HomeMy Public PortalAbout8756 GARIBALDI AVE_Mechanical__ �„ •�;dvoF
that
CI have cerci cats of TIOIJ � 6/3104APPLICATION FOR PERMIT_ . C
��} �aTfirm that I have a certificate of consent to self .
pi nasRd,�ler a certificate of Workers'Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
or a certified copy therpeoyf (Sec 3800, Lab. C-) CE-818(REV. 10/81)
Policy Na4VYV0Z_o ['ampony Tf2TdTL_ E-0410
Q Certified copy Is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy is filed with the county building Inspec- FOR APPLICANT TO FILL IN BUILDING Co
tion deportment. ' I (PRINT OR TYPE ONLY) Rr D I
Date'—ZZ'�v Applicant A( p LOCALITY
NO. TYPE OF APPUANC3 OR EQUIPMENT FEE delrx
CERTIFICATE OF DffiYP-nON FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST' µ rl---
(Thls sectlon need not be completed If the work Involved by ABSOR MON UNIT, BTU• DLSTR*cT No. PROCESS e
the permit is for one hundred dollars(:100)or leu.) /1
I certify that In the performance of the work for which this AIR HANDLING UNIT, CFStl0M
permit Is Issued, I shall not employ anyrson In any manner
to as to become sublect to the Workers Compensation Laws. BOILER, BTU APPROVALS DATE 1 Sr-NATURE
Date Applicant
COMPRESSOR, BTU ROl1C H
NOTICE TO APPLICANT: If; after making this Certificate of VENTILATION SYSTEM FINAL
Exemp ion, you should become subject to the Workers'
Compensation provisiorn of the Labor Code, you must forth- EVAPORATIVE COOLR VALIDATION
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDEDUNIT
'(commencing with Section 7000) of Division 3 of the Buslness WALL
and Professions Code,and my license is In full force and effect.
License Number � �3 Llc. Class GZ d , V
OC
Controctor "Q) Ai 9,C"' Date Z;22- 8 GO
❑ I am exempt under Sec. ;F 9 0 VO A
Plan check fee d
B.&P.C:, for this reason'
PERMIT ISSUING FEES # a o a — 8 a
Date:
Signature TOTAL FEE JY2 I a - 4 &25
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT . 0 0 46256
I hereby affirm that I am exempt from the Contractor's License ,
Law for the following reason (Section 7031.5, Business and NAME ' 88
Profeuions Code):
❑ I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and CITY TE1- NO.
the structure Is not Intended or offered for sale(Section
7044, Business and Professions Code). OWNER
❑ I, as owner of the property, am exclusively contracting MAIL
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCYT L NO.
C1TY
I hereby affirm that there Is a construction lending agency for
the performance of the work for which this permit Is issued CONTRACTOR ,
(Sec. 3097, Cly. C.).
ADDRESS
Lender's Name
Lenders Address CIrY 1 Z€ � TEL NO
STATE .r� LIC
1 certifknnt.1i's his application and state that the UCUISF NO,�jI2 �j CLASS above I . I agree to comply with all County
Landh
relating to building construction,
sentatives of this County to enter
property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
of Applicant or Agent Date .