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HomeMy WebLinkAbout1339A R'ORKLRS'COSiPLNSATIOti DFCLARATION �EA e,$`,2.eo,� A p P L IC AT I O N FO R P E R M IT �7 1 hereby a(firm that I ha.�e a certificate o(conscm to self � "- r�� insure.uracertilica[enlR'orkerc'Comprnsationlnsuranca,oi HEATING-VENTILATING•AIR CONDITIONING U a certifieJ cnpy Iherenf(Sec.3R00,Lab.CJ Pnlicy No. Cnmpany . COUNTY OF LOS ANGELES E3UILD�NG AND SAFETY � �❑ Certified copy is herehy Nrnished, � � Certified copy is filed with the ouunty buiiding insPre[iun FOR APPLICANTTO FILL IN aui�oiNc n'' department. . . A�DRESS 1�_, ���1'�J � � Datr Applican[ (PRINT OR TVPE ONLY) LOCALITV �A CGRTIFICA7E OF FXE�IPTION F(LOSf R'ORKL:RS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE �-�- ___ CO"dYENSr\TION INSURANCE CFtOSS ST. s�f��7�-y;)��� d (This section necd not be completeA if the work involved ABSORPTION UNIT,6TU• - ' �Y O by tlie permi[ is for one hundred dollars (SI00) or'less.) � oisr�icT No. :necesseo�v V 1 Certify th�t in the perf�rmxnce nf Ihe�t'��rk(��r�vhiCh this �+�R HANDLING UNIT,CFM 'O � � permit is issued.1 shall nn[empiny a y percon M any manner O so as tn become bjeM In Ihe�' r' Compens�tion La�t•s. �., _e�,oTU—�� �� f0�p . F- APPROVALS OATE iNSOECTOR'SSIGNATVnE U .Uate_'����ApplicanS—--` — � COMPRESSOR.BTU ROUGH � �{7/� _ _ N NOTICF,TO AI'PLIC.4ICT:If,atter making[h Certificate of VENTILATION SYSTEh9 � � z Fixemption, you-should become subjcct to the R'orkers' - FINAL _- Comprnsstinn prm�isinns of ih±LsUor Cude,you must furth- EVAPOFtATIVE COOLEfi VA IDATION � � �vith comply �vith such procisions ar ihis permit shall be - _ deemeJ rev�keJ. FURNACE: FAV—GGiAVITY_ LICI:NSLDCONTRACTOIISDECLARATION FLOOR� BTU - ' I here6y�affirm th�[I am licenzed unde�prorisions of Chapter HEATER: SUSPENDED. UNIT . . 9 (cnmmencing with Section 7000)af bivisian 3 of the IIusi- WALL � � - ness and Professions Code,and my licznse is in full force and - zffect. 1 License Numhtt_�_�_b_�7"�"�,;,.Class Contr�c[or���t)ate_��_�✓ � � � I�m exempt from the licensing requirements as I am a - IicenseJ architect or a registered professionai,engineer Plan check fee 25°0 of above. - ac[ing in my profession�l capacity (Sec[inn 7051. Bus- �'� 3�9 A. iness and Itrofessions Code). PERMIT ISSUING FEE S �p SQ { . �.�. •�• •a J Lic.or Iteg.No. Date TOTAL FEE �� !Q ' � ilp]1Ii p\5'NP.R-13UILDER➢P:CT.AR.ATION p�qN CHECK APPLICANT � � �2 a`5� I htreby affirm Ihat I am eeempt from'the Contractnr's NAM19E �`a�-��t/ -... '�.� �2 a`5�� l.icense Law for the fnllowing reason (Sectinn 7031.5, I�usi• �-—�— s—L•��'v �2 O� `8 4 ness and Prnftssinns Codz): ADORESS � l, sz o�rncr of[he prnprrty,�+'���do Ihe n�urk and the - structure is nnt intended or o((ercd for sale (Sectinn CITY 7044,Ousiness�nd Protessions Cadc). . OWNER �t� � 1,as owner uf the proDerty,am ezclusively cuntracting . �'�V_ � �ilh IicenseJ con[iactors t<i Cons[ruci �'�e rr�ject ��AIL `��� '^ ,,.,r�����"� . (Sec[ion 70a4,�usinrss�nA I'rotessians Code. A�DRESS �f`(j� �l CONSTIiUCTION LENDING AGVhCY CITY TEL.NO. 1�1'�-����2��a 1 hereby af(irm ihat there is n cansMuction lending sSency CONTRACTOR for the performance nf the work far �chich [his permit is �`��Q� - , - issued(Sec.3097.Civ.C.). , !JI••� Lrnder's V�me AOORE55�1��1 �ti 1 O . p�ll V Lender'sA�ldtts5 . CITY �1�`1n ^,�✓' TEL.NO. ��F"5��� I certif [h�t I hace rcad tl�is a Iication and st�te tha[ the ��� �-V �- µ'� Y PP STATE LIC. \ ahove infnrmatinn is correct.1 aFree to cotnply��'ith all Coun[y L�CFNSE NO.�,�t� �`��LA55 � urdin�ncts and State��tr�s re latine Heating,Ven[ilating�nd Air CunJitioning,an.li reby ::r.�otite representativcs nf lhis SEG I2LVERSIS[�OR EXPLANATOItY LANGUAGh: . . . C .�uy to nter pnn the a+ ve-mentioned property for . .iSFCCfI(1 F i �St`5. , . tiiqna[urc Ne�:...l�ee Date ' � 1� . • . - ,�� � - . ri `, , "� ' - ; . ' .. �•� " � � - - z ,., ` - _ . ` ',; o - r� • � . • _ .. .. N �, , ..�, Z O m N �i , ;"� '.t '. ' . N . � � �1 ' • " � O } ,_ ' , 3s - • N Z _ . O � , � �� , . r . . 3' . � � �, i ' , _ . ,�_ . , . � ' A �� r ..' , '` L7 i^.c ii; � ^ ^_'�. ;..' � _ f ,�,,, �'`C =i .,.�-. �.�ry C y N i. � � .. , C G G JNQrY��:�' �n� C L � C• t c � .cov 7. ��C _ � c G v. - c: ^�� s_ _ .- " .-�, ^ c�.y � ' G.^ ^ �� _�� ^' .. = c =,'... n �,, �. ` ..- ^ .. 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