HomeMy Public PortalAbout8613 GARIBALDI AVE_Mechanical__ - w MRKIER'S 7°°'eDPW°'E° APPLICATION FOR �EftMIT ��� GREEN
I hergpy arm`thet"l have a certificate of consent to self Insure, 7tfA38tC
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or a oertf}fc+tq of orker's Compensation Insuranoe, or o certlned HEATING-VENTILATING AIR CONDITIONING
oopy th (Bbo. Lab.C.) LJ
Polloy No company �� RA( COUNTY OF LOS ANGELES DEPT OF'PUBLIC WORKS BUILDING AND SAFETY DIV.
❑ Certified fs hereby tunished
Certified copy is filed with the county bulkong trupeorion FOR APPLICANT.TO FILL IN LM D4 e
(PRrWr OR TYPE ONLY),
D. Apo.� filo. TYPE of APPtJANCE OR EouiPwENT Fly LOCALITY
NEAREBT
CERTIFICATE OF EXEwPT1oN CACM ST.
COMPETISAT1oN I CE ABSORPTION UNIT BTU
(Fhla section need not be oompidt d H the work Involhr d by the PAGE PARK�4
permit 4 for one hundred do l Fars(III;10-0)or kma.) AIR HMDIJ NO UNIT CFM oerricT rp. r'ra7CH� n
I oertlfy that In the performance of.the work for which thls.permft
Is Issued, I shall not employ any person In any manner aq.as to BTU /� y
become suNW to the Workers' Compenanriop Laws.
COY BTU
APPRwALe DATE NSPecrows 0""uro
Date Appl-M VENTILATION SYST 3A
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH - O-�J-
Exemption,you should beoome subject to the Workers'Compenaadon EVAPORATfV�COOiiFaA FINAL
provisions of the Labor Code, you must forthwith oomply wtth such
provisions or this permit shall be deemed revoked. FURNACe FAU RA
LICENSEDT�DECLARATKM R,0OR B-N ALIbATION
I hereby affirm that I am licensed under provisions.of Chapter ° SU(?PBDED UNIT
(commenoing`Ith'Sectlon 7000) of Division 3 of the Business and HEAT(39 yyr i
Professions Code,end my license Is In full force and effect -
Lkmrwe Number Lbr-Cis"_C17-0
� CAnu>,ctor Oat• D C� _ f '
F-1I em under Sec. Plan check fee
B.BP.C.for this reason PERMIT ISSUING FEE;
Date: TOTAL FEE O d
Sipnahuro OYVNER BUILDER DECLARATION
PLAN cHEOK APPIJC.1Nr fn
Z
I hereby affirm that I am exempt from the Contraotore Llosnse taw
NAME �❑
for the-following reeaon (Section 7031.6, Buslnem and Profesdons , 5 ER-� �
Code): ADDFE88
❑ I, as owner of the.property, or my employees with wages
as their sole compensetlon, will do the work and.the CITY TEL NO. 78■1[I
structure to not Intended or offered for sale (8ectlon 7044, AV�•
Business and Professions Code). OWNER
EltYL i■T
I, as owner of the property, am exclusively contracting .+'
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with licensed contractors to construct the 0roject (8ec- ADpffgS t�/�� Li307 7 ,10
tion 7044, Busineee and Profeeslons Code). n J I
CONSTRUCTION LENDING AGENCY CITY TEL No. / u5) 1 TEti
I hereby affirm that there Is a construction lending a ency for TOTAL -'u` to
the performance of the work for which this permit Is Issued i
(Sec.3097, Clv. C.).
ADDRESS o N�N S (+�y� 1
TEL.
V. f f
Lerdera Name e _ -• - --
CITY c TNO. • �r
Lenders Addrese STATE IJC. -
I oerttfy that I'have read this applloadon and state that the above I IGENSE NO. CLAM — ODG-0001
trlfornudlon Ie oonvct. I agree to comply with all County ordlnancee ilJ S 1
and State laws reieiing to txuMng construction,and hmvby authatre 7'
representatNes of this County to enter upon the above-mendoned 1 :11
pro rty Tor peatlon urpoaea. 8EE REVERSE FOR EXPLANATORY LANOUACif
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