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Home My WebLink About0970A �'`°�'°S""°"°E"AR°'T'°" APPUCATION FOR PERMIT � �I he�ioy afPirm thef I have a cer�iiimte of consenf fo self ' sure,or o certifimte of Workers'Compensation Insmance, �6A364C HEATING - VENTILATING - AIR CONDITIONING �or a certified copy th�eyrleof(Sec.360D,Lob.C.j g� CE-eIB(REV.ID,'el� �tyNo,�t�.�"7Tl Compony ��L�c/� Certifled capy is hera6y f�rnished. COUNTY OF LOS ANGELES BUfLDING AND SAfETY Cenified copy is filed wi�h�he counry building insper POR APPLICANT TO PILL IN auaow� tionde�i/,1,�.� ADDRE55 �� Z �-� '�. � (FRINT OR TYPE ONLY) Dnte Applicam ��TY ' _ � . NO. TVPE OF APPIIANCE OR EqUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORK 5' NEAREST COMPENSA710N INSURANCE CR0.55 S7. (Tfiis socYion nwd not hr<ompiN�d ii ih�work Involwd by ABSORPTION UNIT,HTU DiSiRICt NO. PROCE55ED BY fho permif Is ier ona hundrod dollars(5100)or less.) f� �_ I certify fhot in�he performan<e of ihe work for which�his AiR HAND(ING UNIT,CFM 'V •—y) permil is issued,I shall no�employ any person in ony manner BOILER,9iU l so os to become subjec�to�he Workers'Compensa�ion Lows. ( }� avvaovn�s onte iNsve[roa�s s��cNntuRe Date Applicpnt COMPRESSOR,BiU �n L/��ij eJ-O �v ROUGH ' NOiICE TO APPLICAN7: If, ofter making �his Certifica�e of VENiiwnON Sv57EM FI�Na� _ L Exemption, yau should become s�bjed to the Workers' Compensalion provislons of the tabor Cade,you must for7h- EVnaORA7ivE COOLER vauvArioN with comply wilh such provisions or this permit sholl be deemed revoked. ^� fURNACE�. FAU,_GRAVITY IICENSED CONTRACTORS DECLARATION J FLOOR BiU ��OD 1 hereby affirm that I om li<ensed vnder provisians of Ghapter 9 HEATER SUSPENO[� UNI7� � '(commencing wRb Seciion 7pOp)of Division 3 of the Business � "�'A�� and Profassions Code,and my license is in full force ond effecl. ` J� y Q ,�.d 1 ,v � s ��ZQ M.,.C.tiCo 1n�tiC,t�o ��9��)F, V License Numb Lic Clos ► �!s e c a m� 0c Coniroclor � Date�^� p ❑ I nm exempf un r ec. ��'o"'+��9d � �� C�.C�r W Plan check fee + • 1 �:;G Q�: � B.&P.C.fo��his reason PERMIT ISSUING FEE s �� .h� Daie: U�� C:� Signature TOTAL FEE � (s � OWNER-BUILDER DECLARATION P�AN CHECK APcIiCnM I hereby affirm tha�I am exempt from�he Controctor's License � Law for fhe fallowing reason($e<tion 703L5,Businexs and NAME Professions Code): ❑ I, os owner of fhe praperty, o my employees wifh A�DRESS � wages as their sole compensolion,will do�he work ond CITY TEL NO. the structure is not infended or offered for sale(Se<tion 7044,Business ond Professions Code). • � pWNER � ' ❑ I,as owner of the property,am exdusively comracfing with licensed wntmciors�o mnsfrucf fhe project(Sec- '�'a�� tion 7044,Business and Professions Code). ADDReSS CONSTRUCTION LENDING AGENCY CiTY iE�.NO. I hereby atfirm Ihaf fhere is a construciion lending ogenry fo� ' / 1he pe�formance of the work for which this permlt is issued CONTRACTOR {��y � � �, , .(Sec.3097,Civ.C.). AD�RESS �� / Lender's Name �/ —rv ��TY u,�,�y TEl.NO(� 0��3 Lender's Address �� STATE llC. I cenify Ihot i have read fhis applimtion and sfo�e rhot rhe uCENSE NO. CLASS �—Z(� o6ove information is conect I agree ro comply wifh all County ordinances and Store laws reloting to 6uilding construction, an hereby aulhorize rep.esentalives of ihis County to enrer u 1the o e-me noned property for inspection purposes. SEE REVERSE POR EXPtANATORY IANGUAGE �'s J i�—�� SignaNre of plicant o.Ageni Da+e - I bk'3 t@b d'1�-�!Jl6�@�1.4i11471�d I hcreby at£;,m�hat I a eae�mnt frorr,iho Controc�cr's Llcensc Law far t{ie 4olriowinp r . n�(S�•ction 7031,5, 6usiness ond Frofcssions Code)�nny�ity or caonry which ^--�-----�— rFquires o pFxmit to ronstruc�,cf�or,imc.ove,demol�sb, . w rcqsa'rr ony sirucfuro.prier tc rts is•,uancc, olso r � GYJfCF f�:1 O�1lG:1�fK SUE�1�"Mlf IL�1{I�G?.�OB S�CfC- m�ni fhc!he Is ficercd pursuaN to 1ha p;ovi,ions of the Conirocior's Liccnso io��(Chaptcr S(co� encinn wifh Section 7000)ot Divisicn 3 el thc C��siness and Profes� — sions fock)or thw he is ex�>roRr tncrelrom and ihe basis �or 7he afle�cd e m��ion. Any violenon o( SecNon � — 7037.5 by or,y ap�tflco.�f/or a prrmir subjccfs tf;o appli- . canl lo a civil penaley o�not mo.e i}:an Irve hun�rcd . � '-'- dollars(5500).: � C�I,as ow�ne�oi ihe propeny will da the work,ond — �h�strocture is not inr�nded or oi�ered for snle_ � (Sec.7044,Gusine,aondProfessior,sCode� FheControc- , - tor'a Licrnsa Lovr�e�not cEys!y�o an awnar of prnperty � who 6uilcis o impreves �heraun, aad whe dows sudi " work hrmself provid:d 7hr.t socfi im�ovamur�3s we no+ � intcnded or olfored for sale!f,hcw�r,�er.fhe bui!din2 0� - � imprmvarrwnr is ssld wtihin er+a year of complatls.v,�rhe owncr-botlder w'rll hcre thc burden of Froving t#�at he d�d � �O/�pUI�L�Of ll��F'..'6V6{Lf}}2 Rllf�>-'+5?Gd'f.lE�.� � � � ❑i,as ovmer ot the prc�+Frty,am exd�usively con- acY�ng w�dh lic�sec co�as+ar=_to mn�*run the nro'iec� _ __ f,5ec 7041)Husincss and Profc�sior;Cc+F.��:7he Confroc- ror's Licanse Lc+v dces nef npp�y fa cn o ncr af property _ _ who 6uii:s or Improvrs tl�cvaen,end v�d:o con�recis!ar such projxh wit'�c eontrccfar(s)lice,^scd purs�en+tn thc Controdor's Llccn�;e La�NJ. I om exempl under Sec. B 8 P.C.for this reason—._—.—__.____.�__ Date Qwner INSPELTOR'S NQTES