HomeMy Public PortalAbout4940 GOLDEN WEST AVE_Mechanical__ `"°` I9 have a o''�"°"° consent t APPLICATION FOR PERMIT LIME GREEN
I hereby ■fflrrn that I have a oertlTlcate o1 consent to self Insure,
or A certtjloate of Worker's Compensation Insursnoe, or a certlfled HEATING-VENTILATING-AIR CONDITIONING
copy thereof(Sec.3800 Lab.C.)
0 No. Pa COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
CertMed copy is hereby tunlahed.
❑ CKufi � re
ed y la ed�,u,e� iia,y btWng FOR APPLICANT TO FILL IN BU yd �n lr1Y T
department (PRINT OR TYPE ONLY)
-
LOCALITY.
Data Ap~ NO. TYPE OF APDL A.NCE OR EOUIPUENT FEE
CERTIFICATE OF EKEMPTION FROM WOFN RS' NEAREST r,R ,68 ST. C
COMPENSATION INSURANCE ABSORPTION UN1T BTU
ABSFssoa
(rhls saoUan need not be completed H the work Invotved by the MAP BOOK PAGE PARCEL
permit Is for one hundred dollars($100)or leen.) AIR HANDLING UNIT CFM W1 PriorUSem ay
I certlfy that In the performance of the work for which this permit
Is Issued, I shell not employ any person In-any rhanner so as to BTUD P
beoome subject to the Workers'Compensation Laws. O
COMPRESSOR BTU
BetsF4�¢ . Z Appfkant VENTILATION SYSTEM
wPtnvas oro errscroeresrrarure
NOTICE TO APPLICANT: If, after king C I1loate of ROUGH
Exemption,you should beborne subject the Workers'Compensation EVAPORATTVE COOLER
provisions of the labor Code, you must forthwtth oomply with such FINAL
provisions or this permit shall be deemed revoked. FURNACE: F GRAVrrY
VC-ENSED CONTRACTORS DEQLAFtATION FLOOR BTU VALIDATION
I hereby affirm that I am.lioensed under provlslons of Chapter 9 HEAer SUSPENDED' UNIT
(oorPmenoIng with Section 7000hrl
) of Dalon 3 of the Buslnesa and WALL
Profeeabna Code, and my license Is In full torte and effect
T .r 7
IJoense Number T L/ Y� Lk—Gees F '
c«,t�rDese;G, "3/—93 V.
ElI em pt under
AJL
Sec. Plan Check t99
M, p
&&P.C.for thea reason PERmrr ISSUING FEE i 3307 105.72
Data. TOTAL FEE a
1ITEnS
ftr°°t`rre PI-M CI•IECN(APPLJCANT
co
OWNER BUILDER DE0LARATION TOTAL . j-05-72 z
I hereby amrm that I am exempt from the Contractor's Lloerlsa Law NAME , CHECK 105.72
for the following reason(Section 7031.6, Business end Proleulons �r
Code): ADDRESS 00
❑ I, as owner of the property, or my employsea with wages •
as their sole compensation, will do the work and the CITY TEL NO.
structure Is not Intended or offered for sale (Section 7044, �-y� +y, 9/92
Bueinees and Professions Code). OWNER ll,.tiR.T'�IM016,04
11 r
❑ I, an owner of the property, am exclusively contracting MAU- 6751 1 Ni 7:33
with licensed contractors to construct the project (Seo- ADDRESS -
tIon 7044, Business and Professions Code).
CONSTRUCTION IFN
NDIG AGENCY CITY TEL NO.Z
I hereby affirm that there Is a construction lending a ency for ,
the performance of the work for which this permit is issued CONTRACTOR 9-
��
(Sao-30197, Cty.C.). r
ADDRESS k d
Lenders Name
orrys TEL NDS o
Lenders Address STATE LJC.
I certify that I have read thls application and state that the above i r
caNO. cxABe
Information la correct. I agree to compty with all County ordinances
and State le"relating to bulking oonstrudion,and hereby audvrtze
representatives of this County to enter upon the above-rnentloned
pro for Inepecti0 u 84EE REVERSE FOR EXPLANATORY LANGUAGE
2`
OR A5KTE