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HomeMy WebLinkAbout12_20_1982 - 1817 PEACEFUL HILLS RD ,��aaK�:as���»+E�,.�S.�r��N�����:,��:,T,�v CEA819C�2-80) f#PPLICATION FOR PERMIT I hereb}• affirm that 1 havc a'cer[itica�e nf cnnsent to self � insure,nr a�c�e+.rtifica�eo 15brkers'Compensstirn Insurance,oi HEATING•VENTILATING-AIR CONOITIONING a certified� �' �Sec.3800 'i6.� C.) � � . � � �� Policy N� ompanp ��'�'L� ❑ Cer[i(ied copy is herchy Curnished, C UNTY OF LOS ANGELES n � DING AND SAFETY �Cer[i(ied cnp��i�f�.rd�cith th n '�u' .i� ,inspectinn r BUILDING e5�,-� �. FOR APPLICANT TO FILL IN Aoortess �8,�� �� Ilah_�.K� pplicant__ ___ �_ (PRINT OR TYPE ONLY1 LOCALITY CBRTfIICATF:OG FXFS11'T' 7 ,FRO}115'ORRTitS' NO. TYPE OF APPLIANCE Ofl EQUIPh1ENT FEE COVFLKS.ATION 'iUli;\NCE NEAREST (Tf4t SCCtlon nePd not bC COmplMed if ihe ��'ork im'oh'ed � ABSORPTION UNIT,BTU CROSS 5T. a b}• the permit is fm one handmd dollars (S10D) or tcss.) �ISTRICTNO. P cess oev U !certify ihst in the performance nf the�cnrk fnr which this AIF HANOLING VNIT,CFM ^ _ permit is icsued,I sh�ll nnt emnlog 3ny person in any manner �j� a�/�`��� O - su as to becnme suhject m the\5'nrkers'Cumpensn[ion Lsws. BOILER,BTU Datc Applicant l COMPRESSOR,BTU_�/.V"-�— 'O �PROVALS DATE isSPECTaq'S 3NnTuaE V � ROUGH N N! C TO AYPI.IC.WT:I4�fter making ihi<Certifitate oT VENTIlA710N SYSTEh7 FINAL Z fie� ,ion, ynu should becnme subjec[ [n the lt'nrAed' Compen�ation pru�idons of the Lahnr Cnde,ynu mus�forth- EVAPORATIVE COOLER VALIDATION ���ith comply ���i[h such provisions or tliis permit 5ha11 he ' ideemed re�okrd. FURNACE: FAU rP V�TY LIC}CNSEDCONTILACT[)14SDECLARATfON FLOOR: BTU_ ��� '� ^ T herehy nftirm ihof 1 sm li;en�eel��n�er��r���isions of Chs�ter � HEATER: SVSPENDED UNIT 9 (rommencinK w�th Srctinn 7000)nt 1)ivision 3 of Ihe Rusi- WALL � ness and Pmfessinm C�oJe,anJ mp licrnse is in full forcP anA - e(fecL �^ (/��'/�(7�//J'� • . . Licencr Vumbef.��}7. -.Y I�ss_�r�l_V - �� _ n_ ,_�O, � �_,j� � � llh.���� �..�i�o�r a /� w�_�c. C�nttsc[or���_�.._��)ate_/�r�—_ — - 5�� ��p � � 1 am exempt from �he Iicensing requirements as I am a #{• • • • •8 licensed architect or a regi=tered professional enginerr Plan cheek fee 259'o Of aboVe. � aetin� in my prnfcssion3l ca7�city (Section 705I,Bus- . �'• •5 1.5 0 inecc and rrntessionc CoAe). PERMIT ISSUING FEE S Q • Lic.or lieg.No. D�te TOTAL FEE �1 •'O •5�•��� IIO�1G OtCNER�AIJILDf.R DF.C[.ARATION PLAN CHECK APPLICANT � � � �� O'��O 3-��J 1 herrby affirm that 1 am e.empt from-the Cuntraetor's NqMe � I.icNnse La�v for Ihc fnllo�ving rea�un (Sectinn 7031.5,Dusi• ` n� 1�11'rnfrssinnsCo�t): � AODRE55 � . �� O � , ac maner nt[he pruprrt5'•l�'ill dn[he�eork and the C�T,, TEL.NO. � structure is nol intendeA or o(ferod for e�le (Srctinn 7044,I3uainesc snd Pmfe«ions Cndr). , � ❑ OWNER I,as msner of 1lir proprrly,am exdusively con�r3c�ing �vith licensnd con�ractnrs [n a�nstrucl the project MAIL � (Secii�in 7044,Dnsinrssand Pr��frssionc Code). ADDRESS - CONSTIIUCTION LISVUINC)AGtiNCY CITY TEL.NO. 1 hereby affirm that Ihere is <�cn truc[inn Icndin_v. aFency - � . for the jierform:�nce of the ticnrl: for �chich tliis permit i5 CONTRACTOF �1�I) _ � . issued(Sec.3097,Civ.C.). � ��Vcc�� - LenJer's Namr AODRESS ��� �iy/������1 O - K1�� t� I,ender's Address ��Ty TE�.NO ^/ . 1 ecrtif•thst I hsve rrad [his i.ilic�liun and st�te Ihat Ihe ������ � • ) �I I STATE. IIC. a6m�e information is carretl.[eerte[n compiy«�ith all County UCENSE NO. CLASS o"''••V - ordinances and S[atr laws rrgulo�ing 1{cating,Vtntilafing snd . - Air Condit� ninc,anA herehy authoriie reprezentalit�rs of�his � SF.E REVERSF.FOR IiXPLANATORY LANCUAGE � Cnupt� � N t� r nn [he abm�mentione prupert� . iusp� �� ' re af P� .. D.ate - n _ ., - � � i � • .'. � ~ : r ...-�-- ..�-- _ - -, . ' - .--- - i + - r , � �,`; . _. ,_. `.,"- `i � ` .-='�� m • —=-'' � . ' I� .�.. 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