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Home My Public Portal About6356 TEMPLE CITY BLVD_Mechanical__ TION affirm that I have a certificate AcateDf consent 9/� APPLICATION FOR PERMIT LIME GREEN, I hereby affirm that I have a certlllcate of consent to sell insure or a certificate of Worker a Compensation Insurance or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec 3800 Lob C) G El"NowcgryIs Com �j /p3 COUNTY OF LOS ANGELES DEPT OF PUBLJC WORKS BUILDING AND SAFETY DIV hereby tum RrCennietl copy is filed with the county buffeting inspection FOR APPLICANT TO FILL IN BUILDING / Oepertmem (PRIM OR TYPE ONLY) ADDRESS FJ Date APPlx:enl LOCALITY NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST COMPENSATION INSURANCE CROSS (This section need riot be completed N the work Involved by the ABSORPTION UNIT BTU ASSESSOR MAP BOOT( PAGE PARCEL permit Is for one hundred dollen($100)or leu) NR HANDLING UNIT CFM gelppr NO �. I certify that In the performance of the work for which this permit Is timed I shall not employ any person In any manner so as to BOILER BTU yO� 25/'4.l � become subject shall to the Workers Compensation any 1 del �/_ _ �s COMPRESSOR BTU b 3 Date Applicant ,wvaovun DAMvuosr eaoaAnAe VENTILATION SYSTEM NOTICE TO APPLICANT become alter making thisrker Certlllcete of ROUGH Exemplum you ehould rCodsubject to the Workers Ccmpenssitlon EVAPORATIVE COOLER provisions of the Labor Cade you moat forthwith crompty with each FINAL Provisions or this permit shell be deemed revoked FURNACE FAU LICENSED CONTRACTORS DECLARATION FLOOR BTU C 3 VALIDATION , I hereby affirm that I em licensed under provisions of Chapter B HEATER SUSPENDED—UNIT— (commencing USPENDED 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 Num hArX i_, Lw Class C Z Comrecl DeIV` ❑ I am exempt under Bad/—' s, Plan Check fee r r T A. n.� . .r B AP C for this reason PERMIT ISSUING FEE if _i�7 1'IY.'c 0 DateU Signature TOTAL FEE i l�t�+` d OWNER BUILDER DECLARATION PLAN CHECK APPLICANT1� k 109 - 5 T_ Z I hereby affirm that I em exempt from the Contractor a License Lew NAME100. LI'-(V cc owm for the tollp reason (Section 7031 6 Business and Professions Code) ADDRESS til! ❑ I as, owner of the property or my employees with wages as their sole compensation will do the work and the CITY TEL NO structure Is not intended or offered for sale (Section 7014 Business,and Professions Code) OWNER - ❑ I as owner of the properly em exclusively contracting MNL 771): with licensed contractors to construct the project (Sec ADDRESS hon 7044 Business and Professions Code) TEL NO CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for CONTRACTOR ! the performance of the work for which this permit Is, issued (Sac 3087 Qv C) V Lenders Name cITY ` L� D Lender a Address STATE LIC I certify that I have read this application and state that the above LICENSE NO f CLASS Information is correct I agree to comply with all County ordinances and State laws relating to building construction,and hereby autholtZe repam��W� IN a o1 this County to enter upon the ironed ronsp etion t rpoll" SEE REVERSE FOR EXPLANATORY LANGUAGE I 455, TE