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HomeMy Public PortalAbout9002 GARIBALDI AVE_Mechanical__ "'° sC°"'�'''�"°"° "T'°" DPW 91819 APPLICATION FOR PERMIT LIME GREEN I herby bTflrm that I have a certificate of consent to self Insure, 7E/13B4C X a oerttflcete of Workoes Compensation Insurance, or q cerUfled HEATMG-VENMATING-AIR CONDITIONING copy thereof(Sec.3800 Lab. C.) © No.T�Comp" COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. CerdW copy is hereby furnished. ❑ CerdW copy Is fled with the county building tnspecrion FOR APPLICANT TO FILL IN AD depart (PFIINT OR TYPE ONLY) LOCALITY Dain Appk-d NO. TYPE QF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEIMPT)ON FROM WORKERS' NEAFiEST LAOBS ST. GOAIPENSATION INSURANCE ABSORPTION UNIT BTU ASSESSOR (Fhla section nand not pe.completed tf the work Invohr d by the MAP BOOT( PAOE PAFICQZZ�t permtt to for one hundred dollari($100)or Nsa.) AFI HANDLING UNIT CFM pmRACT Na PROCEMORD BY I certify that In the performance of the work for which this permlt Js Issued, I shall not employ any person n any an F so an to BOER BTU subJaot to the Workers' r on , COMPRESSOR,BTU APP"OVAL9 DATE VIOMATIR! I7afe VENTILATK N SYSTEM NO E TO AP ICANT:7�jr r aklno hle Certificate of ROl1GH n,you should becomct to the W rs'Componaafion EVAPORATNE COOLER prorAslons of the labor Code, you must forthwith comply with such FINAL provisions or this perml-t shell be deemed revoked. FURNACE FAU CiRA LKA Nam CONTRACTORS DECLAFUITION FLOOR aTu VALIDATION I hereby affirm that I am licensed under provisions of Chapter B HEATSUSPENIJED UNIT (commenoing with Section 7000) of DKIslon 3 of the Business and W Professbne Code,and my license Is In full force and I/effect��� tlpenee Number Uc.Class F-1I am exempt under Seo. Plan Chock fee Q B.&V..C.tar Ws reeeon PERMIT ISSUING FEE# D O Deter. FEE ���{{ Ua OWNER8UILDER DE L�,RA,TION PLAN CI�ECI(APPLICANT JL ir Z I hereby afllrm that I am exempt from the Contractors Lloense law NAME ► M3 118.`]0 for the following reason (Section 7031.6,Buolneas and Professions •): ADORE83 1 ITEMS I, as owner of the property, or my employees with wages TOTAL 118 - 20 as their sole compensation, will do the work and the CITY TEL NO. qtr structure Is not Intended or offered for sale (Sectlpn 7044, €CY, 1Is.�,r l Business and Profession Code). OWNER I, as owner of the property, am exclusively contracting MAL Irl a1f41= .V+J with licensed contractors to construct the prcJeot (Sec- ADDRESS { Tion 7044, Business and Profesobne Code). TEL - 6/20/94 fiU f 4CONSTRUCTOLENDING AGENCY ?WW I hereby offlrm that there Is a construction lending a enoy for the performance of the work for which this permit Is Issued CONTRACTDR ► 572 y f ; (Sec.3097,Civ.C.). ADDRESS Lenders Name CITYfAN, 7-6 TEL ,. L.onders Address STATE LIC. I oertffy that I have read this appllcat$on and state that the above UC818E NO. CLASS information Ls corroot I agree to comply with all County ordinances and State fawe to u6ding conaZwcYVon,and hereby wthorize unty to enter upon the above-mentbned pro for I u SEE REVERSE FOR EXPLANATORY UWMAGE 11— - I/Y 1 4 /* OF on 0