HomeMy Public PortalAbout6037 MUSCATEL AVE_Mechanical__ ION
2G-004
WORKER have a certificate
of Consent to 76A38eDPWsfes APPLICATION FOR PERMIT LIME GREEN
I heif96y affitol that 1 have a certificate of consent to self'insurl3., (78A364C
or a certificate Df.WorPr's compensation Insurance,or a certified HEATING-VENTILATING=AIR CONDITIONING
copy th:reof XSec.3800 Lab.C.)
U96//a0;wb6 ar -:_.
Policy No. Company CA L 1" COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
Certified copy is hereby furnished.
❑ Certified copy is filed with the count buildingInspection I FOR APPLICANT TO FILL IN BUILDING 'p
department. 1ll y p n (PRINT OR TYPE ONLY) ADDRESS 603-7 v S C p T L-
Date 7--a-2-- �6 Applicant`v t L y, kA J�fl`u R LOCALITY -� Le
-
NEAREST TYPE OF APPLIANCE OR EQUIPMENT FEE &� ��`
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
CROSS ST.
COMPENSATION INSURANCE ABSORPTION UNIT. BTU
(This section need not be completed if the work involved by the ASSESSOR
MAP BOOK PAGE PARCEL
.permit is for one-hundred dollars($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit I
is issued, I shall not employ•any person in any manner so as to BOILER,BTU
become subject to the Workers'Compensation Laws. ��
/ COMPRESSOR,BTU Q DV
Date I APPROVALS DATE INSPECTOR'S SIGNATURE
Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of I ROUGH
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code;you must forthwith comply with such FINAL
provisions or this permit shall be deemed revoked. FURNACE: FAU GRAV
LICENSED CONTRACTORS DECLARATION I / FLOOR BTU 7 000 B--O VALIDATION
I.hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED • UNIT •• n/��
(commencing'with Section 7000)of Division 3 of the Business and HEATER: WALL
Professions Code,and my license Is in full force and effect. I V ((((1111 U
License Number O a-(g Lie.Class C-0 c r)-D i
pop CL
Contractor�� s WVIw"�� Data Q
❑ e
I Plan check feO
am exempt under Sec. IS
B.&P.C.for this reason PERMIT ISSUING FEE I 8 H
Date: TOTAL FEE / AST°$ LL
Signature ! PLAN CHECK APPLICANT 3303 81.75(�
OWNER-BUILDER DECLARATION 1 ITEMS
hereby affirm that I am exempt from the Contractor's License Law NAME
for the following reason (Section 7031.5, Business and Professions I oil. TOTAL81- 75
Code): ADDRESS
❑ I, as owner of the property, or my employees with wages ,I + CHECK 81°75
as their sole compensation, will do the work and the CITY TEL.NO. CHANGEstructure is not intended or offered for sale(Section 7044, I .00
Business and Professions Code). I OWNER Y Y 1'C r\` L, 2&T-L_M A l C R
❑ I, as owner of the property, am exclusively contracting I MAIL �9 i
with licensed contractors to construct the project (Sec- ADDRESS 603 -7 KJ A US JE 1 n!'T&L 0000-0001 7/22/96
tion 7044,Business and Professions Code). _
' CONSTRUCTION LENDING AGENCY
CITY ),yl a cfTy TEL.NO. 7573 1 AIS 9:09
I
herebyprf affirm that there is a construction lending agency for CONTRACTOR
the erformance of the work for which this permit is Issued yr Z
(Sec.3097,Civ.C.).
ADDRESS I C, R YAC)Iva
Lender's Name
CITY .G` ,AG 0-6 TEL.NO. d�IgO ,if(f'1 1
li 1
Lender's Address STATE C LIC. 1
I certify that I have read this application and state that the above LICENSE NO, ;L$5 6 6 CLASS
information is correct. I agree to comply with all County ordinances .j
and State laws relating to building construction,and hereby authorize
representatives of this County to enter upon the above-mentioned
propego Insp ti n purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE
_ '�6
_tea
GNATURE OF,
OR NT DATE ,