HomeMy Public PortalAbout6218 RENO AVE_Mechanical__ ION
16.1 i.WOthat I have
a certificate
of consent to 20-0046 DPW 9/89 APPLICATION FOR PERMIT LIME GREEN
..._+ �. 76A964C
I heeby of Irm that I have a certificate of consent to self insure,
or a cheieo,( of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING
DO the�{eof($ec.3800 Lab.C.)
Policy No. 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 buildin9 IPectlon ns FOR APPLICANT TO FILL IN BUILDING
❑ department. (PRINT OR TYPE ONLY) ADDRESS
LOCALITY I '
Date Applicant
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST.
COMPENSATION INSURANCE ABSORPTION UNIT,BTU
ASSESSOR
(This section need not be completed if the work Involved by the MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROC
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU O l
become subject to the Workers'Compensation Laws. ' .Z '
COMPRESSOR,BTU S lL7<
APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applicant
NOTICE TO APPLICANT: If, after- I g th[ ert ficate of VENTILATION SYSTEM % ROUGH 15--13-911
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER FINAL ! /T
provisions of the Labor Code,you must forthwith comply with such
provisions or this permit shall be deemed revoked. FURNACE: FAUN bt(y AVITY 2 VALIDATION
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
(commencing with Section 7000)of Division 3 of the Business and WALL
Professions Code,and my license is in full force and effect.
License Number'''" / Lic.Class C
Contractor 711L, 1117) Date ~59 , C
❑ I am exempt under Sec. Plan Check fee D
B.&P.C.for this reason PERMIT ISSUING FEE$
C
J> Date:
— TOTAL FEE ' 00 n
Signature � �����
c °.E
LL PLAN CHECK APPLICANT s=3t;s_;! �
OWNER-BUILDEB)DE46RAON _
I hereby affirm that I am exempt from the Contractor's License Law NAMEpool. J kill
for the following reason(Section 7031.5, Business and Professions
Code): 3 j
4ADDRESS
1, as owner of the property, or my employees with wages A '—
as their sale compensation, will do the work and the CITY TEL.NO.
+ .
structure is not intended or offered for sale (Section 7044, CAECK :e'�'_■LIr L:-'
Business and Professions Code). OWNER I r n' '111
❑ I, as owner of the property, am exclusively contracting (.•i'AkN1.3G °Ill'
MAIL
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code). CITY TEL.NO. [l�li I!I—_I1 I
CONSTRUCTION LENDING AGENCY .+i,:�i
hereby affirm that there is a construction lending agency for CONTRACTOR / / , `= i� 311 "'"
the performance of the work for which this permit Is issued / r:7gi C_
(Sec.3097,Civ.C.).
ADDRESS d Y'd29L ✓)j/�
Lender's Name /
CITY .5;,%/ %LI � TEL.NO.
Lender's Address STATEr LIC.
/ CLASS 4•
I certify that I have read this application and state that the above LICENSE NO.• Z,G(a j''� E
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-mentioned
property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
S1GNATUB&QP*PP13GAfT OR fGENT DATE