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HomeMy WebLinkAbout1009A �V'OHi:I;RS'CO\1PIiNSATiON DGCLARATIOti . 7fA36GC p�.��p L IC�: � I O f� FO R P E R fo�i� � CE-E7E(2-601 1 hereby affirm [hat 1 have a eertificute ot cor,sent �o sclf � � . in��m,or a�.�rtincate of u'or�:ers'e'omptos�tior�I�suran��,��r HEATING-V ENTILATING-AIR CONDITIONING a certified'e�}oyS�y th'e;re�,�ncf�(Sr,e.3800.I.�a—h�C.) Ni�licy\o�""�`�i��m�:�ny_��--�—J.l_�1G_�� I ❑ Ccrtir��•d copy is nerony turnis�red, COUfd7Y OF LOS ANGEtES BUILDING AND SAFETY � Certitied copy is tiled uith�hr munt.nuild;nE inspr�tinn FpF{qppLICANT TO FILL IN aui�oWc ' . Jepsrtmeyp fU�/�,y�^ ��.. AODRCSS Datr��=V��ACPllc�n[��(3-='�l✓�' ' (PFiIN70RTYPGONLV) 113ti��=��A�u�1 �1 � � LOCALITY "�y„O���n (� CLRTIf'1CATI:Of'LXL:}Ik�fIOK FRO\t\�Olthl'ItS' ' fJO. TVPc OF nPFLIANCE OF EQUIPb�ENT FEC �k}_ �"�'•�— COSfPE\S:�i�[ON IKSURAKC7: ' ^^� CROSS ST.� //��' a (This scction nccd not be complctcd if tlic ��ork�imolvcJ <,c,oFarior�urnr,eTu �✓V�nti�y�' p by thc permit is fo� onc hundred dollars (5100)or lrss.) I+ cisrrncrno.� Paocesseoev U 1 ecrllfy Ihat in Ih� perfornlancC��f tl�e�4'urk(nr t�'I�ic'�tt.ii jA1RlIl�NDLI�^JG V�IIT.CF1„1___— �. . � pennil is issued.1 shall na[empiny any persnn in any¢:�nner --__ - � sn as tn become subjec�to ihe 5'.orL:crs'('nm��ns:ilii�n L;����. IGOILFf7,67U — � I - APPROVPIS DATE I�ISPEGTO�'SSIGNATURE W Dute A{�plicant � iCO�b1Fr�E5SOFl,6TU— FlOUGN y . NOTI(:I:TO AI'k'LICANT:If,af[�•r m�kin�;flii.,Certifit�[c��f � IVENTIL:.TION SVSTE�1 � �� F���A� Z t:xemptiun, Y���� slmuld bzcome suhJect tn ttic P'urkers' __ - — c�>m�<�s����,� �«�v�s«,ns �,r ti�r�ot,��c<�d�,yo��m�si r��«i�- !EvaPor;nrivE coo�en VALIDATION with eomplY �'�'ith sucl: prnvisions or thi.s permi[ sH�ll Fr deemed revoked. —�—_'__-- FURNACE: FF1U—GRAVITY_I LICliNSGDCOti7I:ACTOI:SDfCCLARATION FLOOFt� EITU I f herehy affirm thot 1 am iicense�under�re���isi�ns��f Cta�ter hICATEII: �USPENDCD UNI7 j � 9 (commencing with Seclion 7000)nf Uivisfnn 3 of ihe P,uvi� W�+LL I ness and Rofessions Code,and my lice��se is in fuli(orez an� I - n � I L��nsr N�mhc�3`l,���3� L��.���s,�Z�J I I . c��«,�«�rJArn�stt��. n�«4--9-'�I_, �_�_ — � !am exempt from thc licencing reyuiremrnts us I:im.� licenud arehitec[ or a rcgistered profcs;ional rn��.intrr �P�7n Che,CF;(CC 25°0 of above. :`1 0 0 9 F �ctin� in my prolrstinnal cspacitY (Sectiun 7p51. L`us- -------- - — . �ness und 7'rotessions Code). PERMIT ISSUING FEE S S �� �� �[(� I.ic or ecg.No. n�tc _ -- ` �TpTAL FEE (4 .� . .`� �i 5 0 li0\!F O��'NL:{t-HU��.I1F.I2 I1E('LAIi.4TlOt� PLF�N CHECK l�PPLICANT . _ �• • • 14'5Q� I heret�y affirm Ih�t 1 am etempt fr��m�ihe C'on[r;�ct�rr's NAM1�E L�«n_t� L�«�t�,��n� r�,u�v;t��:�r�s��, �s.��i���, �oai.s, ia�,.�- . p 4 E?9—S�1 - ness und Professions Cnde): F.�DRESS � !.as o�vner of[hc prcrport5,��'ii1 d�� thc warA and thc struc�ure is n�it in[enJeel or offerr� for 5a1�� (5�•.tiun CITY TEL.NO. � 70�4,13usiness and Fruf�ssin�c Cndz). � p! - � 1,as�,� ��oe ii,r ov�raEn ` iLL�4C'�E � propertp, um exclusivrly contrz_tinc �1��L`R2Q�E��v � wi�h liccns,;� c��ntr:�cti�rs tn cnns[ruc[ tl�e �r.