HomeMy WebLinkAbout0836A WORKERS'COMPENSATIONDECIARAiION �,APPLICATION FOR PERMIT- �
I hereby affkm tho�I have a certificate of tonsent to self �� i '��� r(fd �
insure,o.o certificate of Workers'Compensation Irisurance, �enaeac ' HEATING - VENTILRTING - AIR CONDITIONING [S
or a certified copy thereof(Sec.3800,Lob.C.) CE-818(REV.t0iet) .
acy No. (la9FR Compony RPavar Tns_ �OUNTY OP LOS ANGELES BUILDING AND SAFETY
Cer�ified copy ii hereby fumished.
� Ceriified copy�s filed with the co r build�ng in ec- FOR APPLICANT TO FILL IN euaoiNG
+i de ortment. ADDRESSZiG6O CO 1@ Dt^iVe
�d� �� (PRINT OR TYFE ONLY)
,�r� ti_�-� �ocnuT�Bld . 19
a �g�ge_Appli
NO. TYPE OF APPIIANCE OR F�UIPMENT FEE
CERT�FICATE OF E ION ROM WO ERS' NEAREST
COMPENS ON INSURANC Ca055 ST.
(Thif eetiton nesd not ba complofad if Iha ork Involvod Y AgSORPTION UNIT,BTU OISiRICi NO. VRp�ESSED BY
Iha permff i�for one hundred dollars(5100) AIR HAN�LING UNIT,CFM f 11^ ��
I certify Ihal in Ihe performonce of Ihe work for whith this. � �
permit is issued,I shall nol employ any person in ony manner
so as to become subjeU lo the Workers'Compe�5a�ion LawS. BOItER,BTU avpe0�At5 DnrE INSPEQORS S�GNATURE '
Date �pplicant COMPRESSOR,B7U ROUGH f:�jrw,r -7—�`� LEti
P'"CE TO APPIICANi: If, oftei moking this Certificate of VENTILATION SYSTEM FiNAL _U�lTt �(r
l �ption, yov should become subject �o �he Workers'
Compensalion provisions of Ihe Labar Code,you must forth- EVAPORATIVE COOLER VALIDATION
with comply with such provisions or this permil sholl be �
deemed reiICENSED CONTRACTORS DECLARATION . F��RCE: FAV BTU GRAVITY gUILDING PERMIT �0542
I hereby ofiirm iho�I am licensed under pro�isions of Chopter 9 SUSPENOEo UNIT_ �
HEATER: WALL '
'(commencing with Section 7000)of Division 3 af�he Business r
and Professions Code and my license is in iull force and effed. - y
/7 7� 4 Exhaust fans 24 00 0
license Numb �`� Lia Closs��_v � - V
Conlracro� Da1e �� , O
❑ r r
I om exempt unde�5et. d w
Plan check fee d
N
s.BP.C.for�his reason PERMIT ISSUING FEE S z
Oafe:
S�gnature TOTAL FEE 91 50
� OWNER-BUIIDER DECIARATION PLAN CHECR APPLICANT
I hereby aifirm that I am exempt irom the Contractor's License �
law for the following reason(Section 7031.5,Business and NAME �
Professions Code): .
} I, as owner oi Ihe property, or my employees wifh ADDRE55
� wages os their sole Compensalion,will do Ihe work and CITV TEL.NO. `��'���'G
fhe slrutture is not intended or offered for sale{Seclion
70d4,Bosiness and Professions CodeJ. �'� • • • • •8
OWNE�e�man pevelo ment
❑ I,os owner of the property,om exclusively contracting
with licensed controcrors to constroct rhe praject(Sec- q0oaE55 I " •9�.5�
tion 7044,Business and Professions Code). �
CONSTRUCTION LENDING AGENCY ��TM LOS An�e 1 es CA iFl,NO. . - • • •9 t 5 0�
I hereby afFirm thol�here is a constr�ction lending agency for
fhe performonte of fhe work for which lhis permil is issued CONTRACTOR. A1 — C � O&, '—8 II
(Sea 3097.Civ.C.1� . . .. � .
ADDRESS 1606�E. Carson Street � � �
Lender's Name
uTv rson C re�.r,o.5 9-1698 _
Lender's Address �
LI .
