HomeMy Public PortalAbout6249 GOLDEN WEST AVE_Mechanical__ W COMPENSA'n0N of �ent to °P'"°'8° APPLICATION FOR PERMIT LIME GREEN,
I hdreby?atflrm tha(I have a certlTloate o1 consent to self Insure, ��
or a certtfloate 61 Worker's-Compensatlon Inaunsnos, or a certMed -HEATING-VENTILATING-AIR CONDITIONING
copy thereof(Seo.3800 Lab.C.)
RdNo. corny COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
CardfW copy la'heroby f anlshed
FOR APPLICANT TO FILL IN "MINGa 1s fled with the ooiuity ixdkf}ng InspoatSon (PRINT OR TYPE ONLY)
LOCANT Y
Daze Ap~ NO. TYPE OF APPLI/WCF OR EQUIPMENT FEE
NEAREST
-GE"FICATE OF EXEAIPTFON FFIOM WORKEPS CROSS ST:
CQIAPENSATION INSURANCE A$80RPlION UNIT BTU
(flits secUon need not be completed ff the work Involved by the hw BOOK �s PAGE PARC-13 0
permit Is for one hundred dollars({100)or lose.) AIR HANDUNO UNIT CFM MTFWTWX PROCESSED By
I csrtffy that In the performance of the work for which this permit
Is Issued, I shall not employ ahyi person In any manner so as to BOfLER,BTt1
become subject to the Workers'(�ompenaatlon Laws, e�r�
BTU
APPFOVALs an saPeorare eawn:rr
VENTILATION SYSTEM
NOTIC T I ANT: If, aft m I CerUlloate of ROUGH
Exom n, should become subject to the orken'Compensation Ey��COOLS /
provlslona of the Labor Code,you must forthwfth comply with such FINAL I—CO
provisions or this permh shall be doomed revoked. FURNAGE: FAu GRAVITY ,5 VALIDATION
ILICENS»CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter ° f HEABUSPE CED UNIT
(oommencing with SeoUon 7000) of Dtvislon 3 o1 the Business, and er WAI I
Professions Code,and my Iloense Is In full force and effecL p
Lkx)nw Number LJc.Claes 4_. .9.0 3 tM4TDabs 7 .*
6 3307 116.38
Plan check fee
1 ITEM
El _ - _ �
I am exempt $�
B.BP.C.for this reason PERMIT ISSUING FEE; TOTAL 113 323'0
DataTOTAL FEE CHECK 113.3 w
Bd
rye
PLAN CHECK APPLICANT _ _ _... _. . �}U)
oWNEA BUIIJ DECLAAAIION Z_
I hereby affirm that I am exempt from the Contractor's Lloense law NAME
for the following reason (Section 7031.6, Buslnmm and Profeoslons , tyryy1ryyyl i �•�p�a
Code): ADORERS .. w�tx�1 ,1/1 � 7
❑ I, an owner o1 the property, or my employees with wages 7889'9 1 AM11:20
as their sole compensation, will do the work and the CITY TEL NO.
structure is not Intended or offered for sale (Section tO44,
Business and Professions Code). OWNER
❑ I, as owner of the property, em exclusively contracting MAL
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Prolessione Code)
CITY TEL NO.
CONSTRUCTION LENDING AGENCY
I hereby afflrm that there Is ■ construction lending apenoy for
the performance o1 the work for which this permit le Issued
(Seo.3097,Civ.CJ.
ADDRESS
Lenders Nam
MY TEL NO.
Lenders Addre" STATE LIC.
I certify that I hays reed this application and atate that the above LICEN:9E NO. CLASS
hiformation Is Correct 1 agree to comply with all County ordlnancee
and State(awe relating to bulWtng oorstuodon,and hereby authatra
representettvee of this Courtty to enter upon the above-mentioned
property for In purposes. SEF REVERSE FOR EXPLANATORY LANGUAGE