HomeMy Public PortalAbout5535 ROSEMEAD BLVD_Mechanical__ In that ISove a certificate
of
7SA3 oPaYef� APPLICATION FOR PERMIT I JJI LE GREEN
I hereby eNlrfrt That I have a certllicela of consent to Bell Insure 76�llaIO
or a certificate of Worker a Compensation Insurance or a cenified HEATING-VENTILATING-AIR CONDITIONING I I
copy thereof(Sac d
3800 Lab C)
Pal ky MIB00 -
0 4 2- Cr,ort'�'RAIf1$ i4a1,s¢l�.t. COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
❑ CeniOed copy d hereby hrrNafted
❑ ca ropy b Mad with the carob bWlNng Inspection FOR (PRINT APPLICANT TO IN A�9S 5535
Dste -3I-9.�� pp___rr1'l�J7Y-Y1 ��T7C7LOCALRY
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS CROSS 8T
,/ NEAREST
COMPENSATION INSURANCE �j' ABSORP-nom INR BTU DO
SSOR
(This section need not be aoraplated If the work Involved by the MAAPBOOK PAGE PARCEL
permit Is for one hundred dollen(111100)or lea) NR HANDLING UNITCFM
I certify that In the performance of the work for which this permit mrncrw ��
Is Issued I shall not employ any person In any manner so as to BOILER BTU—
become
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become subject to the Workers Compensation Laws d
COMPRESSO BTU
DAM A 's simHrvee
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Data APPlkant VENTILATION SYSfE1A0��� o -�
NOTICE TO APPLICANT If after making this Certificate of �J ROUGH }5
.
Exemption you should become aubjecl to the Workers Compensation EVAPORATIVE COOLER
provisions of the Labor Code you must forthwith comply with such FINAL
provisions or this permit shall be deemed revoked FURNACE FAu aRAvrrY 01. 6 bo VALIDATIO
LICENSED CONTRACTORS DECLARATION FLOOR l)TU min
I hereby affirm that I am licensed under provisions of Chapter 8 NFi,TFA SUSPENDED UPBT_ v77U3 1192.00
(commencing with Section 7000) of Division 3 of the Business and WALLProfesslons Code and my license Is In full force and effect -` 0 6O /� �y 2 I l[,llA
Cellp
f/ TOTAL. 2527.55
License Nambr�^'n►5s" LIc cisu�_ PAI , dyad �� a° MICK 2527.55 }
cano-m-ra' ffllam'.10 , Dale �i^31-4� a /Oso .Z,/ "b C .00 Q
❑ I aril exempt under Sac Plan check fee 3 `S-S Q
B aP C fa thla reason PERMIT ISSUING FEESO OMD-Ml 8/31M O
Date TOTAL FEE ro �Z1 2134 1 PM 4l:13
Signature y
OWNER BUILDER DECLARATION PLAN CHECK APPLICANT Z
I hereby affirm that I am exempt from the Contractor a License Lew NAME
for the following reason (Section 7031 5 Business and Profession �-tel ��41
❑Code) I ea owner of the propemp or my employees with wages ADDRESS , "��� 'S�
as their sole compensation will do the work and the crTYSApL bi-GG6 Cp, TEL NO lis
structure is not Intended or offered for sale(Section 7044
Business and Profession Code) OWNER QFFIC7C
❑ I as owner of the property am exclusively contracting MAIL
with licensed contractors to construct the project (Sec ADDWM2200 C51",3 lion 7041 Business and Professions Code) S 0
NO
CONSTRUCTION LENDING AGENCY CITY y3eTEL
I hereby affirm that there Is a construction lending aency for ,
the performance of the work for which this permit ?19 Issued CONTRACTOR
(Sec 3087 CN C)
ADDRESS ,� `u �T[� d\ s
Lendar a Name
CRY s D 1G L` TEL NO
Larger a Address STATE LIC
I certify that I have read this application and state that the above LICENSE NO ZQ �� CLASS
Information is correct I agree to compty,with all Courtty ordinances
and State Laws relaWg to building construction,and hereby authodza
relKesentathros of this County to enter upon the abov mentioned
property for Ins amort pur see SEE REVERSE FOR EXPLANATORY LANGUAGE
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