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HomeMy WebLinkAbout1834A (11) WOlttif-.KS'CO?1Pi:NS?.TIOti DI'.CLAR.ATIDV 7GA3GaC � �,r«h, �f�,�m �h�� � �,��� ���<<�t����r <>f��.,,.,���t ,�,_��� �E-E,II�2�o, �,1='f'L I C�,T I O N FO R 1'E R f�tT � �n.surc,or a cert�ficate nf V,'orkers'Comp�nsation�nscranc�,or HEATING-V ENTILATINGf�IR CONDITIONING u ccrtifi�-1 ierer`(Sec.3F\h��,Lab.C.) /7 7'o�ic s����y,�Comrs��:J%'9-%�—Is>_?/!� I ❑ Ccrtiti�d eop> is hcreb�furnis��rd. COUPdTY OF LOS ANGELES F3UILOING AND SAFETY � Certitied copy i filed o•ith tl,e coun[y�building insP=�tinn depsrtment. FORAFALICANTTOFILLIN po��ess�'f9���'�� � j Ila[e Ap(�IlcUnl (PRINT Ofi TYf'E O'JLV) Ar✓��(J�� LOCALITV li9AN�l�T �.0. TYPE OF C.PPLIA!hCE OR E(7UIPh1ENT FEE G:RTIPICATE OP LXBM1iPT10N 1'RO�t\l'pRI:1:RS' �Y C0�11'L;NSATION 1!JSli1LAtiCf: NE[�REST ' >, (This section need not be completed if the �i�ork imolvee: q6SORp7�ON VrJl7,67U I enoss 57. � p. b}' 1�1C rCiIt11I IS (Of OIIC liundred dnllars ($�n�)1)f �CS'.) I OlSTCICTN�. .JCESSFD.;Y O � [ iertif}�th:it ir,the{�erfonn�ne.�eif tlie�t�orY,(��r x�tiich[his ��F�EiANDLING VNIT,CFA1_ � / � e�mi[is issued,I shatl nn[em lo�an rson i � � 1' P ) >'Pc n an�'munner _Q�f is7o O so ss to breume sohjee[to the\Yorkers'Coinpensatinn La���>. �E�OI�[R,EtTU I AP?ROVALS DATE IYSPECTO SSiG4ATVRE � Uate App(i-cant �COr.aPF{FSSOFl,EiTU qpUGH � NOTICE TO AF']'LICAM1T: N�,oftcr m:ikinp this Ccrtificate nf I VEfJTILt.T10fJ SVSTEht I D� "��� 1'.xemP[inn. �ou chould hecr�mc SUM1J�•ct t�� [tia \1'e�rkers' FINF�L ' . Cumpensa[iun prnvisions uf Ihe Lnbor Coda,you must furtli� �.iih compty «;�h s��ci, pr�e�,�n�s nr u:�s pnrmit zi,au �,r � ;evnrora.nve coo�e� I VALIDATION dceme�revnArel_ FUf�N:.CE: FAU�GRFVITY_ �LICEtiSF.D CO1�TkACTORS DECLAItATIbN FLOOF� BTU_ I hereby affirm that 1 um license�nnder prnv�cions ofCh�{�ter HEATEFS: SUSPENDED UNIT 9 (ci�mmencing�Lith Srcti��n 7000)nf[]ivisinn 3 of tt�a i�i�vl- WALL ness�nd Prnfcssiuns Co�e,and my licensc is in full forcr::nd — — , �•rrr�c. _ —,Z�aA_Ty�od/'����✓_5—.._/1?� ' I.iecnce M1umher I.iz.Ciasz I Con[ractor Datc__ — :1 S3CtP � 1 am exempt frnm thc litensing ceyuirements as I am a �- �y,o �q 8 licensed arehitre� t�r u regateretl professional en�ineer Pl�n Ci1CCk feC 25"o OT Cbov0. r � � x[ino in m5 Drufes�innal c:�paciiy (Scction 7051. Ous —�-- ---- — — :�,=:p, �.v C incss and Nrot��ssions CoA.:). _ PERf.11T�SUING F�1�� � 1— �. .� .tB�G� I.ic.or IteF.No. uatr _ TOTIaL FEE I_glJ�� ��o�tr.a��•Nt:ii-nun,omz ni:cc,.at:.�.no:: PLe.n,criccr,nrr�icFrvT '1 (1,�1'-E 1 I herehy af(irm that I am exempt trom�thc ('nntra�:nr's ;Jt+r,1[ � License La�c fur the follau�ing reasun (Sec[iun 7031.5, Dusi -- ness�nd Yr�ifrsci��ns('��Gc): AODFt[5`: . � f, ac o�+'ner of tlie{+r�i�ertY'. •:ill Sn the���ork an� Ihr CITV TEL.NO. structure ia not in[rnded nr oftered for s�le (Secti�:�n . 7014,f7usinesc;ind yrnfessinnv Cude). " --"" `—'—' I,�s o�cnu oF the prop<rty,am exciueively contracting OLVNEiI o sK�A.,,o.�£s with liezn,ed cnntructurs to construet thc rrnje�t MnIL !� /�- �/ � (Se<[ion 7D14,pusiness and 1'rofessinns Code). .�OD�GS��sjf�_/�_E/9 (.�jj///d(�r�Q CONSTRUCTIOV l.I;NUING AGI:NC1' CITv /.1^G-N.C' T[�.N�AC�/�(�/ �v.r vi 613- I hereby afl'irm that therr i i ci nztru,tiun icn�ing ae��nc� n � ro� u,e F,«r<�«»��,�z or u��'�t'��F'r�� �.i���i� m�, �«�;,�� �� eoNrr,ncTor C.C�i/Y1_RT��U _ �SN_C� issued(Sac,309i.Cir.C.). _ lyTR�_ Lender'sName — ACORE55a vL`�"f���L1��fv�'. a( •V /V Lendcr'�p��rc» CiTY C'-,�y�.-1 TEL.NGg3�_�7�2 . . . t ccreify tha[ [nave read thfs uppnca[i�,n and scatr ihsi the /['�� �v �TI�TE LIC. ahuve Informa[iun it cofleCt.1'Ae•rei lo CUInP11 t�'Iih Jll Counl)' �. L.\CF�Iy��F�:�(1�7��'��^��LASSC��� . arAinance�und St�te I:i�rs regvla�in��}ieating.Ventilalinf:md Air Cunditionin�.und liereby�u[horire representati��es ol'tliis SIiF.KF:VF.RSl�.POR tiXPLANATORti'I.ARGUAGb' Cuun[>� to enter u{��n th� a6n��r-mei�tiuni•d {+ropert�' fnr �"� ^�5�`\. . - . �-��$� Signaturro I•ermitroc Date - INSPECTOR'S NOTES � � 0�5'NEF.-E3UfLllL•I:UEC[,4P.1T10ti �. ' I he}cLp afficm tlia(�f sin c.cempt from thc Contnctor's Licensc La•.�� for thc follo���ir,g rcason(S�•ctia� 7p31.5. . . Q:ai�ress orrd Profrsrions C'odeJ: Ar��� citv or courrrv • : �vl�iclr requires a.pennir �o cunruvet, e!ter, irrrprore, . , • . . . ._ . . .. denroli.�.4.or repair mn'snvcture.prior�o ir.s icrumrre. � ' � alao rcqui,�er ttre applkcr.t for sudr permir �o ji!e a � . � , � - srgrted atctenrenr t/iat hc is lr:eicceJ ➢ursua.��t m d+e . . . , • prorisiorcr of�he Carlrcctori� I.icciue Lew�Clmptcr 9 � . . . . . (cornmeneing r.^,':It Sretion 7000J of Pirisio�r 3 of d:c � � . � 6usiiies� mid Projrrsions Code/ or �l�a� he-is exenr�t � - � rBerelrorn m+�dre Lvsis Jor tl+c e!leRcd exempdo�c Arry � - � riofatenn of Scrrinn:03l.5 b}'ari}�c?plirr.rr�for c f�rrmir _ '� � - � � subjec75 U�e applirm�t f��c ciril penell t�of im7 rnorC tl;rlr¢ � fir;lnnrdred dulfnrs(5500).: ❑ L 2s uv:ncr o(Ihc properry'-u'ill�o the�cork,and the stniclure is nut intendeJ u:o(fer.d far sah. � ' (Sec. 7011, 6usir.r.er mrd Prnh�srruat Cndr: Thc Coi+- . � � � � � tractnr's' l.icr�rce Law daet'r.a!appfe to mt ox�irer af proper7}�irpo build�c��s inrprans d:a-znrr.m�d�cf�o does � s'ueh r.a�rA hi+nself pro:ided llmt suclr irqi�urerneirts are �rot iiuend��d or offerrd for sale. lf. ho�arrer. the buifdrirg or irrr,�rorrrrrent rc rofJ �ri1/+in a�c i�car aj � cor.vple�iorr, tlic moiier-burlAer will lmra d�e burAc�r nf provir{ti tfict he did not 6t�ild or ineprorc for tl�e . , . .. . . .� . �` \ - . purpose of safe.J . , . , . � f,as uancr of Ihc property,arr.c�clusirciy com . � tractin_,�;th liccnscd��or.tractutti tu cunstruc[ILc prnjcet (Settron i0�1»,Bias-ine.ci mrd Profcisio�is Codr:7'Le Cai1- - . . tracto�'s I.iren.ee La�.v dnes rrot eppll' tu mr ox•rter of . prope�tp svlm h;li!d.r nr imprm'es thcreun. arrd x�La � _ rnntrcclr for sueli prnjrrtt x'r11t c tattrccror/s/ lirensed . � punua;�t tu the('oatrcet:�.•i Lrcearc LervJ. ` "r '•. . [am exempt undcr Scc. B�C F.C.for diis re�svr Datc - O�cncr — � � . � - '•.�i . . INSPECTOFi'S NOTES � �` '�•- �� � �• �- • . �'�.... � . ..,-, .. . ... -� . . - .... ,�.��.r .1 ' -�. _ _ _ '1.,. . . ... • . • • . � .