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HomeMy WebLinkAbout1808A . 7GA364C q��LICATION FOR PERP�IT u ccrtificnte of coa,en[ro sclf CE-B7612-BO1 � :�ctrtificnter�t�corkers'Compens��inn�n,urunce,nF HEATfNG•VENTI�ATING-AIR CONDITIONING ��tifi�d eapy fliercnf(Sec.380�,Lah.C-) Nalicv No. ComP�n>� � ;I ❑ C.rtieied c�py Is hmchy furnishrd. COUN7Y OF LOS ANGELES � BUILOING Al�D SAFETY � cer�iriee���py�s ti�ea wt�n inr coun�y�bundt,�F�nsre�t���n FOR APPLICAN7 TO FILL IPd sui�oirv� dtPartm�nf. ADDFlESS I.�s��, �'+?1�o-u r [)ate AF��li:ant (PRINT O�TYGE ONLY) C1�.IlTIF1C\T[:OF'E�L\1PTI0\i�I:01111'pIL1�1:KS' NO. TYPE OF APPLIANCE OR EQUIP,^A[NT FE[ LOCALITY ��,�T v� �� �j���:r C�?iPi!RSATIOti[NSUIZANCI: NEAREST `.a/'�� ��'� (Tf1is SCctiOn need nut bC ComplL•ted 1(11�e tt0f}:in�n�ved A650FPTION UNIT,6TV CROSS ST. �/� O 6y the permit is Por one hund�ed dollaa(5100)ot IossJ — , CISif�iCT10. vriOCE55ED0� („) 1 Cerii(S'th�t tn the performun�e<�f t1iC��'orl:ir�r w'I�ich tttis AIR HANC7LING UN1T_CFht {� � � permit is ia ued.t shall not rmpiny a��y person in any mannrr / �}� n � �j1 � so�s t���ea�me ct�hjeCt to the 1Vnrf:efs'Compen5u[(nn La��'s. �OILER,6TU.—,/�V�_Q��/ f a��b MPFSOVAlS DATE �isv[croa'SSiG^+nnnE U Date Appli�anf COP.7PRESSOa,6TU._ �;OUGH y NOTICI;T'O AI't'LfC:\N7:lf,af�cr m:�king thi.Ccr[i(icut.of VENTILATIO:v SYST[M FiNAL Z l�;x��m�ti„n. 3'�u sh<�ul� btcnme suhl«t to [lie SVorkers' ��� ., ��— Compenc�twn pr��.�sion f[I t,obor Code,�nu must Fur[h- ' ���th Compir «'tli 5uc1 � +inns r�r this [�trmif 5h�11 he EVAFORATIV[COOICR . VALIDATIO dermedr�vokcd. . FVRNACE: FAV�GPAVITY, LICI:KSF:DCO`iT11AC'TOKSIII:CI.ARATION FLOOfI' ❑TU i hcrehy affirm ih:�t 1 um li.rn,e�undcr�a�<�vi.�ians of Cha�tcr HEA7[R: SUSP[NDED UNIT � 9(cnmmenCing with Sectinn 7000)o(Oivisi��ei 3 Of flie�usi- N1ALl � s und Pr��fcs+�uns Codc.antl my'licensu is in(ult fo�cc anJ ' � e ffe ct. I.ici•ns��Numl�cr Lic.Ciasc Contrac[ur Date ' � 1 am ca mpt frnm ihe Iicensiny i'equirentents as t am a �;�e�,s�a earrn�<<ci nr a rr,t«�rra pme�,rio��t��ns��r�•r p�an check fee 25°0 of above. �ctinF irt my Professional cap�city �Secti�n 7057,pus- � y� mess and laotcxs�ons Codr). PERh11T�SSUING FEE S dr,S O . Lic.or Rcti.rru. D�te TOTAL FEE �5 d , IIO�iF.O��'hF:R�F3UILUCI2 UI:CLAI2AT)ON pLAN CNECK APPLICANT �— 1 here��)' uffirm that 1 a _rempt ftum-!he Confrac[n!'e NAME � Licr»sa lau'for[6e fullotn?nB���s��� (SeCtion 70J1.5,Busi� CSsand Nrc�fessianti Cnd�): A�ORESS , ���yfJ� i, us uw� of the Droperfy.���itl dn[he ivark and tlie ! \stfuclureniti nol intCnded o r�(fered (��r 5�1�� (SeC(ion CITV T[L.NO. �o�a,n�.���rs.s�„e r�or�.s;��n,cod<>. -- 'r 1�QQQ � �e'ncr OINNER� �.L~•'L��J^ { �.I� �'�y. . � �S`I� 1,ns o uf tl�c{�ropert)'.am caclusivcly cOn[taCtiny u�itl� license�i eontraetnrs to construct tfie project M�II (s��+���ooaa,�„s�„�•,.,,,,a t���,rrss�,>�5 coa�•�. nooaess ;I ..3 3 5 0 CD\S7I:L�t:T10�Lt'.NUI�'C;AC:I�SICY CITY TEL.�JO. � ' e J�v Q U I IicreLy affirm tli�t there Iti a �nsttuction I�ndirtg a6ene) �ON7RAC'�OR ` for thc performanec f the irork�for u'hich tl�is Perntit is � , ,' � q' �d SSec.3097�Ci0.C). 4 G'I 4�S� Lendec s�artte AD�RESS � ' Q Lender's Address - CITY TEL.NO. I ccrlify'tl�at i hai'c n•ad(t�i5 n}i��liCuti�n an<I 5tafe that[ht STATE LIC. uhn� inlorn�u[ion i. ecf.!sgrre to Cnn�F`�3'��'���I alI Cuuni)' LICFNSE NO. CLASS . ordinances and$fate`�la�t's regula[ing I�feating,Ventil�ting�nd .\ir Conditi�>ning.and her�b5'�uthuriz��rnresentati�'es of this SI:E�.Rt;Vl�;lt51:{�OIt E�i'LANATO1tY'I.AhGUAC:1=. o,���,�s w ��ni,r �po�, i,�� :,no�-r.�n�m�����d prov�•r�s ro� � � Frctinn urpn�es. /' � �����ri. �� �� � ' �. �r.sa�c?on�s raores O1'. ..C:-...-11_D.'._'s.i::.':i. �...,'�;`.):. . � 1 l,c:��t,; ,lil:,.. n .� . . ,•f:... ..�[; . ' . I.i;c�.n: 1 t��.. I �., � r. . . (5��� , i1.5�. , :��i�;ec; cr." !:u�.,., .: (���.... . r.} G�r �. .�.:tr ir;ri��i: r _. ,..' 1^ -,_., . ., ��r•tr. i.�;��a. .. . . _ . . , . . el!�rnoli:'�.�r�i::��i�_ ...�rrrn�, r�;'.:��i�� „ i:�.:.:�... . . . . :'-n rccrir�,.. ;,.r c.;''+,="r i�;. :�!�1: r.,�r_.i, rr, f;.��• r � .• � � , . . . si�::c;! �ta1:��.�::r ,. l.: r. !': �... t.:r.:.. ru t�:.� . � j."ricii�i. 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