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HomeMy WebLinkAbout1498A �."�rt"°"" AppLICATION FOR PERMIT y3��� ......�.,y anmm thot 1 hava a certificare of consent to self � � insore,or a certificate of Wo�kers'Compensmion Insuronce, 76A3��- - NEATING'-.VENTI�ATING - AIR C�NDITIONING p�(�cenif'ed<pp i eof(Sec.38 ,Lab. .) ����` •�� � (!!,!�////�-� . CE.878(REV 70/Bl)._. ..... . _.__..._... __ ._..._..___ � . � d❑o(�cyrYo. � Compan � 3��Q Cemfed topy�s hereby furn�shed. - - - COUNTY OF LOS ANGELES--....- .. BUILDING AND SAFETY � y(--��Ce.tified copy is iiled wi�b rhe coumy build�ng inspec- � � - � -� FOR APPLICANT TO FILL IN �--���—� --� BUd�iNG Y/ n 1�, ' !— ti0n departmenl. �. . . . (PRINT.OR ttPE ONLY) ' AODkE55 / p� �� ��� �`Il '. oaie ���/G—`d 7nPPiimnt J`� �F�'� iocnirzr � at-v � � � NO. TYPE OF ADPl1ANCE OR EOVi7MEN7 FEE � CERTIFICATE OF EXEMPiION fROM WORKERS � � NEARESi ' � � COMPENSATION INSURANCE � . . CRO55 STPj � �'� " - (This secFlo�na►d nat 6�complotod iF the work Involved by-� . A050RFTiON UNIT,BTU . I OR�R�CTNO. >Rp�E53ftl � th�p�rmit is lor one hundred dollan(S70D)or I�ss.) AIR HANDUNG UNIT,<fM ^� �� � � I tenify ihat tn�he�periormance of ihe work far which this. L- - permit is issued,1 sholl nol employ any person in pny monner BOItER,BiU � � I ' �so os l0 6ecome subjecl lo Ibe Workeri Compensalion Laws.. � AVPROVAlS ' DATE w ECiOR'S S�GNATURE - APPlicant . . � � . COMPRESSOR.BTU ROUGH ,. �Dafa � � . . . _ ! NOTICE TO ACPLICANT:If, afrer making this Cerfificole Di y[NTILATIONSYSiEM FiNn� � {,� '�j ' � - Exemption, you should become subjec��Yo the Workers' _ � � �Compenwtion provisions pf Ihe la6ar�Code,you musl fodh- EVAPORATIVE COOLER � � VALIDATION � � Nh�comply with such provisions or ihis permit shoil be � ' deemed revoked. �� - ��' � ' � � / FURNACE: � FAU ��GRAVITY�' ' � � � . ' LICENSED CONTRACTORS DECIARATION - . / FLOOR BTU I , ' I hereby affirm thof 1 am licensed u�der provisions of Chopfer 9 , HEATER: SUSPENDED �UNR �_�� �-' � ��. '(commancing with Secfion�D00)of Division 3 of the Basiness wALI � ' and Professions Code,and my licensa is in fuU force and effect. ' ' q � � � -'�" �' �'� -a ' O � litense Number��yy 9G� _�;�.��o,s���Z L� - J._ . , ... _.. ._ .�. . ... -_ , . � V .. � , �, Contmcror�G" �J'f �Dote��J�/l..�s'7 ..._ _. _ .. .. __ _ - . V :. ❑� I om exempt under Sec. �� . _ . ' Plan check fee - � � 8.8G.C.for�hia reason� a � _ ,• . -PERMIT ISSUING FEE S p U r l 4 9.8 A z ' Dpte: Signature 70TAL FEE 7�j' �,5 • � �'• •. �8 " � � OWNER-BUIIDER�ECIARATION FinN[HECK APPtICAM ' � . � � I, . I hereby affirm thal I om exemp�from fhe CoNmcbPs License . ,. . r � �7 Q'7 5 �. Law for fhe following reasan(Section 7031.5,Business ond, NAME - . ' . r�ote�s�o�s coae�: _ ...7 4.7 5� _ � ❑� 1,as owner o(the pmperfy,o�my employees witb AD�RE55 -� � � . . � wages as iheir sole tompensa♦ion,wi1l do�he wark ond- � ��'Z�-8 7 � - }he sfruc�ure is no�in�ended or offered for sole(Sedion G�tV TEl NO. . . : 70d4,Business and Professions Code)., � � �� pwNER � � � ❑ I,os owner of fhe properfy,om ezduzively controcling_ � � � ' � with licensed contraUors to construcl the project��Sec- '���� �� �-�� � . ��� � - tion 704Q Business and Professions Code). - ADDRE55� � � � �� CONSTRUC110N IFNDING AGENCY� � � - QT ��� ��� ' � - �-TECNO. �- -' �.