AVON AVE_HVAC_8/15/1994_Compressor ION
WORKER'S I have
a certificate
of consent to 200046 DPW 9/89 APPLICATION FOR PERMITLIME GREEN.
a -• 76A364C
F^Siere�y afrm that 1 have a certificate of consent to self insure,
or certificat*e of Worker's Compensation Insurance, or a certified HEATING VENTILATING-AIR CONDITIONING
copy thereof(Sec.3800 Lab. C. L1
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Policy No. r--�fCompany U t COUNTY OF LOS ANGELES DEPT OFPUBLICWORKS BUILDING AND SAFETY DIV.
Certified copy is hereby furnished.
Certified co is filed with the count buildingInspection FOR APPLICANT TO FILL IN BUILDING -� ` - /� �C�lt
de rtm tpy (/y (PRINT OR TYPE ONLY) ADDRESS Gil A
Date Applicant "` LOCALITY i
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
CROSS
COMPENSATION INSURANCE OR /y
ABSORPTION UNIT,BTU ASSESSOR
(This section need not be completed if the work involved by theMAP E PARCEL
BOOK PAG
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT O PRocesseo By
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU
become subject to the Workers' Compensation Laws. ✓� O
COMPRESSOR,BTU '?i7i � ✓
APPROVALS DATEINSPECTOR'S SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption, you should become subject to the Workers' Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL �-
provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION
1 hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT
(commencing with Section 7000)of Division 3 of the Business and HEATER: WALL
Professions Code,and my license is in full force and effect.
Kl `�!�!
License Number ^ Lic.Class (� , •• = --
`Jam ) ���� -L— _ ! r
Contractor Date i �'rr�._! �
❑ Plan check fee
I am exempt under Sec. T!I s L 5 2 � �_--5
B.&P.C.for this reason PERMIT ISSUING FEE$ SL dE+—
"'HECK
tJ
Date: V :t fi• _ e I V
TOTAL FEE t HN[I'•,E =j it W
Signature -
co
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT Z
I hereby affirm that I am exempt from the Contractor's License Law NAME -.0
r
for the following reason (Section 7031.5, Business and Professions `j'3'``} '"} - r
Code): ADDRESS 51
❑ 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 U
❑ I, as owner of the property, am exclusively contracting MAIL vw
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code). JJ
CONSTRUCTION LENDING AGENCY CIT Yftwyy)
�6L TEL.NO.
I hereby affirm that there is a construction lending agency for CONTRACTOR �f(/7 �`
I performance of the work for which this permit Is issued -F.
(Sec.3097, Civ.C.). �� �_
ADDRESS a
Lender's Name pp ,� /J 3p�. (V-V _
n) ZRV
CITY 1�15%/wCU�'Y J EL.NO.�rO
Lender's Address STATE LIC. r-
I certify that I have read this application and state that the above LICENSE NO. G CLASS C
information is correct. I agree to comply with all County ordinances
and State laws relating to building construction,and hereby authorize
representatives of this County to enter upon the above-mentioned
propertyfor,igspe on pur ses. ` SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNA R OF APPL 6 O NT DATE