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HomeMy WebLinkAbout1507A (8) IherebyQORmERSarWh�aNaA��f,�aP�af�o��e�, ose�f . � _ . ,� APPLICATION FOR PERMIT � �y3?/ � .' insure,or a cerlificate of Workers'�Com ensa'ion Insora�ce•' CE•818(REV.10/BI � �� � �� ------ � - ��- � � ' Y�A�fl�d co�yJ�eof(Sec:38 �� �}��anxac � HEATING -'VENTILATING AIR CONDITIONING � - ,�ofic n�o'. Compan s ��} � �t �f-TGg"U �'. � Certified wpy is hereby furnished. - . � � �� �- COUNTY Of LOS ANGELES - -�� --� _ BUILDING AND SAFETY -"��^� !% .. Ce�tified copy is fiied wiih the wunty bu Iding inspec-� - �� - � FOR APPLICAN7 TO�FILL IN- ��- - BURDMG p �/ ./ : lio/n�depOrfinenl. ' �. � (PRINTORTYPEONIY) . . ADDRE55 773 GC„s-7 rjj,�yJa'o/p,s..[i A'� . .. �.. Date /v,,�� APPIicaM� � . LOCALI7Y n � � . NO. TYPE OF APPLIANCE OR EQUIPMENT �� � FEE �•� � � CERTIFICATE OF EXEMPTION FROM WO ERS' ---- � NEaREST � .� � � � COMPENSATION INSURANCE '� - - CkO5S5t. � � � - .�TIIIf 31CfI011 IIPpfI IIOI 60 COtIfPIB}YL(�II1!WO�It IlIYOIV�fI LY � aB50RPTION UNIT,BTU DiSTkICI NO._ PRp�E55ED BY . . fha parmtt is for ona hundrod dollars(S1D0)or lass.) � ' qiR HANDIING UNI7,CFM � � � � " r � � I tenify thot in�he per(ormonce of the work for,which this-- � � / ��� ' �peimit is issued,I shall nof employ any person in ony monne� � � � so as to become subjeu to the Workers'Gompensotion Laws.,... BOItER;BiU �aovaovaa �� onrt � wsveaoa•s siGaaroa¢ ' � Date ��PPlicant � . . . . . COMPRESSOR.BTU ROUGH � � i. �++F'�. ,. � . NOTICE.TO APPLICANT: It, aher making�his Cenificate of VEN71L4TIONSYSTEM � . FINAL ' 'L8� . Exemption,'yov should become subjec� io'the�Workers'�_ . � -� Compensofion provisions oF fbe La6or Code,�you rtiusl forlh• EVAFORAirvE COO�ER � � � ' VA�ID{1T��r1 � . � �with comply with such provisions or this�permit shall ba � I - - � � deemed revoked. . .� �� r� : � / FURNACE: ��FALI TY� �' ��- �� � - � I � ��� UCENSED CONTRACTORS DECLARATION ��. / FLOOR eTU D . � � �I hereby affirm Ihat I am licensed under provisions of Chopter 9' SUSPENDED � � UNIT= � � � I -. � � '(commendn9 with Section 7000)of Division 3 of the Business HEAiER: `A'A�� . , � and Pm(essions Code,ond my license is in full force ond eifecl.��"� ��� . � � "- �.� -'- . � � �" I ��9Y9 6 �-�U a License Number Lic�Class -. . - . . -. . . . .. , � , � . l�J . � ContracloJ I Date �O—/6"�7. .. . . � . ' � . � __ , ! p F.. i ❑ I am eaempl un er Sec. � . ._. _ . . . . . _ _ _... � w �. Plan check fee � �1 5 Q 7/i H 8.8P,C.fo.�his reason Daie: -PERMIT ISSUING FEE S � � � � ? ' /O 5— ti •8 Siqnature TOTAL FEE �J S OWNER-BUILDER DECLARATION � � aa.N eHeCK nP7liG4rli � . � , � �.� �7 4'�5 � � � 1 hereby otfirm thaf I am exempr from 1he Controcror's License � , . 'i . • • �'�Q.'�5 v Law for the following reason(SeUian 703I.5,Business and NAME ' . . • . ' � ProfessionsCode): -� , � �� .' �- - �(�2� _87 � ❑ I, os owner of Ihe property, or my employees wilh ADDRE55 - . �� . � . : - wages as fheir sole compensation,will do the work and -�- � � �. the sfructwe is not intended or offered Ior zale(Section CItY� TEL w0. � . 