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HomeMy Public PortalAbout6026 CAMELLIA AVE_Mechanical__ • WORKER'S have COMPENSATION of consent 9/� APPLICATION FOR PERMIT .IME GREEN, > `,I her" affirm jf1eY I have Q cerUfloate of oonsant to sell Insure, of a oartmbate of Worker's Compensation Insurance, or a oarttfled HATING-VENTILATING-AIR GONDMONING •oopy thomf(Sec. ) 4.1.0,b 'o-LDEn/ Perry E/J4crt ❑ COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUI DING AND SAFETY PrV. Cerd5ed copy is hereby trnialwd. certJW copy,Is filed with the county bulkttng tupecdon FOR APPLICANT TO FILL IN e gg GO hEt:L 1 (PRINT OR TYPE ONLY) /j�(1% .�/ G- 4 R I g.4,•J'fl/fN� - LQcwrY Dole . Tom, Appoasnt HO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAFjtBT CEFMRCATE OF DM MPTION FROM WORKSW ST. (f/✓,i� f COMPENMT)ON INSURANCE ABSORPTION UNIT BTU ASSESSW (This*action nand not be oompleted ft the work Involved by the PAGE PARCEL permit In for one hUndrid dolFars({100)or lea.) AIRµ�OLNG UNIT CFM wo. rrAGE BY I certify that In the performance of the work for which this perrhtt li Issued, t @hall'not employ any person In any manner so as to BTU ` beoome subject to the Workers' compensatloh Laws. �O Q/' COMPFE880R,BTU . AP*IbVMJ .. MT. @moron's 803NATUF6 D!ds APplIc-M VENTTLAT10N SYSTEM NOTICE TO APPLICANT: I1, after making this Certlllbate o1 ROUGH ExerhptIon,you shoukf become subject to the We kers'Compenasdion EVAPORATrVE COOLER provlslons.of the Labor Cod6, you must forthwfth oomply-wtth such FlNAL _� provlalorts or this permit shall be deemed revoked. FURNACE: FAU LICENSED CONTRACTORS DECLARAT)ON FLOOR 8TLI .� 1(ALIDAIr"' I hereby efftrm that I am Ilcensed under provlalphi of Chapter 9HEAl9T %OPENDED UNIT.. �commenoing wnlf on 7000) of Division 3 of the guslness and WALL • roTealone Code, my license In In full'torce and effect Lkanw Number ?7 Uc,Claeb } ContractDr I am eocempt.under Seo. Plan check fee B.BP.C.for this rewon PERMIT ISSUING FEE f j O Date: TOTAL FEE . W. 83grrrhre OWNER-BUILDER DECLARATION FLAN Z I hereby aMthat I am s"mpt from the Contractor's License Law NAME �G MSG,-!/4�/ e q-r ,t.9' ' )or the following reseed (gectlon -0WI.6, Business and Professions Code): A°°REss I2S`�' (Af-!A CLa4ItA . S �'/ OCT.ir I, as owner of the property, or my employees wfth wages as their bele oomppneetlon, will do the work and the CITYd� 4 TEL NO. tr(�7 3L 105.17-!.. structure Is not Intended or offered for sale (Seotlon 7044, /TI 1 1 I ' Businsee and Profeaslons Code). OWNS- oe- © I, as owner of the property, em exclusively contraoting MAIL TVAL 1Q5 - 72 with"Ilcensed contractors to construct the project (Sec- ADDRE88 g'L M��'I A �-t��� 1057 tion 7044, Business and Professions Code). t�LR . CONSTRUCTION LENDING AGENCY CITY ' -<ArJG- IS R I C W Therebyy affirm there is a construction lending apehcy for he periormanoe of the work for wh1dh this permit Ia IssuedCONTRACTOR Seo.30,97,Ctv.C.). ADDFE68 2 S' Pi r 4Ai.J Til C G �r �'► ST / ! DIHOW1 4/15/92 Lender's Name ray iG CITY CA O/A4 TEL No. 57? , OL'2: 1 I p{f 4:-� IoTdere Addre}e - I oertHy that I have reed this applkxifon and state that the above 8TL.1C!7��E NO. 0 79 Mw C 2-2 tnformarion Is sot. I agree to oomply with all County orcilruinoee end Stale g to ullding oxw1 uc0on,and hereby auttrohtze of this Mytoenter upon the above-mentioned Pry 8E�FIEVE}Z8E FOR EXPLANATORY LANGUAGE of oB -Tf "°F"KER'SC°"'PII'8""T`°"DECLARATION 20-0°`eDPW° °° APPLICATION FOR PERMIT IIMEGREEN, I heFeb) affirm tltiat I have a cerUfloate of consent to self Insure, 76A384C or a oerllffoate o}.Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Seo.3800 Lab.C.) oy No. �Ll "a'' �" COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BU MING AND SAFETY DIV. LJ C^-MW copy Is hereby fucWmd. /9.1 CertMed oopy is fled with the county buadbV tnspeotfon FOR APPLICANT TO FILL IN ADDRE BUILDINGM � ,A A /p (PRY) � INT OR TYPE ONLCA M I Date — •� - Applloart�-'• 7/LISArJ17760rFVJ I LOCALITY 'T. L1 No. TYPE of APPLIANCE OR EOtlLPMENT FLS CERA TE OF BC )APT}ON FROM WORKERVNFAREBT CFlGs&ST (-A Q �'cJl�ik S COMPENSATION INSURANCE Ag90FVT1pN UNIT BTU (this section need not be oompleted If the work Involved by the MAPBOOK PAPE PARCEL permit Is for one hundred dollen(*100)or{sae.) AR HANDLING UNIT CFM oe treat sea are I cantly that In the performance of the work for which this permit Is Issued, I shall not employ any person In any manner sb as to 13DILEF1,BTU became subject to the Worker'Compensatfor)Laws. f Bre, b S APPFMALM uAre WrOrorrs erwcrUFA Date Ap~ VENTILATION 8YSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH E)pmptlon;you should become eub)ect'to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwtth oomply with such FINAL provlsloh-&or this permit shall be deemed revoked. FURNACE: FAU VfTY LICENSED CIO ORS DECLARATION FLOOR eru. VALIDATION I herebyattlrm that l am licensed under provisions of Chapter 8 HEAT: BUSPBdlam UNIT (commencing with 8ectlon 7000) of DNlslon 3 of the Business and yyu i Professions Code; end my noense Is In full force and effect. LIcarm Number 8 tic.Claes cor,h•.omr 9'_- MI,-w4 &Aloo. r ❑' 'I am exempt under sea Plan Check fee B.SP.C.for this reason PERiVIIT ISSUING FEE; Dets TOTAL FEE Q a Sig rriure OWNER BUILDER DECLARATION PLAN CHECK APPLICANT coZ I hereby&Mrrn that I am exempt from the Contractors Ucense Law NAME K G MG Alf — e-4!>9 C 1 -e , L for the following reason (Seotlon 7031.6, Business and Profeulons G � i Coe) ADDRESS 12 S' r S A^f7A ee-A A S7r 0/ I, as owner of the property, or my employees with wages '�xJ as their sole compensation, will do the work and the MY �C�Q�A TEL NO. 61 7 ''W7 1} f structure Is not Intended or offered for sale (Section 7044, A I I� ae Buslneand Professions Code). OWNER A(tf G Ej Q S D 4!VA 7 L� I, am owner of the property, am exclusively oontraoting MAIL TOTAL 1>Q� � �� with Iloeneed.opntraotora to construct the projbot (Sec- ADDRESS �2 d�MM��c �H e— �" CHECKffFJ.K" F tion 7044, Buslnees and Profeeeione Code). CONSTRUCTION LENDING AGENCY CITY S�� �����( �� � (� .I3,] I hereby atllrm that there Is ■ construction lending apenoy for r . .the performance of the work for which this permit le Issued CONTRACTOR �� MGC/Gf�iANl e.4L (Seo.3097, Clv.-C j ADDRE88 2r - , S'AN74 CLA" r 7 4Y/ Ot a-OCIO 1 4I15/K Lenders Name . . . CITY A,4 dig ,a No. r 77 �`' f A�! $:? Lenders AddressLL 7 I certify that I have read this applloatton and state that the above �L10ENM NO. p. 3 / LIC. 88 Z� Infonmation is coreject. I agree.to comply with all County ordlnancee and State to�correYrttotlort,and hereby authorize repr Is won the above-mendwed property sp purpOe" SFE REVERSE FOR EXPLANATORY LANGUAGE - "-/grZ� a+