HomeMy Public PortalAbout10231 OLIVE ST_Mechanical__ left 11
I{a':,,"`,yVGthat'I have
a certiIONficate
of consent to 7W64 DPW 9/89 APPLICATION FOR PERMIT LAME GREEN
�Iihere65Laffirm`that'I have a certificate of consent to self Insure, 76A384C
or a cei.Ifl)cate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING
copy thereof(Sec.3800 Lab.C.) "
P❑ollcyNo. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
Certified copy is hereby furnished.
❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING !®Z 3 (•
department. (PRINT OR TYPE ONLY) ADDRESS J
Date Applicant LOCALITY ! "
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEARESTCROSS ST.
COMPENSATION INSURANCE ABSORPTION UNIT BTU A&'D O�lo't,
(This section need not be completed if the work involved by the ASSESSOR00/
permit is for one hundred dollars($100)or less.) 9 MAP BOOK 8 S8 PAGE®�� PARCEL
AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit
is Issued, I shall not employ any person in any manner so as,to BOILER BTU
become subject to the Workers'Compensation Laws 1
COMPRESSOR,BTU APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applice.
VENTILATION SYSTEM
NOTICE T APPLICANT: If, after Ing this Certificate of ROUGH
Exemption,you should become subjec the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you m st forthwith comply with suchFINAL -41
provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION I FLOOR BTU /�.O VALIDATION
I hereby affirm that I am licensed under provisions of Chapter,9 SUSPENDED-UNIT-
(commencing
USPENDED UNIT(commencing with Section 7000)of Division 3 of the Business and HEATER: WALL
Professions Code,and my license is in full force and effect.
5 o a
470 Lic.Claw License Number .� o sO
>
ContractorVWAM f"®ASNDate
,
L
F1Plan check fee
am exempt under Sec. a
B.&P.C.for this reason PERMIT ISSUING FEE$ O Q k
Date: TOTAL FEE
Signature I V
OWNER-BUILDER DECLARATION i PLAN CHECK APPLICANT
C
1 hereby affirm that I am exempt from the Contractor's License Law NAME , t`
-for the following reason(Section 7031.5, Business and Professions / y
Code): ADDRESS /A/ � + ('l�.f.f.o a
I, as owner of the property, or my employees with wages 3307 6,9--,00
as their sole compensation, will do the work and the CITY 6 TEL.NO. 41ifigv ,O _
structure is not intended or offered for sale(Section 7044, 1 ITEMS S
Business and Professions Code). i OWNER
E] 00.
I, as owner of the property, am exclusively contractiniMAIL - -�m
g MAIL A
with licensed contractors to construct:the project (Sec- ADDRESS C NECK 65.00 j
tion 7044,Business and Professions Code). �/
CONSTRUCTION LENDING AGENCY CITY 4 TEL.NO. y`�3f�� CHANGE aCjL?
I hereby affirm that there is a construction lending agency fir CONTRACTOR ,B[�
the performance of the work for which this permit is issueb. �+
(Sec.3087,Civ.C.). g -
ADDRESS 7{/ � '
Lender's Name i r r,r y yrs"
CITY ' TEL.NO. J' i 1:kJ o j
Lender's Address g
I certify that I have read this application and state that the above
LIC
NO. .�� LIC.
Q
information is correct. I agree to comply with all County ordinances
and State laws relating to building construction,and hereby authorize
representatives of this County to enter upon the above-mentione6
propert for inspectio rposes/ i SEE REVERSE FOR EXPLANATORY LANGUAGE
,!r Y Z 9/
SIGNA OF APPLICANT OR AGENT DATE , -