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HomeMy WebLinkAbout1838A (11) I � ��oiz�;i:iesco��rcns.a7io����:cL:�h:�rro� �eAssac ,e�Pf'LIC� TIOf� F��t' �Ef��''��T � 1 hereLy affirm tlwt 1 hava a certificate of cunsent to self CE-81612fl0) 1 � insure,<�r a certificate nt 19urkrrs'Cnmpensation Insurance,o� ' �cer:r���+c��.r - ts��.�&oo.l.ab.c.) HEfaTING•VENTILATING-AIR CONDITIONING ��,>����!!p$31 ' 3����y_FK_LMoN-f_� I ❑ C�•rttti��d�opy i.horchy��mistrcd. � �O��3Y OF LOS ANGEIES BUILDING AND SAFETY �Ccrfificd cnpp is fiied���ith ur/� L ig nspactiun � . � �s'^•n ����J///��/��"w�S FOR APPLICANT TO FILL IN flUILDING 2 CLC—A R C I)�[e2�C4-�¢,��.Iicunt_�/y9S{„_.l_ (PRINTOFiTYFEONLY) AUORESS (Q� R� CI�:IiT11�IC:\TI.O!'k.X1�:�iF'T10N['It0\111'OIiF:I�.kS' NO. TYPE OF APPLIANCE OR EQUIPMENT FC[ LOCALITY���MONf>_fS/ASz. CUS7Pp:h5ATION IYSUIt.AKCfS NCAREST �, (�IliiS SCCtion nCcd nat bc [ompl-�tCQ If the t�'Ork involvcll A650RPTION UNIT,GTU CROSS 5T. d })}' (�IC �1Cfttltl tS �(1� ��n� hnndtc� Joll�rs ($�n��tJ! �L'SS.� D�STFliCTNO. PPOCESSEDBY V I certify th�t in th� ��e[famt�nc�ut(hc«v�rk(<�r���hith tlli,5 AIR HANDLING UNIT,CFM pennit i.iaued,1 shall nnt emplol����Y P�rsnn in any n�nner � �� �� � so a�to M1ecnmc su6j�tl in tl�e�"�r4.ers'Cn����•n.'�itinn�L�t��s. gOILER,RTU �� APPROVAL.; ATE i�iSVECTo�SIGNATURE U � Ua^�_�'�1p{'lic�nt . __ __ � COMPRESSOFi.OTU�.�_�_I IO �OUGN � �,Gf GD W l a,�y— N. �'lll NS' 'Ii 7'O APPI.IC 11T:IF,aftcr r�aAing tlii.>Ccrtificato uf � � - I 2 VENTIL/>TION SYSTEht �J �� IS� .[inn. Snu shuultl becnme su6jec[ to the 1Vurkurs' FINAL / _ Cr>m{+ens:itie�n r:r�visi�n.;<�f[he Lut<�r C�>�e,you murt(i�rtli- EVAPORATIVE COOLER ' �/- with cumply �vitli such provi.ions or this Prnnit shali he � i,'HLI A�N deemetl r���nAe�. FURNACE: FAU p� —��`'�= Io� 1_ICF.\SI:DCOVTRACTORSD2:CLARATION � FLOOR� �7U_ � �. I herehy a((irm that f am lic�•ns��undrr�r��visinns of Ch��i[,r HEATEF2: SUSP[ND[D UNIT �I ( � 9 (enmmencinp���ith Section 7000)c�f[)i��i.ciun 3 of the Pu,i- WALL ness and Prn(rvsiu�s Code,and my lieense is in(ull force and O� �. .•«<�«. �,g22qo-9cv. c-2c� 2 N�cTs�; oUs Lc75 2 I.iccnse Num icr �ic.Clast_ f�/a.KRc�N �2q-�t�— ��$I.�s coiurac�or /_. nalc_ ' � 1 am ezzmp[ from the Iicensiug reyuirements as I am a Gccns�d architcct nr a r�cts�rrrd p�ores,�on�t en���cer Plan check fee 2590 of abova �� $�$A acting in m�� profession�l eaP�city (SeeNnn 7051, Elus- �O ` , • inrss an:l��r��tr:.s�ons cud�). PERMIT ISSUING FEE S �� � �8 Lic.or�trf.[�o. Datc TOTAL FEE .� 5(� c( • •5 1,50 IIOM11I:Ol5'N1�;12�6UI1,p1'K[)F:CI.ARATIO.V' pLAN CHECK APPLICANT � � • •51.50� I hereby affirm Ihat I a i exempt Gum�the Contrsctnr's NAME ' ' t,;«�,���w� r����i��� r�,u<�ti�t�,� «,s�,� �s«i�<,�, �oai.s, H�s�- � �0'a O 1 �84 n�id Prufcssions Cude): AD�RESS � - � - � � i, us o�cr.cr of thr praperq�,�cill do [hc �vork and ;Im � � ' scructure is n�it inten:fed ��r r�ffered.fi�r s�le (Sect:nn CITY . TEL.NO. , 704a,pusinesc and Profassions Cadt). . � o��,•,E�SOCAL.AN_D—L7L�! I,as owner uf[tir propert>', um esNusively cont ucting «'ith IiCci�5tc1 con[r�CtorS fo con5[rucf [hc �+tuj�Ct h1AIL v�`,� �� ( (SecCion 70a4,Ft�sinassund Professiuns Code). ADOREss p v� _f�(J���.