HomeMy WebLinkAbout0836A (4) 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 � ' '
T ' � � � �- � ,.
0 . � �..' � _ : .
N - ' � ' _ ' . r ' .
ZJ . . � � - . -• .. .
� _ _ . �
T • •
N - � .. �
_ . . . _ L; � . _ , ..
� - i -- , �
�- . ... �'., • . . '
f-� � � . _.. . . .
I -
. � � � l-. . . ..
' " i .
`; _ • Z
_ �
- -- ' -- m � _
� . f1
. � ' p
- - - � vi
..i - , �
_ - O
- - ,v =. m
- N
1
' r/i .
. ._ .. ._. . . .. .f ....
.� /
. .. . ' ' . , ;:i .- ' . . : 'y�, .. .
p � a� - �-c F ti-�`n'.��, 'o ° 3 � f F o'in �- o 0 0 0�� o� 3� � � a' r- '-
0 0 � m f o �-� � o ��,o o c N n T.
� . ; � . � po � n�.,p ^:n_. •.����'n ] ��c-o m'n �, �? =' H ' � � m`..o.p _ 3 Q .
� ' O � . O b C._.,.� �ir,� c ,� O � C-r-�l ❑ V+ S 0 'p . �n� - N m• .
� . . '. . �' � (� X ] ti C � .O� IJ ' R N O �'� n O� _ �'� �N �� n S i�O N N � �.
� �' 4�• a� ��'. : - a�. 3 0 3 aN Ac" Ufl`� o �o� °�o'' o 0 0 0-
0 3 ^ N n v, so ° a� � o � ,� mo ° a � ° �.`-�u-o n.o� � f � �
v o ' ° N - ' � �°,=o.r-� � o ��.-�c � � •- �a < �'c -
, - H 3 �� 3F � m £ � f. N ^+o � � Qo � . �� a�-°,��•,o'�'�. o' O � . m
a s�aryN ' ��,o =a 'c � 3y� _ �' nv�:° o � � 3''c ' m �" 70
� � � o 0 0 � " aC � o a`.aa�',°� .o � o 'o �.� � <' � �i�," ° � �� a�
..'i.' � � a � N,n o•o� � o a o �, � ,�.� -o o � r- m o � o o - C
� o o N �,'�o�_ � m -. N o � a� s '� ��b N o a aN o � N o o :r-
�� � n � ��: � S �.�-o ='" � '9a�' °. . o ��� c � 3
v ,� o � � .D o c nv .no �
. F,o, Qv°`° °'°.m�. P ° a� ° a o � � � `''.nN �'` n af %. �
�v .ri -n:� c � �� v � ° a° o o ' 3 °,o o� o ' �. � �
. °� ,Z"^`���.� 0.° s�-o`� '"- °.= ?m �b �-� _ � ` 3 , �
�' �'n °I� 0'-7 ° � � � � o � n i o 3 � �-� � 0 3 ° ,� � o �° n
- ---�� �'a� �o � m °° �v > > nQ, _ ' � <. � c 'Oa-o,"' �.� o o' D
� Nf o o�N 3 °,v °,� o a o °a a �-c o���� _. N 3 ,� � 3 A
�� a o < f m o 0 0- � N °�"m � D
' . � 0.ry � -� � � m � 3 1] 1J O � y O S -.,n j � N ] N N j � O r�i � _I
i . � O S �C`U b �O .(� u'� � p '� n !D Q . � �
� . . � C 7 -�i.�'J S� S Q r• ' a�.C F �ry O�a, n O 7 � a C 7 0 Z
. � ' . /� . C Q� � A CJ . ❑ p C. Q N Z•��� O T�T 7-a 7 H � Q � , �
o N o � � n-� a� c � � �.� v�n °'-3 '� "o'
' �'` � 7 � � O n .. fU � 9 H.O J O n LT'O �.� � � � W
•_ � o� o ;' � 4 s o o � � �, ' �a o �. � �' T o o' �-^i„�
o �c' ao , -< � a'a « 3-� � �
%�i