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Home My Public Portal About9821 GARIBALDI AVE_Mechanical__ WORKERS'COMPENSAnON DECJj-ARAnON APPLICATION FOR PERMIT l afftHrm that,I havq a certifigate of consent to self Q certItIcra1}Jteei�of Worker Compensatio n Insurance, 7 c HEATING = VENTILATING - AIR CONDITIONING jZPol IRb:� om� L C )/ U CE-818(REV. 10/81) Certified copy.Is hereby furnished.. COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certifled copy Is filed with the county bulldin I FOR APPLICANT TO FILL IN BUrLDING (� ! tlo department. (PRINT OR TYPE ONLY) Al�ss K2 E Date ApplI LOC UJTY CEWIFICATE OF E)CEMPTIONNO. TYPE OF APPLIANCE OR EQUIPMENT . . FEE F KERS' NNEAREST COMPENSATION INSU CE CRSS ST' (Thts section need not be completed If*o work Invohred by e UNIT, BTU �rs1x><r NO. the permIlt Is fw one hundred dollars (;100)or less.) AIR HANDLING UNIT, CFM ✓, ',' I cerrtfy that In the performance of the work for which this permit ued, I s111 not employ anyprson In any manner so as t� come �tllcont the WorkerCQrhpensWlon Laws. BOILER, BTU �ppgav�t5 p•rE 0R-S sly RE U )�/► COMPRESSOR, BTU b ROGH I D6te NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the- Worker' -Compensatlon provisions of the'Labor Code, you must forth- EVAPORATIVE COOLER ALIDA-n N with comply with such provisions or this permlt'shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR gTU I hereby affirm that I am iicensed under provisions of Chapter 9 HEATER: SUSPENDED-UNIT- '(commencing USPENDED UNIT'(commencing with Section 7000) of Division 3 of the Business WALL and Professions Code,) 7' and my license Is Infull forces and effect. License Numbed a J / Ls lc. Class p p ContraARCS' ��v , 0 cto te �,; ❑ I am exempt under Sec. d Plan check fee ti B.BP.C. for this reason PERMIT ISSUING FEE ' Date: TOTAL FEE Signature OWNER-BUILDER DECLARATION PLAN APPLKIINT I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, BusFness and NAME D 66 Professions Code): ADDRESS ❑ .1,.as owner of the property, or my employees with >�y� wq"es as their sole compensation,will do the work and CrT-y TEL NO. n 2 the structure Is not Intended or offered for sale(Section e 'a '' 3 u 5 0 F5 7044, Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting r 9. 3 8 8 with licensed contractors to construct the protect (Sec- MAIL Q tlon 7044, Business and Professtbns Code).�f CONSTR O DING AGENCY CrTYI/ V/V 6 oo. g 9I--0 Q I hereby affirm that th e s onstruction lending agency for the performance of t or which.this permit Is Issued CONTRACTOR , (Sec. 3097, Civ. C.). / ADDRESS Lender's Name CIT �/ Y .TEL NO �T Lender's Address STATE ) LIG I certify that I have read this application and state that the LICENSE N01401 :3 cq C]ASS above Informatlon Is correct. I agree to oamply with all County ordinances and State laws relating to building construction, and hereby autho er ntatives of this County to enter n the abov e o property for In ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE t - _ h .. - .. Slgrwtu Applicant or Agent Te A9e4�'cE Gle=+iTe APPLICATION FOR PERMIT HEATING _ VENTILATING - AIR CONDITIONING COUNTY OF, LOS ANGELES BU L�DSS FN DEPARTMEIyT OF COUNTY/ ENGINEER BUILDING AND SAFETY DIVISION LOCALITY _p 1 NEAREST ]CROSS ST. tn n FOR APPLICANT TO FILL-IN OWNER (PRINT OR TYPE ONLY) Rq MAIL TYPE&SrZEOF'EQUIPME-NTADDF3ESS NC' fRt t]AtK OF APPLICATION FEE CITY,-7 e- TEL. NO. 3 FORCE AIR FURNACE, BTU CONTRACTOR COMPRESSOR, BTU ADDRESS VENTILATION FAN t CITY TEL. NO. LIST ALL OTHER& BELOW STATE LIC. LICENSE NO. CLASS / GRO P OC[S 6Y + INSPECTION RACO`R O p F- r U W _ IEL 1.Plan check fee. See reverse.. PFRX11T 1,SS UING FF-F, S TOTAT. FEF " PLAN CHECK APPLICANT NAME ADDRESS CITY TEL.NO: I-HERESY ACKNOWLEDGETHAT.I HAV[.READ'THIS APPLICATION ANd STAT[ .THAT THE ABOVE.IS CQRR[CT:AND AGR[[.TO CO#APLY WITH ALL' ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE - Gf9PBC Y 216NATURIE LATJN9, AIR.CONDITIONING. - ROUG,H � ✓ I- HEREBY CERTIFY THAT I AM NOT ACTING 1 IOLAT ION OF CHAPTER D,.DIVISIO S, OF THC BUSINESS AND R Es9IONAL FINAL LOO[ OF THE STATE OP LI FORNIA. 