� "- � � i I hereby atfirm thot Ihere is a tonstrottion lending ogency for . . , ' � - � the performance of the work for which�his permit is issued --� �pNTRa a ��' �� F'�-�"- . � � - (Sec.3097,Civ.C.). . . _ . . ._..- . ___. . . .__ _.... .. . �� , � . � ..._ . . nooaess � � _. ..,�: .: ,S .._. . .'., � ._ .. .._ . ..._ ..._ . . .._... . -_ I tender's Name � � " (�` / � � ! . . . .. CITY .�J .. ._tI.NO.plb�"/4Qv .... ....__ ._._. ... . '. . .... ... _ ..._._.. .� tender's Addrers � � : STATE ' IIC. ./`.� I certify that I hove reod this applimlion ond sroie�hot�he LiCENSE No. -.. . ._.C1A55 C� .-..- ..- ._... .. _....,._ .. . _ _-__.. _..__. .,_ . .__ � above informo�ion is correct.I agree fo comply wlth oll Counry , . . _ � � - ordinances ond State laws relaring io duild�ng conanuc�ion, , , _ _ _ . ' � ' ' . _. . �. .. __.._.._._ .__..._._ ._...__. . . ., ..... . ; and hereby oulhodze represenlatives of Ihis Counry to enler . � � - opon�he abo�e-meniioned property for inspe<tlon purposes. - ._ SEE REVERSE FOR EXPIANATORY LANGUAGE .. . _ . ._. . . ._._ _. _..�_..._ . . . �, . ... _. , . .. _ .__. . ..... /a-/�—�� . �narwe of Apoliconr o.A9enr ��a1e '_... . . . . . . . ... . . _......._ . ..... .. ........ ... .... . ."''"_'._. .... _. � -. . . . g€ r':. . c, .. . ��,��. .. . . ,iip�. � .� . . ... ���.. .- . , . . . � ti�... . . r. ,. ` - ' r ���I.INSPECiOF'S NOTES � � OWNER-fSUILDER DECIARAT\ION _1; �, � � ` `1r, - ' ' � . ._,.� a.Lie �1�..� . .. t i\.. \ ���;1 ��"�. (,-:'y . ,,,_.�„, �,_ � e're6y�offirm tFot I"am"exempt from dhe Cantracror's , '`.` - � t..s." �.'.. mc Law Toruhe foiloviing�rooson..($eeflon 70JL5, "'"" � ,;` ,. ,, ``. ,- .. �.�-"-`�"„` -- "" ' - 1, qfsi andPro!sslonsCvdeJ A y<Ilyorcounfywhich . "' 8 n � � (��� �?r � �'�� �� - -� y requlres�a permll�o constr�cf olf r Impro e de, olish, � -'-' �- � � � o repo!-ony a}rYc}ure,prfor t 7l �l sua c,olso re- ��� �1�� � .S" y � i.�, , utres the opplitoN for suc6 permTt fo iile a stgned stote- � ; . . �, ,\: `; _ ,'J , � ' . � . . .- .. ., . Confracfo ieLlca'niesiow(Chopler�.9h(comm!encMg f 1�IF . . ,� � k...----�— °.' -' " I_._ . _ . '._ , ; Seclion 7000)o/Di ulon 3 0(Ih Bu:lness and Profes- � � — y_. -`J` ; I \ ,. ,_ __.. , ! b'a or ihct he fs exempl th�refrom 6nd Ihe basls � ����—` ..;:. ��� r. .� ' ...-----'�--� �- �. � � � � .7anfifa a c�ed e empfion. Any�vlalatlon of Secflon I .. , .. .' ' eoY'�Y°PPf cant for a permif subjecfs�fho,appli• i t__— _._ .:� ._._ '. ___ ___ , ' - - � -- _ � WII pencly of nof,morc�}han fivn hundred � .•. . . ��. � � d (5500). . __ _ .._'_. _____. __. _ .__. . r__�. . . ' - i . '. . .'_ �' -_—. .. ...