HomeMy Public PortalAbout10831 GRAND AVE_Mechanical__ wOtithat I9 have
a certificate
NDEConsent to B'� APPLICATION FOR PERMIT LIME GREEN
I hereby affirm that I have a certificate of consent to sell Insure, �7
or a oertlfloate of Worker's Compenaatlon Insuranos, or a cert1 led HEATING-VENTILATING-AIR CONDMONING X11 JJI
copy thereof(Sec.3800 Lab.C.)
PD5cy No• companypany COUNTY OF LOS ANOELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑
CartHw copy is hereby furnished
copy In filed with the county building fr,spectlon FOR APPLJGANT TO FILL IN LDM
ADDRESS j C ��
( R*4T 08 TYPE ONLY)
owe LOGVJTY 'Tc v..l l7
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS, CAOSB ST. �Ayy-�.rw A vttT'�
CompeJSAnoN INSURANCE ABSORPTION UNIT BTU ASSESSOR
(This sectbrr rwwd not be oompWted H the.wpdr Involved by the MAP Spot( PAGE PAR;CEL
permit la for one hundred dollars($100)or less.) ,VR HANDLING UNIT CFM BY
a cartlty that In the performance of the work for which this permit Na � �®
Is Issued, I shell not employ any person In any manner to as to BOtLEA BTU {� J1 P
become sub)pot to the Workers'Compensatlon Lowe. J (J(J
COM PRESSOR,BTU
rarFovALs w,ra awrtsron'PexftArura
Dsie Appllcarrt VENTILATION SYSTEM
NOTICE TO APPLICANT: if, after making thla Certificate of ROUGH
Exempdoh,you should become sub)ect to the Workers' Campensallon EVAPORATIVE COOLER NAL
,provisions of the Labor Code, you must forthwith comply with such R
provlslorls or this permit shall be deemed revoked. JIRNACE. FALL aRAVrrY
LICENSED CONTRACTORS DECLA ATION FLOOR BTU / V ATION
I hereby affirm that I am licensed under provisions of Chapter 9 HEATEFL SUSPENDED UNIT
(commencing with 8ectlon 7000) of Division 3 o1 the Business and WALL
Profesabna Code,and my license Is In full force and effect.
LlcQ Nurtper Lk.Class
Conlraotnr Dade
0 I am exempt under sea Plan Check fee J��
PERMIT ISSUING B.LP.C.for thY reason
w Date:
TOTAL. FEE ,� ACCT..T W
,?,1117 51.CIO 55
PLAN CI-El;f(APPLICANT �,�
OWN EFI-BUILDER DECLAFIATION 1 ITErS
I hereby affirm that I am exempt from the Contractor's Lloenae Law NAME lop !1 TOTAL i a-
for the following reason(Section 7031.4es,Bualneand Professions 3�J17 c'�^W!'�` TO5 1 - 00
Cods): ADDRESS vD31 �Ta AJe
I, as owner of the.property, or my employees with wages
�1't41
as their sole compensation, will do the work and the CrrYZ TEL NO. $l� 'Lt'7 C } ���
structure Is not Intended or offered for sale (Section 7044,
Business end'Profeealons Code). OWNER M
I, as owner o1 the property; am exclusively contracting MAILgy N1 �/ 2l41
with licensed oontractors to construct the project (Sec- ADDRESS .5 me/ Orf-}per i
ifon 7044,Buslnseq and Professions Code). CfT-y TEL NO, !G+J7 1 AM v 4-4
CONSTRUCTION LENDING AGENCY
I hereby afftrm 'that there Is a construction lending agency for ,
I p1Zrmanoe of the work for which this permit Is Issued � � j
(8e0,3097,Ctv.CJ.
17
Lenders Name
Lenders Address STATiff LIC.
1 certify that I have read this applloetion and state thdt the above LICENSE NO. CLASS
InfonTmd3 xT to correct: I agree to comply with all Courtly ordMancoo
and State laws relating to buUng mu tnx;Ow,and hereby euthortre
Mpreewrtattvee of this County to enter upon the above-mentloned
p for Ins b pu SEE REVERSE FOR EXPLANATORY LANaUAQE
7 2-9
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