���R� CO�S7'I;l1CT10\LI:�VUI\'(;AC;l:N(;1' CITV �1 C TEL.NO. . I herchy affirm �h�t thrrc i, u cun.iructiun Iciiding agcrcl' ���,v�-�— f�r the �,�rformuncz �( the����orl: fi�r ���hicl� tl�is �,ermi[ iy CON7RACTOIi �/� ptJ lC,+,n 1_L'=^"``� . . istiued(Set.7097,Civ.C.). �=11���.���v �=t . Lender's Name 11DDRG55 RQ��y Rr— ^n �7 � � Lender's Addres� �_V�1V 1�-_��Y`QI� — CITV T[L.NO. � ����t�ry ,i��i � n�,��rc:ia �iu,;�npi;c:,c;o���,a s�„<<�,�i a,r �1\1L�.HL-.}.I.I�/t �ht�rc infc�rm:lli��n it CorR�Ct.1��Ic�t��Coin�+l��u�itli all Coun[)' LICFNSE NO.��J�S�� C ASS �`V ordinancrs and Stu[r la�rs regulatin��Heating,VentilatinG�nd Air Cunditinnin��,und hcrrbl'authori�r raPrescntutiras uf thiy SF:Ii RlVGKSi[I'OF(;XPI.AM1ATORY LAKUUqG1C � Cuhu.... to •ntrr—�hr abo��e�meutiuned propen)' ior . . �`m • 2-24_$� JignatureufPcrmittee 7)a�e � I�JSFECTOR'S NOT[S � OW'NER-BUII.UER DLCLAP.A f10N . 1 hcrcUy aflirm 1La[i am c�empt fcom llrc Contractor's . License Law to� the follo�ving rcaum/tieaion 709I.5. ' �"�'.. '� „ .. ` .. Qusiness and P�ofrssiora CndeJ: Any� eirl' or coienq• . . . . xdricl�.�requires c.Cenrtit�tn CortstrurL Cf7cr, irrprnre,, ' " . .. :��.r". ' - , - dcr:nlis7�,or repair.o�{v srn;rnue.P�ior.ro irs ITSlfC�ICC. - � . oh�o requires ih,c appliecrir for rurli perr��ii ro fi.'c c � �� ' - �- � � � . . �• - rtgrred sta7eme�it thar he Ls licensed pursuQrrt 7o tGe prnrisiar.c of tl�e Con7rat(or;c I.ireu,se La�v(Ciiapter J � (canrmencing xrtJr Secrion 7Q001 0l Dicrsio+: 3 oj d:e �. . G:ai�tess artd ProJessrnar Co�;eJ o� 11ter l:e is exerrr,�t . - , , drerrfrom end the br.srr for dte al7e�td ezemptiort.Ait}' . � . ' . riolatior�of Secrinrt i 031.5 b}'any nppfieare7 for o pennit , ' � �. suLjecri rkr at'plirent tn a ch'if pe�oc7t}�of��oi mnrr fi:a�� frrc In+�:drr[1 do(!ms/S500J::. , , . ' .. ..... � . ❑.1.�d.���v�cet oC ILc.propertp��ill du Ihe�ru[k,vnd ' � � Ihc structur,is nui intendcd or uflcrcd for salc. . . � . �. .. � (Sec. i0d4. I7u�inecs ar.d Profecsinns Codr: Tlre_�� � . . - lractor's Liccrn'c Law ducs r.ot apply� fa an otiurrrr ��f ' �+ro,nrrt��xd�o bui(ds or iinprores diereur.,prrd wpo does suda work LLnarlf proridcd Iitar sucR ir.rprnceiricros � . , - . • � arr nne i�ucuded or offcrrd fnr rale !f. 1m�rcrcr. the fiuildin, m improrcricr.t is sul�l irit6in erze yccr of mrnpletian, tlie nrorter-hu+ldrr will liarr the broden of prnrirr( 71rat lie did uot b:�ild or imprm�c for the .. . ,.. V_.�._ , . .. , �� i ..__� . purpnyetifsalc./ � ��y� � •. . , �[] l.-os�t��cncr of ttre'F•�mperl}:an':.c�cl�uively con- _ � � . trac[iqg�cith licersed con��ect��rs lo cunsl�ucc lhe p[ujccf �Sec}ion iUlv;l;nsincss ad�!Prnfessiorr{fadei TGe Com lrac7nrs Licensc I.n•�r do:r r�n! a��?h' to on oirrirr af . . � p�operfy k�Ln buifds or inqr�ores fhcreon. end ivlro � cavrarls for surG projrrls irifA a emurar:or(s) lirensed .. _ . _ .. purriemu 7n tlrc CaRrnrmr's Lice�uc LciaJ. _ 1 _ i,-• 1 am excmpt under Sec. li Cc P.C.for this rc�son _ .--. Datc Owncr INSPECTOR'S NOTES �- � - � " ' - � �- � . � ' �