HomeMy Public PortalAbout4514 CLOVERLY AVE_Mechanical__ - 1""r°+that I have'
rtIf"°"°cent to °`� APPLICATION FO PFRI�IIT LIME , GREEN,
eretI fflrm that I hove a c0rtltice[e of consent to sell Insure,
.Ora cer"cate of Worker's Compensation Insurance, or a certlfled HEAlINa-VQ�1-ILATING-14�R'�ND�TIONING
copy th 3600 C.) :.
Pony � c«nQarry I �.
COUNTY OF LOS-ANGEY.ES DEPT OF PUBLIC WORKS BUILDING AND SAFETY QW.
❑ Ce,W Dopy is N"by fumes d.
cerlreed copy r flied with the buknw FOR APPLICANT.TO FILL IK AQ0REao r
(PRINT OR TYPE ONLY)
Dode LOCALMY
nNO. TYPE OF APPLIANCE OR EW PMENT FEENEATIEST
_
G=FICATE OF BOEMPTION MOM WOFIXE '- W. ,
GOMPEN8AT10N LNSURANCE A8soRFTx).N UNIT BTU
(fhM ssctygn need not,be compi*ted H the work Involved try the MAP BOOK PAGE PA(
permit to for one humdred doltata($100)or Iesa.) AIR HAN]XJ1iCi UNrr CFM owrtec,-r wo •. "%ocaeec ev
I certify that In the performance of the-work tot which this permit
is loaded, t shair not employ any person In any manner so as to 13O1 BTU r -
become sub)ect to the Workers'Compensation Laws.
BTU' .
Aarrovnu are DWWTtrre 002W UFEI
Data •AppicaTrt VENTILATION SYSTE=M .
NOTICE'TO APPLICANT:'If, 4fter making this Certificate of ppC}
Exemption,you shoukf become subject to the Workers' Compansati n EVAPORATIVE
prpvlsloris of the Labor Code, you mus)forthwith comply with such FI -
provktlone or this permit shall be deemed revoked. FURNACE FAA land
LICENSED CONTRACTORS DECLARATK N f FLOOR $ru ow VA1-1DATIO7N
I hereby attlrm that I am.11oinsed undAr provlal6ns of Chapter ° � DEtiT�UNfr� -
(commencing with SeOUon 7000) of Division 3 of the-Bu inee'e'and WALL
Profeee}ons Code, and my ficanse Is In-full forts end-sliest. /
Ucww Numbw
(L
COnlradrt
❑ 1 am exempt under Seo Plp'cbedc fe9
B.BP.C_for title reason _ PEFllMlrr f$$UIM4 FEE,; O
Dads TOTAL FEE / W
CL
\ I > e 05NNETIBUILDEFt-DECLARATION PLA►1CF{ECICAPPLIC7INT J: Ay. z
I hereby'affirm thax I am exempt from the Contractor's License Law NAME
for the following reason (Section 7031.6, l3uslness and Professlbns
Code): AD DPESS
- - T
❑ I, as owner bf.the property, or my emplpy0ea with wages ACC t•*
as their sole oorrfpsheatlon, will do the work and the CITY T>No. -�7 � 0(I ,
structure Is not IntQnded or offdred for sale (8e0Uon 7044, ii r
Business •1.
and Profeselons Code). OWNER - n w -ITEMS -
I, at owner of the property,,am exclusively contraoting �lL TOTAL w 48 0.0
with licensed oontrILotore to construct the project .1300- ADpRESS
tion 7044, Business and ��yy�••I/W�y,Prol`esalons Code). . GCM 48��
V.W
CONSTRUCTION LENDING A&ENCCITY T1�No. .
CHAWK
1 hereby sfflrm that there Io-a construction lending a enoy for CONIRACTflR x_�, _ I
the p0rtormance of the wbrk for whigh this permit Iq Issued
(Seb.SN7,Civ.C.). U/29/92
�y/gyp p+�
ADDRESS • 1 rrft7�7L
Landers deme
CITY TTL.Nos491AF _ 7Z$Q 1 .011:06
LerKWs Address STATE LIC.
rttf
I coy that I have reed this appllcatbelate
n end }hal the above LIGE NO. CLASS
Information fe correct. I agree to comply with ail County ordlnanQes }
and Sfiate laws reW&V to lxIlidng conairuodw,and hereby autt>atre
repreerrr>teifvea of thla County to gnter upon the,above-rnentbned
pfor InaPcti
eon purposse. SEE REVERSE AOR E)M-ANATORY LANGUAGE
�ff MA"IN PATL
Z� F