HomeMy Public PortalAbout5517 ROBINHOOD AVE_Mechanical__ 89
-have a cf�icat- „ON �°°"°DPW APPLICATION-FOR PERMIT LIME GREEN,
I hereby ■Harm that I have ■ certlHcnt0,of concept to self Insure,
or a c►rtMcate of Worker's Compeneatton Insurance, or a certMed 'HEA T1NQ-VBMLATING-AIR CONDMONING
copy thereof(sec. 3800 Lib.C.)
PoSay No. C—P" COUNTY'6F LOS ANGLE$ DEPT OF PUBLIC WORKS BUILDING AND S tM— DIY.
LJ
Certified copy IF hereby fumes-q.
❑ certin.d copy Fa sled with tho-oaunty brrud]no Fnpectlon ti FOR APPLICANT TO F]LLIN � J55 1-7
depart—ft (PLANT oA TYPE ONLY)
` IAGh1.ffY - I
Date Applicant NO. TYPE bF APPktANCE OFl Bq 1J A E T FES NEAREST
CETMFtCA1-E OF E)CEM ' M FROM WORf�S' Q1068 BT:
COMPE}NSATFON INSURANCE Q1068
UNIT BTu
(Tina seotlori need riot be.completed H.the work Inyotvpd Uth
y e. MAP PAGE PARCEL
perrhftle for one hundred dollars(8160)or fess.) MFi NANDLJNG UNtf,CFN
I certify that In the performehrb of the work for which this rmR
Is Issued, I shall not employ:any pefeon In any man or
to " BT(p s
become subject to the Workers' pe
Laws �—
COM BTU 96
Data VENTLLATK)N SYSTBI
NOTICE TO APPLICANIT:'If, after aking this- Certificate f�OLN3H
Exemptlon,you should become-subject to the-Worker' EVAPOFtAT1VE•006tE}Y
provisions of the Labor Godo,you must fprthwtth comply w1th such I DIAL
provtslons or this-permit•shall be deemed revoked: FURNACFAU GELAVITY
LKENSED CWrq&CTO4S bkXARA =TKK FLOOR eTuzo, V IDATION
I hereby affirm that I am licensed under provlslohe"o`f Chapter 8 SUSPENDED UNrr ti
(commencing with Seotlon 7-000) of Dlvlslon 3 of the Business ►nd HEA� . w 1L
Professions Code, and my I16en* Is In full force and effectt-7
L kwm ]`r Lbss L.Clow
CcrrftVrtd&►rti'k�J
Plan cheat fee p
Lern exempt under Bac. , . G b •' O
B.BP.C.for arts reeeen PERMIT.ISSVING FEE$
Dm: TOYAL 17EM LU
CL
co
e owNE BUILDER DECLARATIONM-AN Cl-lltCx AP?LC k-r
I hereby affirm that 1 em exempt-trom the Contraotor's License Law NAME
.for the following raison (Seotion 7031.6, Business and Professions
Code): ADDRESS ACCT
1, as owner of the property.❑ P P rty;or ray employees with wages - ;�}-1
. &s their able oompensatlon, will do the. work and the CITY TIL 7
NO. `.•"�`•+f .
structure Is not Intended or'offered for sale (Section 7044, ITEM-
1,
Ci E t
Business and Protssalons Codb). OWNER i E �
❑ 1, es owner of the property, ant ekcluslvdly contracting MAILOTPL 107 m 55
with licensed oorttr■ctors to construct the project (Sec- ,r,DpBESB {o CHECK
tion 7044, Business end Profeablons Cede).
CONSTRUCTFQN LENDINQAGENCY CfTY I �� Al
I hereby afflrm that there Is a construction lending a ency Tor }
the performance of the work fbr which this permit Is Issued � /�
(Sao.3087,Ctv:C,).
o + "•r' 1
ADDRE68 2
Lancet's ere Name
L.ender's Address
I certify that I have read this a�pllcatioo and state that the above LX No. Q q_A8'
Informgtfoa w correct I to Co,u y ordlnances
and State IAw■ g and hereby autttortra
es- Co ty to abuse-mentiore4
pro or In ° Q� SEE REVPJ�8E f-0R EICPLA1iATOHY LANCaUAdE