HomeMy Public PortalAbout10065 GREEN ST_Mechanical__ W „KEA'8 "PENSA"°"DECLARATION 20-0048°e"9r89 ffiAPPLICATION FOS .PERMIT LIME GREEN
I hereby prm that 1 have a certlflGdte of consent tp self Insure, 7ak%4C
or a oerttflcate.of Worker's Compen'eatlori Insurance orgy certlfled H(=ATING-VEN11L ONG'-AIR CONDITIONING
copy .roof sec.3$00Lab. C.)
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POS' COUNTY OF LOS'ANGELES DEPT OF PUBLIC WORKS - BUILDING AND SAFETY DIV.
Ca-'rdw copy is hereby furnished. -+ +
�y� FOR APPL CANT TO FILL IN BUILDM
L7
depart:
copy le(fled with the buBdlnQ inspectionnt FOR
OR TYPE ONLY) AMR .
Date ` Applloard �e TYPE OF APPLIANCE OR EOt1IPMENT FEE LOCALEry.
cBTF icATE OF ommpT7oN mom woRKEFw NEARFB-[
across sr.
COMPENSATION INSURANCE ABSORPTION UNTf•BTU
(fhlaaeotlon_fiwrn
d not be oopleted If the wk Invoked by the PAGE PAFCS�
permh to fpr one hundred dollara($100)or Iwa.) NR HANbuNo UNIT CFm
Dnsrp@OT rro. PFICCaMGM By
I certify that In the performance of the,work for which this permit
Is Issued; I shall not employ.riny person'In any manner so as to DDLEF4 BTU
beoome sub)eot to the Workeu' Compensailon Lows.
BTU
MFT70JNJ .'_DATE P417 OFrs BKN"TUri
Data Ap~ VBrfLATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of r ROUCiIi
Eke-ptfon,you ehoM bsoome sub)eot to the Workers'Compensation EVAPDf1ATfVE COO(IM )
'pfbvlalona of the Labor.Code, you must forthwith oomplywtth such F1NAL.
4provisions or.thle permit shall be deemed revoked. -.. RIRNACF_- FAu V15VALIDATION Y
1 LICENSE CONTAACTORIS DECLARAMN FLOOR BTU
iI hereby affirm that I am Iloensad under provlslohs of Chapter g HEATER .8UgPE1i� UNIT
(oommending with Section 7060) of Division 3 of the Business and WALL
Professions Code, and my Iloense Is In full force and effect
` _44L
License Number S? b Lk,Class
ci• Q•� .t� Sa�eS9 a
Q. I am exempt uda
der sePlan check fee . Q
B.BP.C.for tale re.eon PERMIT ISSUING FEE O
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Datw. TOTAL FEE . a W
re d
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OWNpRBUILDER DECLARATKxJ PLAN
Cl lEa(APPLYC,4Nf Z
I hereby affirm that I am exempt from the Contractor's Ucanee Law NAME '
for the following reason (Section 1031.5, Business end Professions
Code):
' I, u owner of the property, or my employees whh wages —� — A �T.i
as their sole compensation, will do the work and the CITY TEL NO. 7 63.r-
structure Is not Intended or offered for sale (Seotlon 7044,''
Buslness.and Professions Code)..- OWNER 1
QI, as owner of the property, em exoWelvely contracting. N.UL f u TOTAL 63-32
with licensed contractors to construct the pe 0166t (sec- ADORERS L-� ,
tion'7044, Bualneaa and PTofesslons Code), OEM 63i32
CONSTRUCTION LENDING AGENCY 00
I hereby affirm that there Is a construction lending apenay for ,
the performance of the'work for which this pgrmit Is Issued a
(Seo.3007, Ctv.,C.).
ADI� < Q0 t M d a <4_ 0000-Mi 1/14/93
Lender'.Nem*' r
C"rY, a-,� r�No. 7624 1 Ali 9:49
Landed.AddressJ
I ce-riffy that I have read thla applloatlon and state that the above �LICLIC.
I ce-riffy that I �ave read thla appl$o� and state that the above ME NO. 7-- q CL 88
Irttormaifon Is correct- I agree to compiy with all County ordlnancee
and State laws relaiing to btillding conabu tion,and hereby authorize
repreeentatives of thle County to enter upon the above-msntioned
property for Inspect n purpoaee. 8EEE FWVE.FtSE FOR DCIPLANATORY LANGUAGE
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