'ICINATUR-E.' PERMIT VALIDATION. CK. M:o. CASH OF PIERMITTEE11m ' P AN CHECK VALIDATION D N.O. SH : 6,.,�1 17 e 9L 0 "'° S COMPENSATION° "°" 76A-1W B'8° APPLICATION FOR PERMIT LIME GUE.N . I hereby affirm that I have a certtfloate of,consent to self Insure, ore oerttftoate of Worker's Compensation Insurance, or a certtfled HEATING-VENTILATING-AIR CONDITIONING' copy th b.33&W 1 ) Po4oy rrpe1S COUNTY OF LOS ANQELES DEPT OF PUBLIC WORKS . BUILDING AND SAFETY DIV:•. ❑ Cert' copy b hereby fumist»d. rertteed copy breed with thebulkftng m.pecthn FOR APPLICANT TO FILL IN ,pL Date App✓Joarr� /t/�'Z & PRINT OR rrPF ONLY) t ocALrry No. 'TYPE OF APPLfANCE OR EQUtPMENr FEEq NEAREST ' cEFmFK'.ATE OF EXEMPTION FROM WOR}ER& CROSS ST. COMPENSATION INSURANCE rpN UNIT,grU ASSEBSCOR (rhla section need what be completed H the work Involved by the MAP BOOK PAGE PARCEL permit Le for one hundred Dollars(✓tilts)or lose.) Al MAN DLJ NG UNTT CFM censor wo, wMoo®e®er I oertlfy that In the performance of the work for which th(a permit Is Issued; I shall not employ any person In any manner-0 as to BTU become subject to the Worker'Compensatlon Laws. n L COY BTU y Gao (1 rrragvus an seracrarre sraru,Ture Date App - vENTzLATION SYSTEM NOTICE TO APPLICANT: IT, after making this, Certificate of ROUGH Exemption,you should become sub)eot to the Workers'Compeneetion EVAPORATrVE COOLER provisions of the Labor Code, you must forthwtth comply with such RNAL provisions or this permh shall be deemed revoked. FIJRNACe FAU VrfY LICENSED CONTtiACMM DECLARAT)ON 1. FLOOR BTU �s ALIDATIbN I hereby affirm that I am Ilcenaed under provlalons of Chapter 0 HEATER SIJBPFNDED UNrr (commenoing with Section 7000) of Division 3 oT the Business and WALT Professions Code, and my Hoense b In full force and affecL Ur ¢ense Number 0 7� Lk;.CUM Confredor _ V ❑ I-am exeno under SePlan check fee Sec. O B.BP.C.for thio reason PERMIT ISSUING FEE: Data. TOTAL FEE LLF CL PLAN CHECK AP?Lr WT OWNER-BUILDER DECLARATION Z I hereby aMrm that I am exempt from the Contraotor's License Law NAME , for the following reason (Section 7031.6, Business and Professions Code): ADDS v ,�!�£�-r . F-11. l I, as owner of the property, or my employees with wages 7 i,� as their sole compensation, will do the work and the CITY TE.:NO. -3307 J!.W structure Is not Intended or offered for sale (Section 7044, 7 Business and Profeeelons Code). OWNER 1 I u tI ❑ I, as owner of the property, am exgl0elvely contracting YAJL TOTAL 3-1 - 00 with licensed contractors to construct the project (Sec-, ADDRESS / �[! tion 7044, Business and Professions Gods). CfTY TEL NOZ CFECK 377..00CONSTAUCIION LENDING AGENCY a aYZC .03I hereby affirm that there Is a cbnstructlon lending agency for i 477YZC the performance of the work for which this permit Is Issued CONI�CT , (Sec.3007,Clv.C.). �yyyy i p r 4 ADDREBB / L.fL^JLrLrL�Ll1 -7/19/91A/ 7117f 7 1 L.endees Nary» CRY TEL.NO. 10 8105 _ 1 AM 9:59 Lenders Address STATE LIC. I certtfy that I have read this appllcatJon and state that the above LICENSE W. CLASS - trrformatlon is correct. I agree to comply with all County ordIrwoee and State laws relating to bLddIng oonsiructlon,and hereby au#Kxtze Vpof this County to enter upon the.above-men on purposes. / 8EE:REVERBE FOR EXPLANAf.ORY LANGUAGE oe