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HomeMy WebLinkAbout0822A (4) . I �voaxF.Ks�cox,�,_r;s�Tiovoec:,,nRnrron 76A3� APPL�ICATION FOR PERMIT � I heroby affirm that I have a�cer[iPicate nY consent to self . CE-818(2E01 � . ipsure,or a certificate oi Workers'Compensation Insurance,o� � HEATING-VENTILATING-AIR CONDITIONING - . �a certified��yy/.'�e�ot(Sec.3800.Lab.C.) - �^.. N}"J.Li �� Ynlicy No. C��mpany . . I..'�} C��rtiiied cnpy�s hereby eurn�sn�d. COUNTV OF LOS ANGE4ES BUILDING AND SAFETY ti �y Ce tified cnpy u filed w�ith .: �ounty buitd�.g�p�{� tion BUILDING �.21� /7 ^ 7^' ir �,i. ��,{/J" , FOR APPLICANT TO FILL iN r(ra ADDRESS d! �,,,� Date L_Applicanr . d� � (PRWT OR TYPE ONLY) LOCALITV � (;k:RTII'ICATL�:Or}.XF�:A9P710N I� Oti1 WORKERS' NO. TYPE OF APPIfANCE OR EQUIPMENT FEE � � COMPENSATIOti1NSU2ANCE; NEAREST , (This section need not Ne compteted if the work involved ABSORPTION UNIT,BTU CROSS 57. � �� � O , by the permit is for one hundreJ dollars (3100)or less.) OISTRICTNO. PROCESSEOBY (� • I certif}�Ihai in the perfonnence}nf th pK�eirk for x�hich this AIR HANDLING UNIT,CFM � � T1 ��O � O � permii is issued.-i shall not emplo�any erson in any manner / �.J� V � so as[n becume subject to the N�OfI:C[4�C.OR1��I15Jf11)II Laws. / BOILER,BTU � +�� VV h � APPROVA4S DATE INSVECTaF'SSIGNATUPE fJ . Dafe ' qppli�anf�,__ COMPFESSOF,BTU ROUGH p' N - NOTICF.TO AYPLIC.4NT:!f,xftrr mnkirig ihis CertiPicate of VENTILATION SYSTEM 2 + k;xempti�n, you should bzcume subject [o ihe Wurkers' FINAL � Com}�ensation pr�visions of the I.abor Code,you must for[h- � � with comply with such provisirns or this perrrlit shall be EVAPOFATIVE CDOLEFl � VALIDATION �. d�emed revoked. FURNACE: FAU�GRAVITY � � • LCI:NSEllCON"fItACTOliSDi'�CI.ARATION FLOOR� BTU , . � • I hereby Affirm thut 1 am licensed under provisions oF Chaptcr HEATER: SUSPENDED UNi7 - • 9 (cammencing with Se�ti��+i 7000)of Divisian 3 of the Bus�- WALL � ' � ness and Professiuns Code,anA my Iicensr•is in full force nnd - effecL �Q /� " License Numher -�"��/ Lic.Class__,t,.l���y` '� � Cnnt�actor_��1L/� Date..� �_�R��— . � 1 am ezemp[ from the licensing requiraments a.E I am a � Iicensed architect or a registered professiunal engineer plan check fee 25%of above. � - actinp in my professionn3 c;ipacity (Sactian 7051, Bus- — - 7ness ana erorr,�ions Cnde). PERMIT ISSUING FEE$ S7,j" t,ic.or Keg.tJu. Dute_ TOTAI FEE - I�fO'vIE DW"V3:R-$I7If.UF:R UECL.4R,4TION PLAN CNECK APP�ICANT � � 7 hereby effirm that I um nzempt fr��m�[he Con[ractot's NAME � ' ' License Law f��r the foilowing re�sun (Seciion 7031.5,Bus� Q 2.2 A . ness xnd Yiofessio��s Cnde): AD�RESS � 8 � � [, es owner of the proper[y,will do'the work�nd ihe - 3�'� � �' � structure i nut intrnded or offerod for sate (Sec[iun CITY TEL.NO. # •8 7U44.Businzas and Yrofessions L'ode). . �,•'.yJ�:5 O . . ❑ � OWNEP � I,as owner of the property,�m exclusively contrncting ith iicensed cnntructors to construct the projett MALL � ��+•3 3.5 0�� � (Section 7044,Bu6inexs and Yrofessions'Code). - ADDRESS � � - � � - � ' CONSTRLCf[O�I.l;NUlKG AGENCY CITY TEL.NO. ' �'��Z S�"si� � i hereb}• affirm that therr is u construction Icnding agency . . fot the pertnrmance Uf the work fnr wltich t1u5 pefnll[ is CONTRACTOR - � � i5sued(Sec.3097,Ci��.C.). � ` - � . �. �ender's Name ADORESS � Lender's Address � CITY TEL.NO. � , � 1 cectifs'that 1 have read t6is applica[i�n nnd st;ile thrt the STATE LIC. � . � � ubove informa[inn is mrrec[.I agree io comply w�i[h ell Caunty LICENSE NO. CLA55 . ordinances and Stntc laivs re�ulating Hcating,Ventiluting and - . Air Conditioning.and fiere�+p au�horire rcpresentatives of this SEE:ItEVGRSG FOR E%PLANATURY LANGUAGE County� !o entei bnve-inentione� p u0eny for � , . inspe• -purposes� � � � . . lt i9 , Sign e of Y i�r: Date , _ _ _- -- -- � f , � .. . . . . .'