HomeMy Public PortalAbout10629 ROSEGLEN ST_Mechanical__ WORt�A'B oOAAPENSATKxN DeaARAnoN 75A9 DPta
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A P P t I CAT I O N FOR: PERMIT `
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I hereby affirm that I have a oer"cate of consent to,self Insure,
ar a cerdflcate of Workers ompepsatlon Inauranoe, or a oaritfled HEATING-VENTILATING-Ali EN
CONDITIONING
copy thereof(Seo.3909 Lab.C.)
F'Soday No. Cornpam' COUNTY OF LOS ANGE)ES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY flIV.
❑ Certfw copy is hereby fumlejied.
❑ Carttfled oopy is ff{ed with the obunty building Inspection FOR APPLICANT TO FILL IN
(PRNT OR TYPE ONLY) ADDRESS ADDRESS �v
LOCALITYL .
Date r APpilics?? _ NO. TYPE OF APP41ANC:E OR ECAAPMEN F E
C
(�FNTTF)cAT�of E(Emi-T10N mom woFn07�S' FKMsY
Aose ST. L&
COMPENSAT)ON INSURANCE A1380AATlON 1JNff BT11 ASSESSOR
(Sh16,weaftp nosd riot be oomplotod Jf,ttm stock lhvotvod by the MAP BOOK PAGE PAACEL
psrrfilt la,for ono hundrad dollars(000)or INa.) AIA HANDLING UNIT CFM
oanarcTNoPFA3CUB@M BY
I certlty that In the psrforrhance of the work,for which this permit
Is Issued, Ishall not employany pereen 'mariner so into BOl MTU 4, ;
become subject to the Workers'Com
COM BTU
APPnovKq nAn s�uresu�a�rut
D VEIFnLATTON SYSTEM - r-
NO7"Ek&[CART.: Jf; after, mnkln9 this Certificate of ROt1GH
Ex*mptlorr,you 4hbuld beoome eub)ebt f9 the;Workers'Compao,&rdo4 EVAPORATIVE COOLER
FNAL
.provisions atthe Labor Cod*, you must forthwith comply with subh
provisions or thla-permR shajf be deemed revoked. FURNACE: FAU O
LICVN8MCONTF�TORSf1ECLAAA.T1oN Ft00A -BTU � VALIDATION
hereby affirm xhat G em Ilcenspd ondef provisions of Chapter 9 SUSPENDED UNIT -
(comm6noing,with Sectlon 7000)of Division 3 of the Business and HEATER WALL
Orbtesslona C xle,`and my-Ilos-nae Is In'full torte and ettdoi
Lkxfra Number Llo.Cte�e
❑ I am exempt under Seo. Plan speck tee
B.SP.C.for this reason PERMIT ISSUING FEE$,XIUr 0
buts: TOTAL FEE L
OWNER-BUILDER DECLJI!�A71oN PtANf u Z
I hereby al lrrp that I am exempt from the Contractor's License Law NAME , y
for the following reason (Sectlon-703},6, Busi
lnees and Profeselons �'I •T
Cod*): 7t{
1,as owner of the property, or _.my employ**a with wages � �`
as th*lr pole compensation, will do"the work and the CITY TEL NO. I ITEMS
structure Is not frttended or offered for sale (Section 7044, TIS i
Business and Profeaslons Code). OWNER TOTk 71 -- 2.1
❑ I, as owner of the property, am sxpluslvely bonttacting MAIL t -�Fi r} -
wlfh licensed contractors to construct the projgot (Seo- `-71 i L_�
don 7044, Buolne*s and Professions Cqd*). CITY
CONSTRUCTION LENDING AGENCY PL TEN_-40.
I hereby affirm that there le a,aonstruogon lending a9enoy for A Q
the performanoo'of:th�e work for which this permit Is Issued 1��{•yy-�-�'��y�y q �}
(Secs 3997,Civ. C.). Fr: 03001 .. -V24192
AJi. Ftp .� I.
L-eodore Nam*
CITY j XLi l�N6.
LerxWe Address STATE LEC.
I ceRffy that I have read this applloat}on and state that the above LICENSE NO. CLASS Qili�
Informerion Is condi. i agree to comply with all County ordlnenoes
pnd laws ng bundbng oxmtructlon,and hereby alnhortre
rep of th eater upon the above-mentioned
ppope for I 1 pu SEE REVERSE FOR EXPL NATOkY LAIIOUAOE
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