HomeMy Public PortalAbout5349 BUTTONS AVE_Mechanical__ �AVOthat I have a certificate
DECLARATION 76A36,tC 9/99 APPLICATION FOR PERMIT .LIME GREEN
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I :Oreby atlirm that I have a certificate of consent to salt insure,
or a certificl+te c4 iVorker's Compensation Insurance, or a certified i'
R�t r f Sec. 0 LL �C.) r / - HEATING - VENTfLAT�NG-AIR CONDITIONING
61cy No, ' "��/`Z`ompany n �on f 1XW5
COUNTY F LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
Certified copy is hereby furnished.
Q Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN. BUILDING FI�u Avp `
deeppa� �
rtm-ent. a�n w n (PRINT OR TYPE ONLY) ADDRESS [ff l
Date - L—15 Applicant +�.G{.Liw LA LOCALITY
INDTYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FRO WORKERS' NEAREST
CROSS ST_.
COMPENSATION INSURANCE ABSORPTION UNIT,BTU -
(This section need not be completed if the'work involved by the ASSESSOR
OK PAGE PARCEL',
permit Is for one hundred dollars($100)or less.) AIR HANDLING UNIT.CFM MAP
I certify that in the performance of the work for which this permit DISTRI:TNO. PRCCIs DBr ,
is issued, I shall not employ any person in any manner so as toBOILER,BTU - `
become subject to the Workers'Compensation Laws. OaCOMPRESSOR,BTUAPPROVALS DATE INSPECTOR'S SIGNATURE.
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption, you shoultl become subject to the Workers'CompensationEVAPORATIVE COOLERprovisions of the Labor Code, you must forthwith comply with such FINAL 16-provisions or LICENSED CONTRACTORS DECLARATION FLOORhis permit shall be deemed revoked. CE: FAU_j— tAOVII � „ VALIDATION
Thereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT_ �f/(commencing with Section ]000) of Division 3 of the Business andHEATER: WALL ,
Professions Code,and my license is in full force and effect.' -
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License Number
17 L�i[c.Class�j -
Contractor NESL%Ib.ni r:�ltki6 2 (�-1 D v a
' o y ACGT.� o
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I am exempt under Sea
Plan check fee 33(]:3 143.40
cc
B.aP.C.for this reason PERMIT ISSUING FEE$ 124p 06 - 1 ITEMS O
Date: - - TOTALFEE TOTAL 14; 40 w1431+0
7-rteoo11 4Rt$rk _y� 10
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Signature PLAN CHECK APPLICANT - ,N
OWNER-BUILDER DECLARATION fiik
I hereby affirm that I am exempt from the Contractor's-License Law NAME
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
1, as owner of the property, am exclusively contracting MAILwith licensed contractors to construct the,project (Sec- ADDRESS
tion 7044, Business and Professions Code).,
CONSTRUCTION LENDING AGENCY agency cy for:
CITY i l ' TEL.NO. G
hereby affirm that there iso construction lendingCONTRACTO .� �C7f I O� D
the performance of the,work for which this permit Is issued Tn.� J - - - -
(Sec.3097,Civ.C.).
ADORES ry O S .•�e-
Lentler's Name env
Lender's Address A I _
I certify that I have read this application and state that the above STATE LIC.
NO. CLASS i
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 - -
p operty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE -
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SIGNAT F APPLICANT OR AGENT DAT '