I cerlify Ih61 I have read this applicotion ond slofe Ihot fhe LICENSE NO. 4'2OF)5O.. CLA55 C—ZO
obove information is correct.I agree to comply wirh oll Counry
ordinonces o tate laws relating to boilding conslroction, .
and eby auth rize representalives of this County�o enter - � � �'� ��� � �
u e a ove eniioned pr erty f�inspedion purposes. SEE REVFRSE FOR EXPLANA70RY LANGUAGE ,.
'8-88
gnaiure o Appll m or Agent Date . . .. . - . ... . . -
N , • •
'� i ,
� . � . ' ` � ' � _ .
�U � . _ . " ' `. '
H ' � ,.. . � -. .
z ... .. 1 _ . . .
0 � . � . _ . � . .
H . ..
� � � , _ C; : '; ..
_- ._ � '_` ' ""' .
�.. � .
� F- . � ; _.. . . � .
' ' .. •
�.. - •
� ' �
- i .
- . • - � � m � -
. ' • O
� - . � - - , . . 7c
' ' �• _. _ - . � �
. � _' - _. - 0 ,
' - _ - V1
_ 1
' " .- ... -y �/'� .
.. , .. -f ..."
, - �i /
• O � W _ ; .,.J, - : ; '-. ..
� , o o ac F�N1� �, o , •ti�. . .. .
� � v � n�-o �;'�°�°.'. ° �a ;, ° .��-O �o' 000000n3.o � ' m � �
, n X °b �•�-., _ ��'; a ��-° �^ N = = � � � ;�• .� N � T� .
^4
� � Q ,��.p�� �. � � ?.C' . v C lJ N tn �'�n O � 0 O �_ _ � Q'
� ' o � 4 ��„h� �.- ac343 `-' � a^ - � a`Do.sn3-iac� ° � �
, - a o N.o � � T� o Q j o =4 N +�c o U c`c o �o°_ Q�o'_. o � .`
( �- � ' �',�F '. o� �� o �' i _ °,-•o.�c�. o o� � �o`".o�.o�.� � �� �
,, `^' Q � . 3 � � mf a w � � o `-� � � ,r v � �.c _
.., , � � � ^ �'�° o H � '�'`'O F�o c � 3.a«.° �'�, : �a ��"� � �,° �.3 vo? . Z
��• . � � o � � o � a(� � �-�q b,p a - �U e�"� b �� a'c '�u �" m
p � n Q Ni] -On�-�.� q'O N O r� 'O � O o n x 3-�� �J �';� n p j-O �
- � � o o N �, " • o m f , a � H � �, . o � Q . .-., � �
. � a � �' �- � a � � � 4� <' a 3 , `" ^ m o � ^ �
�s° o n o�o o-`� ao�° a� ° ?c�`� � � �, ��b� ° H N o o C
�- . �-� r',�,,;' .° � co ° � cv° o av � �� � 4i N �v �.n�� p
�.• ' " °�.7��°��'c � n �c �a �°�° o 0 3 `S�t o ^ a x
- . � �o ;-v' �° a�-� '�"-- 0,= � �b ° ° � � `: ' � �
� �� o.� °�'-< o � � o � p � �� 3 � � 3-� � ` o .. `n 3 , �
� . n 4� � m o o F 3 0 � � � 3 'c �-o � 3 o y� b m
. U foo � 3 oro ',�� > > o Q _ `� � < � � ,00' � N '�<' O �. �
� T a � ; O 4 O a — 7 O� J'� • n O O D
O �
4� " y ^ ^ ° �' O �-3 .F�-� � � ° �o-� � ` ��°�� c� �` r 3 D
n �
' � ' �� . b 7 �.�j S''-C' `'�b �] o U �1�'u n i N � � � j o-a j o � ^� "'�
N �b p �' j-4`� H C c; �q o. o � a � n n o .. Q
.-��+� o N o o II � a o . Q N 2,� � o �-�--�a'�n o`� ° �� > > Z
. 7 r b � O � 7� 4� c ` >- [ � N q � J a p_O
9 � . n .. � � 9N � 'Jpq- 1 �p � `C.v '
- ,� o ° � � n � aro � j � o' ° aa �. o° F °,000FV°
an , ° -•c ^ 'a �4�� �• " 3-n o � �-� u, °
_—_—��,_,._,.�-�.`��_
