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Home My Public Portal About5540 PAL MAL AVE_Mechanical__ ION WORKER'S thatIhave of consent to o/tm APPLICATION FOR PERMIT LIME GREEN I NnDy affirm that I have •certificate of consent to self Insure or lceniticate of Worker,-Comperlsation Imurance or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec 31100 Lab C I 22!")lo W7�--73Qcompeny 5T-A-TF 'F0 TVX) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV CerlHbd copy Is hereby Mmehed ❑ DerlXled copy le filed with the BUILDING building Inspection FOR APPLICANT TO FILL IN BUILDS 4� A M L A V E depw enl (PRINT OR TYPE ONLY) ADDRESS DoteLOCALITY�°"t 1q TYPE OF APPLIANCE OR EauwMEhrr FEE M LE C • CERTIFICATE OF EXEMPTION FROM WORMERS NEAREST COMPENSATION INSURANCE ABSORPTION CROSSST V (This asctlon need not be completed N the wore Involved by the 11Nrt BTUASSESSOR YAP 8001( PAGE PARCEL permit Is for one hundred dollen f or lees) NR HANDLING UXrt CFM oumect p ate n. I certify that at In the performance of the work for which title permit Is Issued I shall not employ any person in any manner so as to MOILER 13711 v become subject to the Waken Compensation Laws / COMPRESSOR BTU Date Applicem �x^ov� are smemoeeeoaxnxw VENTiLAT10N SYSTEM NOTICE TO APPLICANT If alter meting this Certificate of ROUGH Exemption you should became subject to the Workers Compensation EVAPORATIVE COOLER provisions of the Labor Code you must forthwith comply with such FINAL provisions or this Permit Snell be deemed revoked FURNACE FAU_ORAVITV LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that i am licensed under provision,of Chapter g SUSPENDED UNrr_ (commencing with Section 7000)of Division 3 of the Business and HEATER WALL Professions Code and my license Is in full force and affect Lkxmse Number .4--47441 Lk Clang Poo. } n. Contractor air N CQ A=�,, , Date 2 _-- 5�9 ❑ I am exempt under Sec Plan check fee Q B aP C fa NY resew PERMIT ISSUING FEEWV 7S O Dole TOTAL FEE 15W South- IL OWNER BUILDER DECLARATION PLAN CHECK APPLICANT Z ' I hereby affirm that I am exempt from the Contractor•License Lew NAME or the following reason (Section 7031 5 Business and Professions Code) ADDRE A.C:.t 1 as owner of the property or my employee, with wages as their sole compensation, will do the work and the C" TEL NO —117 -9. IK structure Is not Intended or offered la sole(Section 7011 1 I(Ehl` Business and Profession,Code) OWNER ❑ I as owmr of the property am exclusively contracting MAIL 101 AL 39 . 30 with licensed contractors to construct the project (Sec. ADDRESS _ ikn 7044 Business and Prolesekns Code) CHECK CONSTRUCTION LENDING AGENCY CRY TEL NO :NAN 711 C 01] I hereby affirm e o there la •fonwhichl this lending agency for , the per11ormence of the work for which this permit , Issued CONTRACTOR (Sec 3087 CN C) ADDRESS Lender a Name LIlC1:1-C1U�11 t��SI i Lander a Address CITY TEL NO 191]1 1 ,11110:1: I cartity that I hew read this epplkation and state that the above STA NO CLIC rnformetlon le correct I agree to comply with all County ordinances and State Tawe relating to building construction and hereby authod:e representathres of this County to enter upon the abovsmernioned property for inspection urpoa a SEE REVERSE FOR EXPLANATORY LANGUAGE Ir 2-25-92 stri�— WORKER atI have COMPENSATION DECLARATION �°DPW ef» APPLICATION FOR PERMIT LIME GREEN I hereby eN1Im Thal I have .cenllkqte of consent to self insure 7�7tMC «-s cMilicata of Worker a Compensation Insurance or e certillad HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec 3800 Lab C) Pobcy No Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV ❑ C111W copy b hereby fumhMo ❑ Cenlfhd copy 1. d with the courdy building inspection FOR APPLICANT TO FILL IN BUILDING depaRraarH (PRINT OR TYPE ONLY) ADDRESS load s O IIjJQ/ DateLOCALITY �• APPllrltrll NO TYPE OF APPLIANCE OR EOUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST COMPENSATION INSURANCE CROSS ST ABSORPTION UN ,BTU ASSESSOR B (Thio t Is for need not be completed the work Involved by the MAP BOOK PAGE PARCEL permit Is forr ons hhundred dollars(i1000)or ISu) AIR HANDLING UNIT,CFM fO1K,'111a .AOQd�1.r I certify that In the pertormence of the work for whkh this permit Is issued I shall not employ any person In any manner so as to BOLER BTU become subject to the Workers Compensalldn �Q 14-13�Q� � COMPRESSORBTU 9 Date — -(aLAPWkem uwavua DATEamwty¢ vlxnuTloN erBreM NOTICE TO APPLICANT If after mak n e ertllicele of ROUGH 2 Ezampdon you Should became subject to the Workers Compensation provisions of the Labor Code you must forthwith comply with such EVAPORATIVE shall be AWrbFINAL provisions«this CTS OE FAu ATION�SEDCONTRACTORDECLAaTION FOR BTU ✓ � V LID 1 hereby affirm that I em licensed under provision. of Chapter S SUSPENDED UNrT_ (Commencing with Section 7000)of Division 3 of the Business and HEATER WALL Professions Code and my license Is In full force and effect _ TE LkenYNumber !/�3 �D 3 Lk risco -c o-G -�•_, a«r.p t ► 1C .7 a D«W,aor [UfJ T EI�TR1. D„. y-13-4? 8 ❑ I am exempt ander Sec Plan check fee I� i_ 1 72 Cr e aP C for this reeaon PERMIT ISSUING FEE$ 7,1— (''I�!`{ +)� v 0 D8° TOTAL FEE t n',H _'. LU Si«ueae .(e OWNER CLARATION PLAN CHECK APPLICANT VI 2 I hereby affirm that I sm exempt Iron the Contractor a License Law NAME for the following reason(Section 7031 a Business and Professions Code) ADDRESS 1 A'S i': I as owner of the prop" or my employees with Wages as their sole compensation will do the work and the CRY TEL NO Structure Is not Intended or offered for eels(Section 7044 ❑ Business and Prelessfons Code) OWNER s I as owner of the property am exclusively contracting PAIL with licensed contractors to construct the project (Sec ADDRESS •� /,v0/ �Jf tion 7041 Business and Profession*Code) Cm /E- TEL /dJ CONSTRUCTION LENDING AGENCY /� I hereby affirm that there is a construction lending aency for Pe ► the performance of the work for which this permit Issued CONTRACTOR (Sec 3097 Cir C) Lwx*a Name ADDRESS / ESB CIfYa�.9 TEL NO (%yeCV L*ndw•Address ATE CL I certify that I have read this application and state that the above NTLI 16E NO CLASS udormatlon b Dont; I agree to complywith cog County orumartcxre and State lam relateg to building construction and hereby auftdz° repressntattves of this County to enter upon the above mentioned property for I rp es 41-13- %2 SEE REVERSE FGR EXPLANATORY LANGUAGE 5133� � CAM n