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HomeMy WebLinkAbout1830A (11) lCpItKE1:S'CO\IPI;?JSAT101G UI'.C'L:\RAiIOh 76A8G4C � ne�ee� �ir,.m �h�� , �,�,�e ;���«�f;���r �,r���.,,«„� ,�_��� ��-o�s�zeo, ,4PPLICp,TlOf�! FOR PERPv91T insure,oracealificatanll':orkers'Com,��nsationintur:mcc,ur HEATING-VE�JTILATING-AIR CONDITIONING � u certified op�the (tirc 3800,I.ah.('.) ���>���>!C�rl� �33��3,s���>—C'�Cf�Ot�s LI I ❑ Certir�d mpy is h�•reny tu�nished. COUNTY�F LOS ANGELES BUILDING AND SAFETY Certificd eo �is filed�sith bu'_ ���� �� � '� � � ' p � ��iun �y��nti jricpcctinn `�. /��I �L�� FOR APPLICANTTO FILL IN 6UILDING 2 CLt. C� K CYnI l�te � TAp licant /_v_wJ �Pf11NT OR TYPE ONLY) �+ODRESS ��___A LOCALITY �� 1� I�/�0�.Il��a R CF:RTIT'ICATC OI'EXl:�li'TIO�f'1:0`.11':Ol;f:f:1:S' NO. TYPE OF APPLiANCE OR EQUIPMENT FEE J�L�l 1� CO.`4VI;tiSATlO�IVSL;I2A\Cl: NEAREST (This sectinn necd not be complMed if the �tivrA invol:ed �AESOnPTION U41T,fITU � CROSsST. }� U)' [�IC PCfRlil IS f0i OPC �IIJf1t�Ll`l� ����]TS (S(0�� UC �CSS.� DISTRiCTkO FROCESSE 11Y 0 I certi(y tl�at in Ih�• p�•rtnrm;�n��e��f l��,e����rA f��r�.lii�ti:liis Alfi NANOLING UNIT.CFM /1, V permi[is issued,]shall not rmpin>�anl'prnnn i�i�iny mmuier ��.J � so as to btcome xubjeet tn[he " r{:er�'('��- �ens�ti��n La«s. EDILER,PTU 0 (�� � OQ APPROVAIS% ATE INSPECTO�'SSiGNATURE W ; I)a[ _ ?"A{�{�licartt . _ ._ ^ __ _l ICOti1FRE.",SOR.L7TU �•� ROUGH N l:TO:119'CIGIKT: IL after makir,,:thi.Q•nificotc nf - .N � I VENTILATION SVSTEh1 FINAL Z , I:x. .ption. You shuuld heeome �uhjec[ m Ihe \Cur6_rs' _ Compensati��n pr�n�isions n(tliz L:i1��r C"nde,}'ou mus;fiirth- EVF.POFlATIVE CODLEF with comrly �.�ith such pro��isionc or this prrmit sh:�li Fc � v�' �N deemed re��nkecl. FUH�lF�CE: Ft1U 'C{t Y_ pV , LICL:tiSEDC;OVTILACTORS1IE:CI.:\ItA7l0\' � FIOGF�• BT�—Si�— U , I iierehy affirm tl�at I am licen.e[f und�r rrrr��isi�rs nf('h��ter HEAT[L;: �USP[NDED UNIT 9 (cnmmencinr wi�h S��i�li��n 7000)��f[)ivi,i��n J of th�3-.usi- L^lALL ness and Professions CnJa•, d m5 license is in full f��rcc and � j� �ert•��. e)�i229 o-9�P. 1� NLL35� OJ�L�S I Licensc Numbrr I.�c.Cl.ic�C 2�_ t S� Contractur�����v.�� 17.�ce�'2_l�UT � ��•�� � i� � 1�m rxemp[ Cmm thc lia�nsing reyuiremen[c nc I am a � licensed arehitec[ ur u re�isterrd p:ofessiunal en,:ioccr P�gn CIICCk fee 25;u Of dhOVO. � acting in m�� profestiion�l esp�ciry (Scctiun 70s1. lius- — inrsl and l�rotcs.s�ons Code). PERMIT ISSUING FEE S Q SO tic.or Reg.Nn. Uatc _ TOTAL FEE 4�j 00 E10\lli O\l'�I:IL-M;ILDT:R D3:CLARqTIOti pLAPJ CHECK APPLICANT � i hcreby afl'irm that I arn etemp[ 4unr the Contr:ictor's NAME L�;�a�<e Law fur Iho (nllu�c;ne re��sun (Scctiun 70J1.5. 13usi- � r nd Prnfrsziuns Cndr): ADDRESS � � I, as a�vner of the prnprrt7'.«'ilI do tlie�curF, anC tl:r R� 8 3.�{� � stru��ure is no[ in(cn��•cl or of(�•r�•� f��r sal: (S<cti��n CITY TEL.NO. . . 7014.13u.ines�anJ yu�(�•.ci��nti('��dc). — — �'•.• •''��8 � O . OVJNEFi���� � ('�1—�/ , ' l�as owner uf the PruPer[5',am exclusivell'contr�eting .�Jr.l����.�--1�7�+V ( ♦ •�I�Q Q with licensed cnntrnctors to cunctrucl lhe prnject h"A�L C /������ , . (Scctiun 703-1,13usiness�nd f`r�f�ssir�nc Cc�:f�). /+Dt]nE55�j���Q,N�a V v�sJ v= _ ,�,• •4�O O U COnSTFLU('Tlp\LI'.NUI�'C:AC;1:�(:Y C�TY O�J/��C,..'