HomeMy WebLinkAbout1846A (11)i,kORK I. RS'(W I Pi.NSA I ]ON F)I.('L.AI(AI1ON
Cate "T consent I.., -If
ne,eh) af-, ill ii It I .- ollzi, 'i
rl 'Te 1" 1 if Wor f, e is' Compensation Insuran- or
'fi,, C"j, T r,of 31000, LOY C.)
_d It
e �. - - T �,) 871 A P Ill,
Certified copy is 1,,trehy furnished.
Certified copy is fll1 iitli o u n I.,
DaLe
Ck IRTI[WATE 01' FAI%MPTION FROM WORKERS'
COMPENSATION INSURANCL
(This section need tint he completed if the work involved
by the permit is for one hundred dollars (SIOO) or less.)
I ,ertifv that in the pv,f.irrnl,,ec of the sv,rk for which this
pormit i, issued, I shell not CrhI',I,A % per,.on in any
% manner
si
lq(T() If -
E, );on, voll uld 'uhjct T,; the
C""'p-lisatiun pro,;,iori, of the Lebor Code, you most forth-
'r'1111 CIIITI with >ueh pro,;,ioil, :r this permit shall be
&cmed revoked.
I hcreh, 1, 'firm I -it 1 1. 1 _,_d ..-iJc4ji'I;,i0,os ?f Chapter
kh -`ND) A Civilian :he Bosi
�!nd P F; is in full Torn, -1,, 1
eo,r Nurl,er—_ CI
'vt I"orri C. li--i" 'E-i;,t4r,m,nts as I ,in a
Ii:h;te,,i or ,I Tc;zkior:! rli.Atv�hiil enFinecr
tri jrti'! .. m� pt,;tl (Suctior, is!. Bus-
in- :Iiij 11-f-,ions Code).'
I w. or R-,. No.,,.11,it,
HOME i)vNIIR 3k FLW it in,(:LAI<,kTION
aff;' (Ilat I _., 't.,-�n IF., C1Iiktlt,)l'1
I i_Mse 1.3". for The follo,,inz r,a,oii '7o3I 5, R.-
r: I, Code):
L )jas o%vner of the property, 11 an the ii,ork and the
structure i, nut intended or offered for sale (Section
"04-1, Ito , i'l e', :.rid code).
F1I. as (ziler of tl,e p-pt;rly• am eluiv,,Iy eontricting
with licensed contractors III contrict the P-j"t
(Section 7044, ilusiness aced Pjla'IIsSigIil Code).
r, i\STQI:I 1!(7'N !_NIANG kr.;! NCY
IS hereby a fri�,.h that he,, i, ',I �J UStrUltim, lending agenrt
for the of the k to,, whidi this perini is
issued
(Sec. 3097, Ci,. C.).
Lender's Address
I certify that I Ila- rend this appljeatioo 21113 state lh',It the
ahi%e infcrnnaflon is correct. I agree lac colrilI) with all C-rity
o, d in antes and State law;iti-, Heating. Ventilating and
Air CondiEioriijiv.. and lher,•bv juthorii, ret-sentatives of this
C� to I the abuse-,itio-d jnope,i) for
lr�W2-?,q- P4
Signature of pirmittec Date
76A364C
CE 818 (2 90) APPLICAT!ON F OR PERMIT
HEATING -VENTILATING -AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Lev 2
FOR APPLICANT TO FILL IN BUILDING
ADDRESS P_
(PRINT OR TYPE ONLY) 10 -------
_T_! LOCALITY
NO. !TYPE OF APPLIANCE 08 EOUIPMENT FEE k A MO
ABSORPTION UNIT, BTU_
;AIR HANDLING UNIT, CFM
!BOILER, BTU__.
1C('MPPFSS0R, BTU 5,1 0—
EN TI LATI UN S', S i EM
1 EVAPORATIVE COOLER
'FURNACE:
U RNACP_=, ,___�jqAVlTY__
FLOOR'- rL,
-*UNIT
000
THEATER: SUSPENDED 1i U N! T
IVA LL
Plan check fee 25% of above.
PERMIT ISSUING FEE S
NEAREST
CROSS ST.
0
T NO
0
APPF DATE
1111ALS
SIGNATURE
1
ROUGH
! a-
U)
z
FINAL
=46
kPLAN CHECK APPLICANT
NAME
- - - ----- -- - -- ------------
ADDRESS
CITY
TEL. NO.
0 W N E R
?MAIL
iADDnESS
CITY QRA&jQ)C_
TEL NO. it
'CONTRACTOR
HA 1Z K I 5CW__H_T1:2),1
ADDRESS 189C) %-_-TM0rZ
CITY A,_
TFL.N..
,IA14(Z
---Etc.
SFIF R>V I RSI' I OR EXPLANATORY LANGUAGE
218k6A
#0 .... 8
1- -51.50
..-51.505
0301 -84
I
,111 ,1I
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