-_'_ _ ..1„, ,..;_.:.... i ; olla❑I,as owner of.ihe proPerty will do�he work,and ..___ ' _._._ .. ,______.. .._._ _ . . . . '�. �. � �j �� ,: �,1 , _ . . . .........: . .:�-lhe structure is nm iNended dr.offered for sa�e. .'.. . ,__.._'___.__-_ . . . �_ �..._.__. .. .__." t � .'.._ ; '� � � f ,.."�Sec.7044.Business andProfesiloniCode:.ifieConfrac � �d � � , � _ ;� � •!or's lkense Low does not apply fo an owrier of propcMy ,'� _ .____ .. , � . � !_:._�._ ._J_____.__....__ .. .. _.. .._._!.__'. � ... ��..�wfio bulfds.or�tmproves.ifiereon,andwhodaessuch � �____ -� �_ .. � -._ . i work himsell proNded fbol surh improvemoMrore not � � ��������.� �--.�.:` �-_:�;._.-�` '. �-��j� % InteridedoroReredlor�safe;l(,"howover,ihe build�n�or � ? _ _. , .. . . � .. Improvemenf!s s.old wtfhln one year o!compleNon,fhe � ' � -,--- ------ ��-� � ��� �� > -�'-�-:�ownei•bullderwUlhavelheburdenolprovingfhathedid . .,. ..;. . . . _�_ ._ . _.. ___, . .� � � . �� � � . -�. � �- �^not 6�dl,vos owner of tFe eroPpofos/eam excluslve � �;. �e', t , t _, �,;. � . ; . . . . . : -�. ._.._...__.____ . ��_,.i.i � . .�. . .'. p � ly con.. ' ' . � \.t; ' .. �..tracting wilh licensed contrattors'to toqsfruei�F,e projece . ,, , I � ; , __.__.'_ ____...�._.____.__ _._.__'. . _.....'L _.' �-�� ,(Sec 7044j Buslness and Professions Code:7hu Corttroc- . - ! � � � � ��lora Ucensv Loiv'doci not oppfy to an owner of property � � (` i___._'_.___I .__ .____. ._._..__._. _._..... _.._l. .__. wBo 6uilds o{Improves.ihereon,and who coniracls for . . , '. _ _.._. � . � ! " `-"���� ��" : s�th pro�etts wltB a mnfraclor(sJ 6censed pursvonl fo . ..- n�rS �•J� ; :: ,. . �''_ _i.._ :��-. .-:'.-� :�....._..__ . ._ ._ . ._ . '_' _.lheConfrocfor'sLkensel6wJ:�. , . .. . . � �- •._�:.___ . . __. .__. .. _..._.. _._ „ � ,js ... .� - . ... _ , — — . _ _ , , , .... � , — - - ._ . ___ __. _ ___.__� ,; , ,M , • � � � , . ' ... ... --I am eicempt�under Sec'�_� _-' `� .,��_ . ;.. . ,, . , , , ...ri ,. .'c.1 ° • �j� .. .B$P.C.for lhis reoson � '�.`t— �S01 ', : ,t —;. ;_ _ �� , , �_ � � ` � , . . ,,,. ,., ,�._ . , . .. . . j----- __.._...__ __ ___ _ � _� . . �� � Date . . . �.- y �, . _ , ; ,....,..._ �_ , -. , _ ..�.. �. . .,,.� - , , � . . _...- ._ . ._. .. _.-. . . . . . .. . .�� _ , ..._ -. '. . ` .-_,., ` \ ,.._ .... , ....:`�� ....�.? �Owner:.. . . . . . . _ : j t _ � - , „ ..'i . . . , . . � ,. . , ..�.—.__—.___—_. .._"_.�..T. 4�..•.. ' �� �� ..� ��.. . .��,.. � .. ' . � . � �.�.� �_ . . , .. , _..___ ....�.... _ _. ..... ../ _ � �. , .. INSPECiOR'S NOTES � -� � � c - ��`- . � � ' � "�-"� . , . .. _..� �.:-.i� . � � � . - .._.._._ . _ _.:., . ... , , � _. . . �__.... ��-: �: ti � --__.__._-- —- ...... ._. __.._......_... . . : . + �. � .-.. ., �. . _ . . . � , . � �� -- — ---- . -_ ._'-- --. _.:...._.. _. _ ..._--- . .. , , � - - ..... ---_..__._ .......__.__.__. �_-_ ._..�,.. ... :� . r"�, .�,� _ ' , � �.. . ., . .. � .��i: .i � � ,i.. - - � . . � .... . . . . .. . .. � �_ `� `��� �;� "—��.-+ J,i..i' �- . i., , _� i: