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HomeMy WebLinkAbout1005A APPLtCA'f�+D�_ . __ _....__ _.__�___ ..._.._ _ .__ -. ---- - . _ __. __'�...wwnflN ,M fapR����'L�UMBI�II.�G PERNII�' � ,..o.ry vnRm flipt I hove q c�[tiftmie of�ca�xen�to sat# ��payp � inaure,a.a cartNKqte af Wnrkali' rtlp an Ins�rarrce, eE e�v(aEv.toia�) � o.a cen�tktlmpp rflwffed•Rx�144.�C.1 C011NTY OF LOS ANGELES SUIL4ING AND3AFETY . 7viiry Na�.�,.Compony �� . CerpfledeaRNiahero6Yh�rnifhed� .. . - .-. . . . . _ . _._. ._.._.. j fOR A7RICAM TO flLL IN(NiINT OR TIiEj � 9 �0�y_��q . Cemt�ed wPp�s��rad wnh�he �mxy tduie' ec- —+ ��t � nan d3pamrterd. , ivauieeQ rixruve ox itFnn a *� eac�wrr �i �- ,� /j�l ts O""' �' w�resaosEr , DWn���^���q*� � G��-/�itlfi . � CERtIFI[AzEQR 14FKA64yWRKERS' BAm/ue SNOSSsr. !' �1NINSUY2N7CF ' :��R OWwER� F (thlt�edio�i ����'f.�6����q fi��pIiNddEfii�ii,y?o ie�v6lv�d iry E P - � d tl � 1 tAVaioRr hwu� r � ffie armB.ts drbni�hvn n .tlollbr��t31�OZ,ar•f�.� 4 � 1 cenity fFrm irt�Re pertarc�pnw Cf tiva YRork Ipr which�h�s � � � �7armi�ia inued;ktROU.neremp�ay�tlnY On' emy mcnnar -.� nTM .j+ jj((,�r m. .,� sa os bbecome snb�ett�o the WatB �'Goin n lows. j oisNwns�a / � � (�_��� p7 `' � CONTwKTOR � A�/C � Do�e_r� �..r—.n._a...l�pPlirA. -- � .. � p,onasw.nsHEra qppRE4s K rronc�to APDCt<AIV'[:tf.ait mqR;np.�B1s Cem}ioaro of � � N &empdtln. YCn drOuk�bBLOb'm tub1'�T i0 12M�Wbrkers' SNruN�WT1GP00tRECEProR � GomPeneWfon�4+-0�i4n3•of�ehnla6o�COFfe,Wu musf fonh- �v,wn SN2m�ct�t srSiEW� uiv iE�.tJOt�/Z' �i I Nriq�mmpfy w�eh fue/s.prorbions ar tNq�dtpl'm6�hd!be Eiw7e iAC. � deemed revcked�- WatErt HEnaEa lKENSF NO.��� Cta55 '- �`�D' - uCENSR3 CONfRaL3Q[2S OfCif+RAn4N -opimcr No�" er� 4 i tie.e4n auuro+t�r�ocn uca�d w�def a+�i�o�a otchov�er 9 cws srsrtn+ r ouners 0 v Y. (mmmeneirg neuk Sae94n 7Q0(Aeh 6MSIpn�8 ofi�he�du�ine�.. .pttFtEts �' � and Pmt3�onsLqiJ�oIX1�my itCArue is�in fuil fprcg Otd eRx1. �6fQt t�R FINAL � 1,+� DAiE � l'.r�/�_$' ALIbAT10N � Liceroe Num6er ��-��V / .+:•.C1 � � e m �.,.�/,�'�'j fINAI O Conhoctor . Dcte LL._,1.� � . BY . � V ❑ W I om ezempi nnder 6ec. � � e.Bv.C.ta t�w raaso� ��on theck f8a 2 Dare: puinnBiNG CERn+I�r ISSUtFiG FEE a -� ��. . Siprptxe TOiqt.FEE � . Ptan cheek nppFicqnt E, , :.� SINGtE FAMQY � . '"6 G la S C. HOME QWPlER-BURUER DECLARA�ION Name � {'� � t hereby cNirm�Iwt i am ezempl from�Re Gomronor n License � -��.. w�F.5� law for the following remon(Sectlon 7p31,5,Buf�nesa o�d �f°a - Vrofessions Code); � City Tel.No. � . o ��c'�.:-��:T� ❑ 1,m owner oi tde proparty,wfll do the wark and tha ► muNuro b noi in�er�ded or offerod for wle(Secrhn L;. 1 �—�j 7045,Busine�s and Rofensions Code1. � � � - CpN$FRURfON i,ENQING AGEAICY I hereby aHtrm ihat there is o coracn���ion#ertdinp agency for . the perfar�rmnco ot N+e�work fw wNFek thy pprmh-is�ued . . (J66.���iY.�.}. Lenda�s Nama lender'a�fdresf � 1 wrtity thot I Mve repr!this ppp�wilon aM atafe 1�+ae�he � � � above��rfofmof n ie cnn4n.I pytee Ip mmpty w�fh qll Counry � � � ardinanca�a -Smte lowa.a imsng.PlumDirp,and Mrehy - ou�horiza r re�emoeires ai ls Ca�my ro en�er uRwn tl�e - � ubo.e-�.+ '�ed �rry r =�,ype �pvrrn� SEE R�YERSE�If'EXPtANATORY�qkIGUAGE —�PJ s� .e e.minae eoro � rroaOvnts oaTE iNsrEerae'SSiGNa ae WSPECTOR'S N07ES OWNER-6UILDFR DECLARATION � ` UNDERSIABWDRK J/jl - I here6y affirm tho'I o empt from the.Conlroctor's ' ROUGHRl1M8iNG licensa law for �hc follow'�g reason (Secfion 7031.5, GASPIPING ' ' � BusinessondProfessfonsCodeJ:AnyNryorcounfywhich � reqWres opermk�o conslruv,alfer,lmprove,demofisfi, GASVENi or repair aoy struUurc,prtor to Ils Issuonce,afso re�� HOT WAT£R HEATER � yufrx fhe appiiconl far su<h parmtf�o(ile o siqned sfc�o- '� PlUMB7NG FIXTURfS � menf lhof he Is IicensedFursuanf fo fhe provlslons of Ihe . GASiEST CoMrotlor's Llcense Law(Chopfer 9(commenclnp wi�h ' LRILItt CO.NO7IFIED Secfton 7000J of D'rvle7on 3 0l Tha Buslnes�end P�ofes- , � sions Cods)or lhof ba Is exsmpt fherefrom ond the bas�s � n c� for fhe alleged exempfion. Any violal7on ot Seclion � FIHa� . Ln(rr ox ,}�on[ - � 7031.5 by any appptant/or o permD subjec�s thc oppli- � cont/o o eivil p�nofty oF nof more fhon fivo hundred � � do(iars(55Q0J.: . INOUSTRIAL � ❑I,as owner a{the propery witl do the work,and VlASTE APFROVA� . fhe strucf�re ls n0�intended or offered for sale. . - ',,/ � (Sec.IOK,8usfness ond Professlons Code: ihv Confrar � �z'G'u� �I�, 6 '+ .y(//��jSI � � ror's L�wnselow doss nol opply to on owner o�prope.ry J f�'Y . who bullds or Improves fhereon,�and wfio does sucfi � /S,S' �/�t0 work hlmself provfdsd tFai soch fmp�ovemenfs'orc no� � �.�a�1� J 's � � 7ntended of o{fered iorsale,H,however,the 6uifdin�or �� � Improvemenf Is sold wRhln orte"yocr o(mmplefion,the owner-botfdorwt(I have the 6urden of proving ihat ha did ' � . not buIld or impreve for Iha purpose of sale.J � . ,I am exempt under Sec , � � B&P.C.for this reason � i � � Dale �. Owner INSPECTOR'S TSOTES I i � � i I