_--.—_��If� T .".�',PdOI f_�:.�..__.._. ._.�._._....._,.._._.. . .. . 1 . 1""„ � '^ �i �~ Q'r�"tiEK-BUILDER DECLARATiON S�, _.._,._ -- --- __�_��� :�•. �. � . _ � ; 1}�sreby;�ffirm tl;at 1 am exempt fmm�ffie Contractox's� � , _ .� ..�.__,_____.�.._.W---.—_----�__...._..._—_..�.._____.._ Li�ense La;�. for tiie follo�ring reason(Sectr�n 703f.5,'�' . . . . . .. .. . � , , X::sn�e=ss a,n1 ProJ'rrs�aris CadeJ: Any ciry ar mun)y . � � i(rttL rq e�iras u pe<mih,to corrstnact, a(ter, lmprove-� • :— :� �_�.:__..�..�._:�._____.__ :.____ . . � r `:y' Y'� � t � - � � � � � � ' d na.1 ir�1�>re�c'j piay=.�•rructure.Prior to ttr��suance, � .. � "� � � also /`�e7r�-5[he�df�$ifiK,kt for such permi[�:to �i(e u � . . � �-������ 4��..1., � - ' � � � . � � � � � signer; sea�ement�„�l:ar he�is licensed pursuaht td rhe � " pr��nnnr<.f riie Contrrl2t�ri License Lnw(Ch¢pter 9 � , f `�f 3 � i. !;�'+�� � �o - - . - - . ��y Ico imeecinp wiih Sectfori 7000) oj Division 3 of rha . ��� � �� , �� �� � �� . -� ---- ---�� ---�-��-- , -- Liuiness ttrid Pr�njessions Code/ or rhat he is ezempt � � { , ._.. �. � .� � �Y ttierej o�n orr:!U:e b�3is for the allegeJ exemption.Any � . .- t.,4-.��.-�G{���1,_i , t j '. �__—.._ _._.--�.-- . . -_�i----.._- .... .____.—._ �let.;,ri af Section 703I.5 6y anyapPlican[fora permit �' i .. . . . . .. . � �.��- _ ti�,n � , �'( � s�bJe�t�d+e aypt�car�t ro a ciril�enaltv-of not more thart - � . . . . . " . ` e d�rr�red�'�(flrs'f�S500d� '. . . . . . �.. . �._..—__.�. _�,...____.�_.,.._ ......._..._._._.� i . � � � . . . . . . , ❑ 1 as i u�.r of tiie properly will do the wo�k,and � � . � „ � - ' �,��_._.�....._.:�.._......,.___.�__._...._..__.�..�.,.�_...r._..� tt s r c;u:c is no�in[enAed or ofiemd fm sale. ' . . 'r � �.,,.�,� : - . .. . � /Sc:. 7094, Ruairress and Rofe.rararas Ccule: The Cori. , , - " . - �� „_,_ ____�..___ _._,_,`._ rraetnri i.rci•nse Law does not apply to on owr�er.of . � - � � � ;n�operty:cLa br.:lds or imVrover thereon,and wha does � ..'� �., , . � ._.�....J._�._._._.._�.__..__._..__._.��.._ s.:clr «:o�x l�i�n,elf provided that such improvementr. ; � . . . are nor�irrcuded or offered Jor sate. 7J, however, rhe _ � ` . � � � ' l,��eik:i�i� or irn,nrove+rtent is mld within one Vear of , " �� � � � � � � `^ cnmpleuon, the oiviver-builder wilf huve the burden ¢ ' ... . � . of orovin:: tHar !:e diC nnt bui(d or improve jor the ' , , _ . ---._�..__ ._.._.._...__.____._�. ---". I+P ' olw�:a7e.� ,� -i:,..��,;. I . . . . . . . � i.`�as_��'�u'ncr nf[ht pk�..fitY,'�m esclusively Con� r : +.._�.—._'___.....__._._�___._.��__._._.�.._.,�..�. t( t�i a'iL��licensed con[ra.;to55 to c,onafruf[the project ! , , " � ' � � (S A b r.�?/.�F4,gurrr+ess m�d��dfersebrs's�Co<le.�The Can- �� . ^"""�—'-" �--'� .--��— � —"—� ,.ariar's�`Lircrrz^ I,qw dnes nor aPAly to en owner of ' , . � � � " , � -� ;���i:perrv wLv bui!ds or imFroves thereon, nrrA who � . ...__,�.._.__�.__._,__-�__.�.._�..__�_�_ .<��:�tre�ts fur.ruch projce�awitharnnrraceor/fJ licerrred ' � , � - � . . � � . � ._ nrusuu,u tr.the Car+trcetor,'s Licanre LawJ. ( ! � �: � ...... _._-_.__.A_.�._.._._..�__`_.—._ . ` ' _--__.. . _ �______.—_.._�� E ani c;cempi under Sec. i �_ ___�_�-------_- .�-- C�.N.C.for tle%s reason ., ..i: _�_. I _.--- _-----------------.,____._ . " . - . CSaCe�� , . .. . . . � ; .�. __.._�__--__.�_ . �.._�.,.�.. (yy:n+:r--- --- -- - .�__..._..,__,..___. _.____.—___._. i � INSPECTOR'S NOTES �� - � ' � ' _ ___.__. __....�.__�._�._ .._..._____...�. . . , �, r,. . .---- _____..__ _—__�._ t �. -'s,�� i � � ; � '� __ _ _._ __. ._._�__.__.__,_._. ._____._.__----—--- � ; ; � , . � r � 4�41 ;,. _� ; r ,� 3.,A � � . . __ ��_-----------___ _..------....____ � _ �v ,