HomeMy Public PortalAbout9050 GARIBALDI AVE_Mechanical__ "'° e°°'`' "°"°�1 �°°"� '"°'�
eAPPLICATION FOR PERMIT LME GREEN
I-fietdby ttlnn that L have a carttfitbate of consent to self lf Insure, - {�
or a eertifleate of Work"Gomperfaatton I France, or a certified HEATING-VENTILATING-AIR CONDITIONING I1
copy thereof(goo.3800 Lab.C.) u
Pallcy No EL
Company `� COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
u Cerbfled copy b hereby turnlehed.
(. ❑
Corned In fled with thebotion—mbi r /' FOR P CAN(PRINT ORT ETDOLFlLL IN AD SO ,iev
NO. TYPE OF APPUANCE OR EQUIPMENT FEE
NEAREST
CATE OF EXEMPTfON FROM WOF60DW CF4066 ST. ;
COMPENSAnON INSURANCE. ABBORPTION LJNrr,BTU -ASSESSOR
(This Motlon.need not be compMrted ff the work Involirsd by the MAP BOOK PA0EARCEiff �
�
permit l•tow one hundred dohars(8100)ose-
r lo ) Affil HANMING UNIT CFM-
hl
Deracr wa Price BY
I certify that In the performanoe of the work for which this permit
Is Ifeuad, I shall not employ any person In any manner so as to gq BTU
become subject to the Worker'Compeneatkm Laws. O
BTU i
Mraovv.s DATE 04M
Date I Appiraru VEN-nLATION SYSTEM
NOTICE TO APPLICANT: If,'efter making this Certificate of PLOUGH
Exemption,you should become subject to the Workers'Compeneaiton EVAPOf1ATIVE COOtFA
provisions of the tabor Cod6,you must forthwith comply with such FINAL
provisions or this permtt ahsll be deemed revoked. FURNACE FAU RAVff1 Y
LICENSED,CONTRACTORSDECLAFtAT10N - FLOOR —BTU (� D VALIDATION
I.hereby affirm that I am licensed Unser provlslone o} Chapter 8 MWENDf� _UNIT
(commencing with Section 7000) of D slon 3 of the Business and A WALL
Prof Code,and my license Is In full force and effect. n "
L.lcense Num Lk C
1�:M T
�3 7 5, 3303
1 .
❑ I sm exempt under
Plan check fee i T- �
B.sP.C.for PERMIT ISSUING FEE_ TOTAL
1 135_ 81
o TOTAL FEE -
1,35.37..Q
ro oNMER$UILDER DFCLAFUTfON PLAN CHECK APPL{CANi L•Il C RS .00z
J hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031.6, Business and Professions
Code): MCC—W- 1 1 3/ 9/515
I, as owner of the property, or my employees with wages,. 9418 1 AM '9.16
an their sole compensation, will do the work and the CITY l.fTa-NO
struoture Is not Intended or offered for sale (Section 7044, 0111
Business and Profeasloas Code).
❑ I, as owner of the property, am exclusively contracting IIAlL
with lloensed oontraotors to construct the project (8e0- ,rpO orQj
tion 7044, Business and Profeeelone Code).
CONSTRUCTION kFNDANG AGENCY CITY' GL.�d� TJX NO./ L��O�
I hereby affirm that there Is a construction lending agency for ,
the performance of the work for which this permit la ]as uad CONTRACTOR
{Seo.3087,Civ.C.).
ADDRESS Q
Lmxwe Name
/ / '7 TEL
US
I certf}y OatrI have read this application and state that the above STATEL NO{� /Q/ CLASS ^�Q
btformatlon is correct. I agree to comply with all County ordlnances
and Stats Tawe relattng-to W52N oonatntotion,and hereby a&Mile
repreeentetNee oLthla County to enter upon the above-mentioned
propel for I Ion purposes. BE REVERSE FOR ENPLANATORY LAWUAOE
of on