HomeMy Public PortalAbout6418 LIVIA AVE_Mechanical__ ION
WORKER'S h ve aceSATate of consent to 76A346DPW9/89 APPlL�CAT�®0V' FOR PERK LIME
GREEN76A364C wl
hereby affirm that I have a certificate of consent to self Insure, _
or aFertingate of Worker's Compensation Insurance, or a certified
HEATING-VENTILATING -AIR CONDITIONING' -
copy thereof(Sec 3800 Lab C) A ;
Policy No Company COUNTY OF LOS ANGELES ;,DEPT OF PUBLIC WORKS , BUILDING AND SAFETY'DIV.
Certified copy Is hereby furnished a
Certified co is filed with the coup building inspection FOR APPLICANT`TO FILL IN ''' BUILDING
PY county 9 Pe ADDRESS
department //�� (PRINT OR TYPE ONLY) .. ,
Date Applicant nNd"'O. /�' all4tk` LOCALITY
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' - NEAREST, "
CROSS ST
COMPENSATION INSURANCE e ,IABSORPTION UNIT,BTU
(This section need,not{be completed If the work involved by the ASSESSOR'MAP.BOOK ;oOs PAGE PARCELQ7J y `„p
permit is for'one hundred dollars($100)or less.)- AIR HANDLING UNIT,CFM ' Q
DISTRICT NO PROCESSED BY
I certify that In the performance of the work for which this permit
is Issued, I shall not employ any person In any manner so as to BOILER,BTU ' G
become subject to the Workers'Compensation•Laws De
° COMPRESSOR BTU
` APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT If, after making'this Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensation a
19
`,r •FINAL 'V J
provisions of•the Labor Code, you must forthwith comply,with such EVAPORATIVE.COOLER
provisions or this permit shall be deemed revoked ," FURNACE FAU GRAVITY -
LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION
I hereby affirm that I am licensed under provisions,of Chapter 9 .SUSPENDED UNIT
(commencing with Section 7000) of Division 3 of the Business and HEATER WALL
Professions Code,and my license is in full force and effect d
License Number' �L-7 S 74 Llc Class
tras
-a5
Cono
Plan check.fee (.1
I m exempt under SEC Q
B&P C,for th_Is"reason PERMIT ISSUING FEE S2 7
Date s TOTAL FEE j/ `. W
Signature "' Q.
PLAN CHECK APPLICANT C0
- OWNER-BUILDER DECLARATION v Z_
I hereby affirm that I am exempt from the Contractor's License Law NAME ifv�■-1lZ D AGGT a
for the following reason (Section 7031 5, Business end'Professions. / / C °g
Code) :. ADDRESS (O,�-/li0 ,�,7V.7 35.40
I,'as owner of the property, or my employees with wages• i TTCp�.
EMS
as their sole compensation, will do the work and the CITY T -C TEL NO 1 ITEMS
structure is not intended or offered for sale (Section 7044, ' TOTAL +� ® �
Business and Professions Code) OWNER �^ tf(11
I, as owner of the property, am exclusively contracting. 5 � - c}{E�y� Y5.40
MAIL r['
_ with licensed contractors to construct the protect (Sec- ADDRESS , - lrfilll\VL .nn
tion 7044, Business and Professions Code)
CONSTRUCTION LENDING AGENCY CITY TEL NO
I hereby affirm that there is a construction lendingagency for, 1 c"
the performance of the work for which this permit Is Issued CONTRACTOR [vi�jl/�,�5 D f�('t(y(>_.(ool 9/27/95
(Sec 3097;Civ C) w�,a �+'�'+`�'
A
ADDRESS _ ' .v ._. .. 42•a1b 1 I'i10.49' .t
Lender's Name /
CITY TEL NO S'Sitj56 _
Lender's AddressSTATE LIC
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I certify that I have read this application and state that the above LICENSE NO 7 � �,y 74 73>CLASS
Information Is correct I agree to comply with all County ordinances
and State laws relating to building construction,and hereby authonze
re resentatives of this County to enter upon the above-mentioned
pr arty for pe on urpo es SEE REVERSE FOR EXPLANATORY LANGUAGE
(GNAT RE OF APPLICANT OR AGENT DATE -