HomeMy WebLinkAbout1846Ai,kORK I. RS'(W I Pi(NSA T ]ON F)I.CL.AI(AI1ON
ollzi, Cate "T consent I.., -If
ne,eh) af—, ill ii It I .— It 'Te 1" 1 if Wor f, e is' Cohhp�.sutitirt Insurance, or
'fi,, C"j, T r,of 31000, LOY C.)
_d It
e . - - _!; �,) 871 A P Ill,
Certified copy is 1,,trehy furnished.
Certified copy is til1 iitli o u n I.,
Date
Ck IRTI[WATE 01' FAI%MPTION FROM WORKERS'
COMPENSATION INSURANCL
(This section need tint he (ompleted if the work involved
bv the permit is for one hundred dollars (SIOO) or less.)
I ,ertifv that in the pv,f.irrnl,," of the vrk 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 abject T,; the
C""'p—lisatiun pro,;,iori, of the Lbor Code, vou most forth-
tltl CIIITI ,ith ueh pro,;,ioil, :r this permit shall be
&cmed revoked.
I hcreh, 1, 'firm I.i f 1 1. 4ji'I;,i0,os ?f Chapter
I! I -INO) A . nisi'm J — :hz Bosi
ij in full Torn,i,,l
,fio't. 448 ZZ90. 9(0 I
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HOME i)vNIIR 3k FLW it in,(:LAI<,kTION
I
1 -tense l 3, for The 1�Illollinz n1alo, (F,' 7031
r: 1, 1, Code):
La,i utener property, ,ill d�, the 11—k and the
structure i, our intended or offered for s'ile (Section
. 04-1, :.rid Code).
I as owner of tl., p-pt;rly• am eluiv,,Iq eontricting
with licensed contractors III contrict the project
iScctioll 7044, llhlessded PjlarlsSin.41 COde).
i" (I NST It 1:(1 !QN !-I NIANC lo.;! NCY
�hereby affirin that there i, oIlStrUlti011 lending igen,%
.r the
I, of the a,,k to,, this permit is
issued
(Sec. 3097, Ci,. C.).
Lender's Address
I certify that I Ila— read this appljeatioo 21113 state lh,,It the
ahi%e infcrnnaflon is correct. I agree to coltilI) Isith all C—tity
o, d in anew and State law;iti-, Hoating. Ventilating and
Air CondiEioriijiv.. and lher,•bv juthorii, rerresentatives of this
Cl met to I the abuse-titio-d jnope,i) for
lr�W2-?,q- 84
Signature of pirmittec Date
76A364C
CE 818 (2 90) APP_ICAT!ON F OR PERMIT
HEATING -VENTILATING -Alf? CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
s:40--a 2
FOR APPLICANT TO FILL IN BUILDING
(PRINT OR TYPE OADDRESS P_NLY) -------
I LOCALITY
NO.!TYPE OF APPLIANCE OF; EOUIPMENT FEE k A MO
NEAREST
I g CROSS ST.
ABSORPTION UNIT, BTU ____.�: 1-
DISTPICT NO
AIR HANDLING UNIT, CI'M
601 LE R, BTU APPROVALS DATE E TCPSSIGNATURE
60
'COMPRFSSOR, HTit
ROUGH
S`iSIEM
1 EVAPORATIVE COOLER Ll! ATI
'FURNACE
FLOOR'—
!HEATER: SUSPENDED —*UN T
WALL
12
it! LIS
Plan check fee 25% of above.
PERMIT ISSUING FEE S
---------FTOTA L F �E
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL. NO.
0 W N E R _A(,_AN r1j iy=\/
?MAIL
CITY QRAr-jQjC_ TEL NO.
jCONTRACTOR H 1Z K I 5CW__H_TC7,1
ADDRESS 189
0 fI ;
I %aT M OR
CITY TEL. NO.
A-_�A.14(ajm
SFIF R>Vl RSI' I OR EXPLANATORY LANGUAGE
218k6A
#0 .... 8
1- -51.50
..-51.505
0301 -84
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