7044,Business ond Professions Code). . � �� ' � � - � � i -� - - ��� �- � � � - �. .. . OWNER. ��M1 O7✓ � . , . ❑ I,as owner of fhe property,am eadosively conlrocling. �1` � � .' '�. wilh licensed coNracrors to conshuct rha project�Sec- p0oRE55 � � � � � - � � tion 7044,Business ond Professions Codej.� � � � � . � CONSTRUCTION IENDING AGENCY . '���- ' CITY --TEI.NO. �--"-�"— �'` '�� ' � I hereby offirm Ihat fhere is a construafion lending agency for - � ► I fhe performonce af the work for which Ihis permit is issued �- CONTRACT � � '�--' � � - i (Sec.3097,Civ.C.). � . `_._. .. . - ._... ._ _ .__ . .__.. ... . . . .. ._ ADDRE55 3 f �. .- ,.. _ ._ � :�....-. ... � . . . tender'sName �. . .._.. .__. . .... . _ ... ...__. .. '. � . ..._ _ CI �� .. TEL.NO... [���L/[/ .. ..�. __.. _ . ���, .... .. . '. Lender's Address p . ���� �.� � - ��� �� � � � � I certify thot I have read this applimrion ond srare�hm�he ._ IiCENSE NO. G / �� . CLA55 �i�.Z.Q ' . .. �, ._. _._.._. ._ . _.-.........._. ..... .. ... .... .. . . above iniormatian is rorrecL 1 agree lo comply wifh all County . , ' � ord�nantes and Stare laws relating to 6uild�ng wnstrucfion, � � - � � '� � �. and hereby auihorize representotives of this County io en�er� ���-� �� . ����� �� �� � �� �� - - �- � � �� ��` �-�' , - � pon the above-menfianed propery for inspec�ion purposes. � � SEE REVERSE FOR EXPLANATORY LANGUAGE � . � �, ' /G—/G--S�]� . , _ _. --- . Signature of Applimnl or Agent � Oole . ... ...-.. .. . . ... .. . . .. . .... . .- . . � .. � � - , , . . `'. , :,.._.. '; :'. , ?:. ; � ., '� ,. . ,. _ _ .. ,. . , � ' ; _: � . :; r,:-, --.' �N -'.OWNER-EUILDER DECLARATION , SPECTOR'S NOTES `t � fF �t�a �-, � l.�'�•,j�,��`- . . � . „-.. �'�` ��' I hereb'y'aff rm'il.ar��l am exe ptf om the Com octor's � ...�. y .:.. . .: ........:... ...._ . ,........15�..:t - � � �_.��� �license Low for'fhe foilowing reason(Sectlon 703L5. . ,.___......_..._�._�___.....__._._....v,-..__�_.__... . _.. -"-"--`—.--_._ _,._.. ._-:..,._..._____ ...�........_ �- ) Anyciryofcountywh/ch .. Business and Prolessions Code: < <1�t� .,'� �,t. . �� ` �.." . - .. .. .. .. . . .�requ7rex a perm7f�fo consfruct,e Iler'Improve._demolish. � - �'- � � �--� - �� � or repair_ony sirudure,prlori�io-ihlssuonce,olso re• . j �� �5_�(� , ' -� ��� , y ��' � ! I�_J�`,'�,qufresiheapplspnHorsuchpc�miifoille'aslgnedstofo- . -' �V �- �'-�� ' ' - � � � ' ' � � menf Ihaf Fo!s flcansCdpursuaM fa fhc provfsfons of Ifie � �1..'\� �`�\ ci L� � ,1 , Coniracfors.license�low(Cfidpier,9(commencing wuh �-' .�:: .,;-�- .^., ..." ..�" . . •. ..�-' � � � � ... . �. � . ) f bivislon 3 0(fhe Bus�ness and P,rofez� ;"., . -.�, . . ... .. �. /.: , . .. . Secflon 7000 0 1 ' . . . . lons Code) �Ihot he Is e empk Iherelrom�and I'no basis , , - i. � ��� " ' (or fhe,tilleged exempf�on_,Any violaflon �ol Secffon , i . .�. i ; ._. ,.._..._._ . _:: , ' -- ' � .� :- :- , " .. . � . .:. 7031.5 by'any oppiicant!o{�a�permit'subjects fhe appli- --_._ :.-- �- -.__. _ _ . _._ . � . . . . ,, . ,. . .. .; . ',�____..__.__. ._ ...___ .__. ���'�+-i �.ccM�fo�a.civll penclty o1 nof more Ihon 1Wo hundred , � .__.__ �.:._ ._,_.__ . ___ �.'_. . S ' I .. � dollors(5500).: �. , . _.... .