�j�:�t A�tAIL �i L� 4� �l (Seetion 7034,I7usinessand PrnfessionsCode). AOD�[SS/o S�, LL.J�LIv"_C�'D�I�IE . CITY ��`� T[L.NO. . consneuciiou�Ltiuircc nci:Ncs' �T I heren>' a«irm th�t enere is a constructiw��end�n�: :�cenar '— - �— ror tne v«h�rn,uncr or uir a�ork ror �,��,ic�i uii. prrn,it f} corarRncroR�Awt�'S��LIY�MJG� (�'N..�'J, issucd(Sec.3097.Civ.C.). . �1C—-" .µ^ • L�nder's\sme � ADOFiES.",�*'"'�U��wi,J��f�.1L�i.�•1 . . Lender'>Address CITY����_ --rE�.No.�,R438( . f eertif5' [hat 1 h�ce rrad �his;�pplication and st:de ths� ihr �TATC� Q LIC. /' �� �bo��o inf��rn��tion is curri�c[.[uFr�e lo er>m{+1�����ith all C��unt)� ���ICF-N�F NO ��f��7 � c�ASS l_. ordinancrs and Sta[c I��cs regula[im,:H��a[inr.\'rntil.�tin;;and Air Cnnditioning,and hereby auihori�e rrprescntatices u(ihis SI;L:REVL:Ittii:I'OH 6:XYI.P.NATORI'I.ANG((AGl' . . County to enrer upnn the ,ibocr-meu[iun,d I`roparU� for � . ���`�+ n r� —a� �-J=��o� . .natureofPerm�,ter D:te i — � � INSPECTOR'SNOTES � � � OP1NEl:•BUILDEA DLCLARATI01� `!iisrr6y a[fi�ri ihat�]ain esempt fcom�thc ConVactor's License La�e for Ihe follo�cine rczson(Seclioi� 70j1.5. � � � Business artd Irofr;siwrs ('edeJ: Air�� riry o� co�uiry� . . ,_ � , � �vf�ick requires a F�crn�ir to constnicf, aller, improi•e, �� •� , �� � - � . - , dentolish.a-repcir.ertr sfructure,prinr!o its.issuance, � , elso ieq�•ires t6c�apP'lcar.r jor sud� peroii!�to fitr a � • ' . � �' - si„u��d smr�irieru dm: hc is ticensed pursvarr: ro d:e prncicions of!Le Co�urc�lor's Li<'ense Lax(Cl�apter 9 � . . ._. . . . � (cnmt.•rr+einb �ri�h Sectinn 70001 of Diris�o�e .?aj r(�e - � Qusineas and R'ufessionr CadeJ or d�at Le i.ti exempt � fl�e�efrt�n prrd d;e br.sis far Ilie allegeAexenq�tion.,tny � _� . ' _ rrnlarion of Sc<�fiou i031.5 bt'arry ar�p(icaat f�r a pernut � �� ' - -� saG�ec�s thc applicmu�o a ririi pei�Qlt��oj�ror morr tharr , . five lnurdred du!fars 15 s001.: � . ❑ 1.as awncr al Ihc pmperty��'i;l du thc���orA.ard � thc structnrc is not intcnScJ or ut7cred for sutc. - , _ , (Ser. JOJ4, Uusrrrcss and 11'nfestioas Code: TLc Cum . tractnr's Lirense Law does �ro� app7p m mt u�tvicr af _ � properry v:hu Guild.;ur ii+:,rrorea 7fitrear.and�rho du:t � sucit icork f�ims•eK {?�nrided rfta� s�relt i�rtprm'e�ne�ttr . are not i�rtrnd2d or nf(rred for sale. !f. Gowrrer. tlic � buildi�rq or iurproren+e��r ir sold ���irirLr o�re t'car oJ . [wrtpletiuri. Ihe mr�,erbuildrr icrl! Hm�e die btvdeit of prarirtg llmt he did nor buifd or intprore for the , purpusc of safa J . . �-�]I, as��u�ncr of[hc propc��y,anr c�dusivcly con- � . [r�c[in_uith liccnscd cuntrac[ors tu constnict thc projcct (Seciimi 7011.�-Prari�izss ar.J Ib�oJessioru C'ode:The Com rraru�r's I.irer�sc l.atic docs r+ot appl�� ta m� ox•ner oJ . . . propert}� �vJ�n builda ur intprores tLerro��, m+d x'lia .. ., connocls for sur7� pruJcc7s�ciU�c caitractor(sl licc�u'ed , � . . - rneca�aur to dre Co�vrcct��r)�l.irrns:•Lcit��. 1 am exempt under Sec. IS&P.C.for tLiti res�un--- � D�tc O�vncr . INSPECTOR'S NOTES ' � � � � � � " i . ^ .. .. ' � , ,