� Tf_L.NO. I hrreb5' �ffinn that there i i c�i tructiun Icndin,ag��ncy 1�, . 0���''8 4 for the perfarmuner uf tlre����or{: for �chich Uiic pernut is COPJTFiACTOR H/�CZRt��I___N�G . �� � ;s,�ea(sr�.30��,c��.c.�. 1.�nar�•shamr — aoonEss � �g���L=C1�y�. � Lender'sAddresa — CI7Y TEL.NO. � �� —_1��1�.HL1_N � 1 certi(y ihst I nace re�d this:q,�•licati��n and st:�te itc�t Ihe SrnTE LI0. �—q� abu�c iltft�rma[ion is CarlcC[.1 arrre tt�C��nl{�ly v:i[h ull Co�.lr.[y LIr;FNSF No.��j'���� CLASS C. . ordinances and St:�tr lu�cs rr�'uiatinf•.Hcatinp.Venli!.iting und � . Air Cundilioning.and hrrehg authon�a rcprcarn[uticcs uf Ihis SI:1�:I<CVI:RSI�:POR F:hPLAN:�TORY LANGU.4GF: � I��t�� ent ���tlic ol>i����menti��ned �ro�<ril' fnr , i � tin�ir�.5 2-2q-$4 ' Signaturt of 1'cnnrt�er Date . . . � I,"....�CTO^,:1:0'1"� --�..__. .� �., .,......;i�i.L%�;-.ii�('i.r'�:�.':"i'IG'� _ ,� 7 P-n�i:y a�l fi�. !�,.rt t::n c�crr.pt fr�r.i CI•r Ccntc:-ctoi s it � — Lic���;� Ca� i.ir tli. I'uliav::r�,l reu:a^7Sectiort 7031.�. , -. ; . -� _ . .. - 1'u�ird+ ur,_' � i�t�:fcr.s ['odeJ: .inr tir)' n� courty � . . — ---- ._ r.lr.'cD. . < �r'mi� t�� :nirsrr<�(, c!1c�. in�?r�re,. • .. . - .-• ._ . . .. - . i,r�:�e..'�.�nr��e�nv nc�.�xtr.�.n.r:�.Prio�tt i:t i�su,^..ccc. cl,s��-rrr::i.-<�� �1i;: c}•;:'i_Crff Ji�-Svcl� pzrr.iil fo fil� c � � , � � , . , , . _ si:n:�d e:c:<°.rt:r.t t::: i�� i�� rcensc^;1 purt��a�x ro tke - ��rnriricv:, ��,`l;:� C',vrtnai'ror's f.tccir,��d /a:: (Clu;!Ir�9 (eum•ar;:rir, n�irl. J�°:rrn,i iOUCJ nf Diri.rni. 9 nf thc " . 7h:[;r:- . �.. .;)"..; �nr.� - '�j cr d:.:t !; ir escr,�pt . ti:�rejrorrr ar.J ti�, l.:sir far��iu a!!:A'�'d cYemptin:.,ir!:' - _ .� r(ofCti+r,r�Sd.:i.vi 7l'j1.P ub•o^}'ePPlicmt�j%�rapermif , . . .- . • . ' s�!pl;eLe l%;✓c;n::!i.m:i fu a ci�fI p'nalry oJl:ar rno�r rl:an fi:�'lr:; ��c „�s(5`il.�; � " . , . . ..' ❑ I.I�:uc,rrr nf cl.c p;.,�.riy'�citi di�t!�c i�:o:F..::q�;l � . - � 1!1��r[l:Ltllr_i;f.��i�1t.n.:�..�1 1�:lillirCL fttr s::lC. . ' . /5�c. il!!�J. l;untcef cn;: 13�,l:seiar�s Cod.: 77r � � � - ' ' � [rL�uor's /.ice:�cr T.a�r dir�r r.nr ap,^7p tr, m� o�ti•ner o( ' � . p'o(�crf}' � ��l:ui��'s m in�;ror:s'tl�crrnu.a.�i�xho duer �uch un;:,��6inirclj �:�oride:i thn: sucA'inip�u��e�trents � �:� 4.: � �. { �� r.a• ii!t:udr�'r�•o/;:r.a?fi�r s�lc•. !7. h.o}.'crcr. dre ' _� �. . bi�i(;li.:,' ar int;'ro�'imri« ir ro;ti r:rtr:in Unr t�car of , . rpm,^;etio�!. �iie � �n:rr�b::il.^,cr wi!! hav. f'+e Lurde�t <,J�rorin;' ti�at 7ie d'd -tut bui!1 or i,nF/��'�'f�r t!re ' �- ' _ � .�._ - . ' .,. , -. p:rrtqseufsc,'c.J - � n�7.��s:.�u•r.cr rd tLi nro;�crt}',am c�d�.ici�elr con� . ' ' ' � . ' _- ir:ic,i-,;v.iti:lic�.r.��d cnn[ccl�:�Ju cnns[rc.r ih�;pr��icct (S�.�r� i•!:. �,. ,ec n.r.d F�nj"�°Srinr. Ca f�.7'l�.,Ca" u'arr:,�'� I.icrr��Laiv d�irs r:nt cppl�• tu crt nnvrer of /vn;,rrp� u�l.�,r hui'.Is or i��:pror�s tlturer.. ar.:t �v1to ,�ryrc��ts%�,Y s;�:l:proldct�r;itliacnritrr.:tor(.eJ !ic<'iu�'d . .. , pe•�.un-t1:,�th�('or�trett.�r'rLi�e'r��:eLc�.�.J. , . I an�c�c��;!ln�d�r S�c. .— C ec I'.C�.for 1Li�.rea�,uc. — i-. .. . ; i - _ � �, a � � llatc-- , . . � � - , � � . -. - U��a�•r — ----- INSPECTOR'S P.OTES - - � '' � � � •� � �� —.�.'_. _ -- . ' __ , . I