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Home My Public Portal About5524 PAL MAL AVE_Mechanical__ • WORKER have a COMPENSATION of consent ��Wal� APPLICATION FOR PERMIT LIME GREEN Tl ODD ' 1lipreby affirm that 1 neve a certificate of tortoni to self Insure or a eenllicate of Worker a Compensation Insurance or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec 3800 Le C) -{/�• P004 '8 9 ` " COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV ❑ Cenlfied copy Is hereby IurnlMed ❑ Certified copy 13 filed with the Maly buss otbn FOR APPLICANT TO FILL IN ADDRESS 6 aa department v (PRINT OR TYPE ONLY) auu*n Date? AppB Lw=--- ta TYPE DP APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST COMPENSATION INSURANCE CROSS ST (This section need not be completed It the work Invotvad by the ABSORPTION UNIT,S7UASSESSOR permit IS for one hundred denture(8100)or Is"1 AIR 1UNDUHD IkrfT CFM MAP BOOK PAGE �� PARCEL r mat�sm w I certify that In the performance of the work for which this permit No Is Issued 1 shell not employ any person In any manner so as to BOILER STU become subject to the Workers Compensation Laws SD COMPRESSOR BTU Date ApplicantrrnnwAu sun r,msroes exnrunx¢ vomuTION SYSTEM NOTICE 70 APPLICANT If after making this Certificate of ROUGH Exemption you should become sub)ect 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_GRAVRY LICENSED CONTRACTORS DECLARATION FLOOR 37I7 VALIDATION iv I hereby affirm that I tum licensed under provisions of Chapter 8 SUSPENDED UNTT_ (commencing with Section 700D)of Division 3 of the Business and HEATER WALL Professions Code and my license Is In full force and effect Dov 3 03 License Number 4;dJf->51A�- Lk Class IL cantraaar �lt1: ou. 7-2-7-9�- RC: � .r ❑ 1 an exempt under Sec Plan Check fee `T'_ !y,_•p v �¢•. re B aP C for thisason PERMIT ISSUING FEE$ Date TOTAL FEE 6 i;Al lr.i _r,..r n Signature, 70 BUILDER DECLARATION PLAN CHECK APPLICANT _{ � ♦ S'!).c- Z I hereby affirm that 1 am exempt from the Contractor a License Law NAME 'a-�..•� , ({ 1`1OG •-)- la Business following reason(Section 7031 5 Businand Professions ��TF�/ Code) ADDRESS E] I ss owner of the property or my employees with supe° 39 1—DDD i 7/�7/9 ' as their sole compensation will do the work and the CRY —77TEL NO � -• structure Is not Intended or offered for sale(Section 70" 461_- AM 9. 11 Business and Professions Code) OWNER ' ❑ I as owner of the property am exclusively contracting MAL with licensed contractors to construct the project (Sec ADDRESS tion 7044 Business and Professions Code) CONSTRUCTION LENDOIG AGENCY CRY TEL NO I hereby affirm that there Is a construction lending agency for CONTRACT the performance of the work for which this permit 4s Issued (Sec 3007 Civ C) ADDRESS 7 3 Lender a Name '',x, CITY f�i d1�! f� TEL ND 7Y7&7 Lender a Address �rLLIC 1 cenity that I have read thus applicabort and state that the above STATE NO s 7 3,5,;(r CUSS Information Is correct I agree to comply with all County ordirte ,x,S and State laws reL"to building construction,and hereby authorize representatives of this County to enter upon the above-mentioned Property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE T1KE or ADEIIr DAM 7'A3$A`:W`1E°'[/TE APPLICATION FOR PERMIT ' HEATING - VENTILATING - AIR CONDITIONING BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN BUILD NG (PRINT OR TYPE ONLY) ADDRESS LOCALITY NO YPE OF APPLIANCE OR EQUIPMENT FEE NEAREST ABSORPTION UNIT, BTU CROSS ST Zt IAIe S OWNER in* C VR If AIR HANDLING UNIT, CFM MAIL ADDRESS BOILER, BTU CIT TEL NO COMPRESSOR BTU CONTRAS OR VENTILATION SYSTEM ADDRESS EVAPORATIVE COOL R CITY TEL NO FURNACE FAU GR VJ_TY STATE LIC FLOOR BTU O LICENSE NO CLASS HEATER SUSPENDED