HomeMy WebLinkAbout1848Akl'lr It K,,'l:., , �i.l- o..Il};A-I Ii�V � a� CLA. 1•'A i 1, N
I here hy %ffirin 0) ,.1 1 ha'= j ceculi":,;r „I C;MS�11I to ;rIt
insure, ur a certif,Cate 01 l•VurkcrS' Corn persat]On insurance, Or
a certified ki f.5 _.g00.
I�
Palicy No.}1•""!,hill::ny
Certlfletl cop) fi h,%by fkji ,,1 ed ,..
I C'erUfied copy „filed wtlh t inti to 'pectioa
a,pp
Date ,-3 EI��;rnt
C'ERTIFIC'ATE OF i XLAIPTION FRUM %V(_WKFRS'
COMPFNJ ,.NTION 1NSURANCL
(This section need not bU completed it the work involved
by dt# permit is ror tine hundred dollars (5100) or less.)
1 certity [lint io the IierlOmir;nr: (,t the wiirl,. 10, which this
permit is sssued. I shill not ml,lw. ;n> pv.rsun in dny manner
so as to hecf,n-te 5ublecI in thr ih'ork .r5 Co open:anon Late;
I)ate' Apl1lir.-,n1
NOTICE TO kPI`LICANT IL atter malting this Cerrificatc Of
Exemption, you should tit—Me:-itEe.1 to the Workers'
Compensation pr,,visi<,n,; if Ih, L ,I, ,I COde, you must forth-
with comply utth such prrn,slr, oiis permil shall he
deemed revoked.
L ICENSI•_D C( NT l'.AC'TC>RS I1T1:'L ,-%RA`rION
1 hereby affirm th;;1 I am licensed un%ler provisions of Chapter
9 (commencing with Secl,[,n 700) of Uivisi,n 3 of the Busi-
ness and Professions Code. and my license is to toll force and
effect.7
License Nui*i/l
. Li,. C -lass
Contract„ri)ate _ �'`p
I am exempt Irom the liccn_inp r�yu,remenis as 1 am a
licensed archil�ct •.:E .. .rci trrie;l professional engineer
acting in my prrlfes3i„nal cspac:Ity (Section 7051, Bus-
I,7C%g and (r,d--)-
LiL. or keg. No. Dote
HOME OWNER-BIIILDEN, DL;'l_APATIJN
I hereby affirm tttst 1 am exempt Ir 1!1C Ihz C(intrael Or'S
License Law for the tollovn�, r,: son 7031.5, Busi.
nest' anti Profz;ssons Cod,=)
El1, as owner „t the property, will (lu lha wurk and the
structure i:: nni intended nl offerer for sole (Section
7044, Hwinos;�.,-�tif PrnF_%s_',L• C: -Jr).
❑ 1, as Dwner of the ulopt:irv. .nI 1trS+vvly co;itract,ng
with licen4Lc cOnhfllcLv_ sir(,::I the prolcct
(Section 7 m
044. Busui�ss and Prr,tess omi Code),
C0NST R 11 C-1 ft':~l I_i: N Ill '4(_. A1,ENr_ y
1 hereby affirm that tY,--.ro i< :, .:olISIZU'Aior. tending agen,:y
for the perfwm-ince =1 tit, a � rh lOr sahl_h this permit is
sssued (Sec 3097, Civ.
Lender's ?Name
Lender's Address.
I certify that C have read 0119 eppla:•atn,n atsd ;bile that the
above information is correct. i e t; cantpl� with ail rounty
ordinances anct�” are' 1 :r xls'iw, !ir:,tua,, Vrntiialing and
Air Conditiul i elet,S ht,Iia: represe,Iratives of lhi;
C'O Un IV to e1 + fi t? u•,r rnrntioncd properly Ic.r
insp0rtio r
Stgnaturenfpenn'¢�ec flare
;E -81c APPLICATION FOR PERMIT
HEATING -VENTILATING -AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN
(PRINT OR TYPE ONLY)
BUILDING
ADORESS
r`f' • s' ✓fir'.
LOCALITY
Nr s.
TYPE OF APPLIANCE OR EQUIPMENT
FEE
NEAREST
CROSS ST.
-�••l '
ABSORPTION UNIT, BTU
AIR HANDLING UNIT, CPM
DISTRICT NOPROCESSED
ay
1
BOILER, BTU
�
APPROVALS DATE INISPECF09$S11,NA'r'PPE
COMPRESSOR, BTU
ROUGH
VENTILATION SYSTEM
FINAL
EVAPORATIVE COOLER
VALIDATION
FURNACE', FAU GRAVITY
FLOOR BTU
HEATER SUSPENDED UNIT
WALL
Plan check fee 25% of above.
PERMIT ISSUING FEE $
s
''-
TOTAL FEE
(°
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TIL' NO
y
a%'+fl.%'p/r •f:+:
OWNER AllMAIL
ADDRESS
C$TV /�A!!"'%li,y.� TEL r10
CONTRACTOR i / �•�
ADDRESS
TEL. NO.
FTAP
E NO, "' �µ''n� CLASS
SEE REVLRSE FOR EXPLANATORY LANGUAGE
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