HomeMy Public PortalAbout9226 ROSEGLEN ST_Mechanical__ WdRKETSCOMPEZISA„oN°ten"°"Til °°"°° '"°'� APPLICATION FOR PERMIT LIME GREEN
I hereby arm that khave a oerUflco
cate of consent to seat Insure,
or•oeFt(ncaie bf Worker's Compensation Insurance, or a oertffled HEATING.VENTILATING.AIR CONDITIONING
copy thereof(Sac.`dSOO Lab.C.)
No. Con's COUNTY OF LOS ANGELES DEPT OF PUBLJQ WORKS BUILDING AND SAFETY DIV.
Certtfled copy is hereby fumlethed.
❑ .;CwffiW co
copy Is ffled with the'county bulKng Inspection FOR APPLICANT TO FILL IN ,U�
PRINT OR TYPE ONLY)
Dela AppOoarrt LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT• FEE
CEFMFfCATE OF EXEMPTION FROM WORK FLS' NCA088 9T. /C/�%//t�iT�✓�
COMPENSAT7oN INSURANCE ABSDRPTpN UNrt BTU
(Thls eecUon need not be oomplefwd If the work Invotved by the MAP BOOT( PAGE PARCEL
permtt la for one hundred dollars(11111 DO)or leas.) AIR HANDLING UNIT CFM
- owrnr.-r no "COMM By
I oerdfy that In the performanoe of the work for which this permit
Is Issued, I shall not employ any person In any manner so as to BOILER,gTU
become aubjeCt to the Workers'CompenaaUon laws.
COMPRESSOR,BTU
nareovxu aR ewaorom swrunsw
Date Appfbant gygTg t
HOT ICE TO APPLICANT: If, after making this CQrtlfloate of1.7
ROUGH111-23-41
Exemption,you should bebome subject to the Work"'ComperuraUon E1r TfVE COOLER NAL
.provisions 6f the Labor Code, you must forthwith comply with suoh R
provisions or this pwmtt shall be deemed revoked. FU1R7UCF-, FAU GRAVfTY
LICE14s»CONTRACTORS DECLARXTpN FLOOR , BTUVALIDATIbN
I hereby afflrm that I am Iloensgd .under provisions of Chapter 9 HEATS SUSPEtAEDT_UNIT
•(commencing with Section 7060) of DlYW6n 3 bf the Business and WALL
Prolumlona Code,and my Ilcerm Is In full foroe and effect — n
Libenee Number Lie.Cless
- a
conte Ddm r1GGT.T
F-1I am exempt ur$der Seo Plan Check fee 31
s�07 - - 67.15 8
B.SP.C.for this reoeon PERMIT ISSUING FEE; = 1 1 0
Dem: TOTAL FEE -- 14TAL 6-7- J-5 W
— �y
PLAN CHECK APPLICANT y �CK 57■15. Z
OWN ER DECLARATION �� �y_���y� _
I hereby afflrm that I am exempt'from the.Contractore UCense Law NAME , _ 1.1Oka - •0I
for.thOollowing reason (Sectlon 7031.6, Business end Professions -
AMRESS �.. . Mil a+7
. -1, as owner of the property, or my employees with wages �—OW1 11/17172
as their sole compeneatldn, will do the work and the :. .. �{{ � p.;r
structure Is not Intended or offered for sale (Section 7044, 6W J. Am 4■v2
Business and Professions Code). I OWNER
❑ I, as owner of the properly, am exclusively oontraotlgg
MAIL
with licensed contraotors to oonetruot the project (Seo- Al7DRFB8 jj
tion 7644, Business and Prgfeealons Code). 1
CONSTRUCTION LENDING AGENCY CITY h1 �3I
I hereby affirm that there Is a oonitruotlon lending apanoy for CONTRACTOR ,
the performance of the work for whloh this permit Is Issued
(Seo.3097, CIv.C.).
Alm
Lender's Neme
CITY
I Lenders Address STATE LIC: -
I certH}c that J Ilcatlorr and state that the above 1-ICOM NO. CLASS
Inform I agree to ply with all County ordinances _
and rig to bufld}ng ot$n,and hereby authorize
rep my to nter upon the/'above-mentioned
pr a ` / __e!;? f SFE REVEFtBE FOR EXPLANATORY LANGUAGE
OR AGafr EATEr