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1_6_1986 - 21015 PATHFINDER RD
� � , . . �.� r�j � : . - e . � `"°RKERs•`°"'°E"S"T'°"°E""R"T'°" APPLICATION FOR PERMIT � I hereby offrrm tha�I have a certiticote of tonsent to self � � ' . . � � �insure,or a cerhf cate of Workers'Compensation Insurance, r' � , � � � � � . o�a ce(iified copy thereof(Set.3800,�ab.C.) �C�eA�� � •, �HEATING - VENTILATING - AIR CONDITIONING � . ' 1�/�!.i� ��'�%•�:,. . -1 ,�/818(REV.10/81) : � , _.�..--� . .�.-..�F+-•�-�•— . .P❑olicy No.'- Company;.-'i�::l:.ti,j-;' . �. . � . ...� :.__.�-__.. .,..,.�_.. . Certi(ied ropy is hereby furnisRed. !COUNTY OF LOS ANGELES �BUILDING AND SAFETY T�• Certified copy is filed with the mvnty building inspeo- FOR'APPLICANT TO FILL IN sVitDiNG �.�� ':`j_� fior�de artmenl. � " �. (PRINi OR TYPE ONLY) � ADDRE55 —�- J .t�,�J Date �/'r� ':�:lC APPIiEaM�'�,.�, �i�ti .- `�� . . � . LOUtIri �7.;t.:�._�: „� .NO. TYPE OF APPIIANCE OR E�UIPMENT . FEE CERTIFICATE OF EXEMPT�ON fROM WORKERS' CROSS St. 7'��C,L��,', l',�,r_.'Y.,�- � COMPENSATION INSURANCE " - . � (Thi�sadton nead not be eompiotud if fhe work involvod by Ag$ORPTION UNIT,9TU ois�wia rvo. � . , eeocEsseo ar . th�p�rmif is ior one hundred dollorz(f100)or les�.) - � � ' - �� �- � ' .:�;'-� ' i � � AIR HANDLMG UNIT,CFM ' . ..,%.,...____�:-�.-- , � .. I certify that in the performance of 1he work for which fh(s� _. ........- ;:;-�;,� � . .. :. ........ -. permit is issued,I thali not er�iAloy any person in any monner gOItER,BTU + � -�se as ro betome subject to 1he Workeri Compensalion Laws. P.vvaovnls D0.TE � INSPECTOR'SSIGNATVRE - � Dafe eppli[anf � - ' COMPRESSOR STU�' ROUGH � - ' NOTICE TO APPIICANT: If, oNer moking this Certifimte of � VEMILATIOy�SYSTFM� - � ?�;� ... FiNA� � � Exemplion, you shoold become subject to the Wo�ke�s' "'-- � '�� � Compensarion provisions of the lobor Code,yoo musr forth- evnvo2nnJe Coaiee VALIDATION wilh comply wi�b s�th piovisions or Ihis permit sball be � . � . � deemed revoked. FURNACE: . . FAU�GRAVITY � LICENSED CONTRACTORS DECLARATION . FIOOR BTU - I hereby affirm fhot I am licensed onder provisions of Chapter 9 SUSrENDFD UNIT_ �- � � � '(commencing with Seclion 7000)of Division 3 of the Business � HEATER: WA�� . � }� and Professlons Code,ond my license is in full force and effecf. - � . . � " � Q �:7: r� =i tt: V License Number� � �� Lic Class `^ - , � � . j !f // +�'r�i' u. Controctor r,�=.- t-. .Date l� +'-':". , - . .. .�i��.�: ��:!t � �, ❑ I am exempt vnder Sec � �� - ?Y,°,!i+i i;"��: Q � �,�,, Plan check fee „ m B.BP.C.for fhis rea: _,1 :(;',',r_'�,r;(1 O i�� PERMIT ISSUING FEE S �` [r`a�a. �� ,� g -_�,,,.,;; f� .✓ TOTAL FEE �rJ o'e.� r 2l:.. r"'- . Signoture — " !+—..`. � .� . �r;:�,�i � - �OWNER-�UIkDfFfEECLARATION ttAN CHECK A7PLICANi� . - � �� � � }�,�:Q�;,,;_,M �here6y effirm that I am exemp��from the Confrador's License .. . , � � � . _ � � Low for�he following reason(Section 7031.5,Business ond NnME ' ' Professions Code): ,� . . � � - - ❑ I, as owner of fhe property, or my employees wilh ADDRE55 - - � - - , � . � . � wages os fheir sole compensalion,will do the work and � the strudura is not intended or offered for sale(Section CiTV rEL NO. . 70a4,Business and Professions Code). . �� - � . - _. . . OWNER "'.1,r�:r,�. t . .�::. ..,... • .. _ -• � ❑ I,as owner of the property„om exdusively contracting - " ` � . � wilh IicenSed confrot�org to construct the projeU(Seo ��� 1 ..: �. � ..... . � � � � : '�. ._.._... _,_........ . tion 7044,Bosiness and Professions Code). AD�RE55 r . /.� _ : %.•''� CONSTRUCTION:LENDING AGENCY GTY �i.r r , ��!; TEL.NO.y: � . , . , � I hereby affirm that there is a conshuUion lending ogency for • ' ► . .. � the performonce of the work'for which this permil is issued COMRACTOR�� ' . . � � ' � � .(Sec.3097.Civ.C.). . -.`f+�����`' �. .. . � � ADDRE55 �._'�.'--� .. � � . . � .. ' . Lendei s Name " - � � - .. � . CIN.;'_.. �J TEL.NO �._- _ ::..�� . . . . � . Lender's Address ' � . � STATE IIC. . � � - - I cerfiiy ihat f a e read this app�imlion and sfa�e Ihal the IICENSE NO GLASS � . � � - '_ � obove inf ation is correct.I agree m comply with all County . • � ordinan a and Stote laws reloting to building constroUion, ... � ond h eby aWherize reptesemolives o(this Counfy io enter . � - - . upon he abov�m�ernry"oned properfy for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ,:�,`j'�!,!T r, .-f..�y � . . . . . . � . . , . � 9��..o1�-Ap�tic5n�oiAgem -0ate . . � . i ---_.. �. ,:�.'�_ ,. ..�,. .. . 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