� �. .. , t � . � . ., j .. ._. ._.. _.._._.._. .�� "�- .��.� �. , ❑I,as owner of Jhe property will do ifie work,.ond � � - ,_._.. ' ' -.. .. _ .._ I�--""�"� �-'"�--�" ��"�- �"' �-" ---�--�� �i - , „ _._, �_ ,. . ; --� the strudure is"nat inlendeil oi�offered for salo�`..� � '-�-. --_-.r� �-__. .�._-- --- '- � . � . ...... ..i , � �`..� .:f5ec.7044,BuslnessondProfesstonsCodo:�.TheContrar ' . ;<<�,.� •�:r � .,�, . �-•for's Uconse law daes nof opply,fo an owner of properry '. U ' :, .... ..� ; :�.� . ----�-� -"" �__. �� ' �.�� ' wbo 6ullds.or lmproves thereon,.and�who does.such � \� work hlmseff provlded ifia�such improvemenfs ore nof . � -:���.7��,.�i\, ,- < i.S � � � � \ . Infended or offeredYo�solo:H;howover,Ihe bu�fding or . � � ... .� �_,� � ' ... � Improvemenf�s s.old wHhln ana year of complef/on,�fhe �'� ' i � ' � �� �� � :�� �.bwne�•6ullder will have fha barden o/proving thaf he did '��. _ _. . . . :..__ _... __ _. _ .__. ,� � .0 � • ; -�'��'nof bulfd'or improve for the porpose�o(sofe.J - � � ' _.C�'� � ;.:_.. .____ �--+ �.�'i ': -�t ����. ', . ` w,7�I.asownei�of]hep�operty,amexdusWelycon- . - � � � - � \. �, " '.-P"trncting with Ilcensed controctors 1`dconurutf the project ,_;. � ; , � -.;_._...1 . i .. .._......__::._._ ......_.__.... .._ '.""_. ' ' �.(Sec.7044)Business�cndPro(essionsCodo:i�eCon�roo . �� . , , � , , ��-- for'i'Litenso law does not appfy'to�vn6wncr of properly i � ' ' � �- ------���- - ----� - -- �-------�---- �-�-- �� Y � who bu(Id;or Improves lhereon,ond who con�rocts lor ' _.._ . �' �,"n� r • , � • '-��' � � � ��"����� � such projetls wllh a conhaclor(s)licrosed pursuan�lo . .�.. . ..-,-- . -'.. ..- - . - ...-- - ��� --� - '�ihe Controofar's Lkenm LawJ.'` . ... , r _. . .. e e • • • " . �� . 1 . -' . . .. �t ... ._ ....._ _-_ _.._ �.. ."_ " ..._.._ . '.___"" .. i , . .r`. `, . _ _ . . .___ ._."' __ '____' � . ,.. �,._�. i . � Y. A` • ' . . ' _ . . _ � _". .._ ._ . . ._ ... ..__ .._' __'. ........... . .. .""_ `_.'_ '__'_ " ' �., , J �� • � � � � � � • � � ' I am exempt under Sec. � , :A� • • ,. c�- i. .�,,` , . .: ,,..,�. �... ._� r . .�� ,., . ,.,,.... . . ,. � , - ���f i - B 8 P.C.�for Ihis�reason . . " �. . .. . . . ....) � � ... . . �� ..� _ . .__ - �... - i ... .� . �. . • � . . .�. �. . . , . .,._._ . . _" _'. '_"._ ._.._ . _�...! . �;� � Date ' ' t !_.�._. y.. . 1 �..`��,� �_i 1 � . . . . . , . . . , _-' - �-- � -��� � �:: � .\ �. . . . � � , � � j _ : Owner � � __, _ .__�__ .�._ _ _.._ } i �:�� .}_`_r . �r � . . � . �� . -. - , `,,, . 1 . ' - . i . . .�,....�:� "�,:�. . . .,. . . ..�. .. . . ... .. . �. ���_� t ;.:�_ ' ---� , . ;. INSPECTOR'S NOTES —--- _ - �.. � _ � � � ,` ,. ,., ..., � � � _� __ _ __ ._ _.' -----, , � . r,_ �� <:'`. ��l . ___...---� --�- --- --�----- ..___ � , . . .. . , � .,� . < :_._.:. . .--- -----_. ._---,�- - - -- --- -...-- �- -._. ..__. .:�� .. .. . . �..� ,. . _ . ... , E . \ �-. _\[� �! ,. . � ..� . i.� . _ � . . �a, - _ - ,- .�.. . . . � . , . ,. ��� ..,.. i � .,.�,.-�. n r.:..�. ,�....,;.,., .., ;. . . . . . ["_ . �\_.J� �._\ ,\„ ��':.S .. �,:�'•1 ...�,__... . ... . _..., ... �_ __ ._ _..> , ... . . .. \, . . . , . .�.. '\�,