UNIT— DISTRICT NO GROUP ZONE I PROCES ED BY WALL Ile INSPECTION RECORDV cN yW N Plan check fee 25% of above PERMIT ISSUING FEE $ TOTAL FEE PLAN CHECK APPLICANT NAME ADDRESS CITY TEL NO I HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY MIT. ALL ORDINANCES AND LAWS REGULATING HEATINO VENTI LATINS AIR CONDITIONING 1 HEREBY CERTIFY THAT I AM NOT ACTINO IN V ATION APPROVAL[ DAT[ IIUR[CTOIIy D1014TDRC OF CHAPTER G DIVISION 3 OF THE GUGI 3! AND r.0 ZONAL CODE OF THE STATE OF CALIFORNIA ROUGH f --r SIGNATURE OP PERMITTEE a FINAL �� , I -» --G PLAN CHECK VALIDATION cK M O CAS. PERMIT VALIDATION cK M 0 CAS. 7 6 1 nMgy 741 0 2.J 0 L- w4wERsCOMPENSATION DECLARATION M&MCPwoleo APPLICATION FOR PERMITLIME GREEN I hereby Wflrm thaf I have a certificate of consent to sell Insure 7�'1erC or a certificate of Worker•Compensation Insurance or a cenllled HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec 3800 Lab C) PaNo COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV ceralied copy 1.hereDr flan Caroled copy Ia Bled with du ng Inspection FOR APPLICANT TO FILL IN �� dppytRyRt (PRarT OR TYPE Oran N. PRI bift]: Dau 8/26 A�� NO TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY Ave. CERTIFICATE OF EXEMPTION FROM WORKS NEAREST CROSS 3T COMPENSATION INSURANCE ABSORPTION UNITSTU (This section need not be completed If the work In" d by the ASSESSOR MAS BOOK PAGE PAROL permit Is for ons hundred dollars($100)or less) NR HANDUNG UNITCFM ewrmcr ap p ry 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 "LEK BTU become subject to the Workers'Compensatlon Laws �Q� .�Gkt�c.eC-rte COMPRESSOR Dau ApplicantAr. &S DAM ra.scrarr a ma.Tua vFxnuTION aysrEAl NOTICE 70 APPLICANT If eller making this Certificate of F10llOH Exemption you should become subject to the Workers Compensation EVAPORATIVE COOLER provisions of the Leber Code you must forthwith comply with such FINAL provisions or this permit&hall be deemed revoked FURNACE FAU LICENSED CONTRACTORS DECLARATION FLOOR v s VALIDATION I hereby affirm that I am licensed under provisions of Chapter $ HEATER SUSPEN AMT_ (commencing with Section 7000) of Division 3 of the Business and WALL Pmfesa oma Code and my license is In full force and effect / riz License Number 589544 Ik CMsC20 �. P Caliber Date 8/26 ACCT&:a - Contractor❑ l am exempt under sec Plan check fee 3307 98.06 Q B$P C for this reason PERMIT ISSUING FEES 5' 1 ITEMS O Onto TOTAL FEE TOTAL 98Ob W Signature PN CHECK APPLICANT OECK �•�� N U OWNER BUILDER DECLARATION iyiAL12 s0 Z I hereby affirm that I on exempt from the Contractor s License Law NAME , {.FNS for the following reason (Section 7031 8 Business and Professions Code) ADDRESS �(yI/� E] I "owner of the property or my employees with wages OOOO—OODI 8/27/r-' as their sole compensation, will do the work and the CRY TEL NO structure 1&not Intended or offered for eels (Section 7044 5224 1 AM 7:44 Business and Professions Code) OWNER Kenneth Garcia ❑ I as owner of the property am exclusively contracting MAIL with licensed contractors to construct the project (Sec ADDRESS tion 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY CITY 4 4 8-8 8 5 5 I hereby affirm that there Is a construction lending aency for ► the performance of the work for which this permit fa Issued CONTRACTOR (Sec 3087 Ch, C) ADDS 18301 Irvine Blvd. Lender s Name CIT TEL NO Lender&Address, CITY LIC I certify that I have read this application and elate that the above LICENSE NO 89644 CLASS fnrormatlon b I agree to comply with all County ordinances end Stats g to building construction,and hereby authorize repnsentat ear this my to enter upon the above-mentioned props f Ins 10 purpoan ^ � ^ BFB?REVERSE FOR EXPLANATORY LANGUAGE