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HomeMy WebLinkAbout1790A (10) : _ _ _ ._-" r+.« 5 �„v_ an<�xmr- --`�a-. ..�.<�.�_. . __ .. ... .. ..._., ,. `,-+�: __,:> .. �� PY � ) =a� 76A364�.�� .:� ,-. - j� . �'y� „_,_` ���ppp - � WORKERS'COMPENSATION���CCARAT7�N � APP�ICATI V N ��0� �E�MI 1 � � µ� � J� I h eby aff�m that I ha e a certifimte of conse t ia self . . _ in u e r a c bficale of Wo k rs Compensnt on Insuronce, °""`" �� � � , u�:.. or a ce ' ed-c thereaf 5e.� 3a � �ob c � c ,_,HEATIN� - VENTilAT11J�A RIR CONDifi1��:N11�G �� - �3 _�C���`3rq.�.p nY �� � CE 818iREv +0/811� _ _ .- �_ _ J •a Certified copy�s hereby t�rn�shed COUNTY OF L05 ANGECE$` BUILDING AND SAFETY �� . , , � �. y,z <. _�_ _ _ .=t. �� , ' _�=.-_ �a _,�,_ ��_.� _ �- ,� _ _� . � Certified mpy is filed with the couniy building inspec: � . f�R{�PP��CJ+nJ'�'`�Q�}`����(,""�� BUILDING - � � - � tion departmeni. . - .- .--.- ADDRE55�.. (.�`f S ��{� W`� �� . � . . (PRINT OR TYPE ONiY)� -- __ .. � ...a..�..� .,.... - Doie � Applc nt - .. .._. . . .._ . �OCA[ITv � 7/il�'�r�/v��7 ��� ,,�_-:_ NO'-'� NPE OF�APP�VANCE OR Ef3UIPNi'ENT FEE CERTIFICATE OF EXENIPTION`FROAA�WO�KERS'e� - --�� -�_�� NEAREST . , . . � _ __ CONiPEN5A7CON IN�R�I�IGE�"�� � - � '� CR09S�Si�. � �,,,�ti,_ ._�.,. ___ (This secfion need not be completed if fhe work�involved by ABSOZP'nON UNIT,BTU - - oisseia Nc.��' axocesseo e � fhe permit is for_one hundred dollars(S100f or less.) - � � - � i� � (\ � ��-- AIR HANDLING UNIT.CFM P;�y` � I certify ihat in ihe performance�ot the o k.for hich this � . . . �. � . . }ie�mit�is issued,I shpll not employ any pe so in any-manner- gOILER,BTU � � sa os to become'subjechto fhe Workers Compensotion Lows. . . nvaae•+na - - oare - �.so=croa�s sicH<auae . . COMPRESSOR.BTU - ... ROUGH � �'�:. `.�/�� Date � ApplicanJ � � �---- - � . NOTICE�TO APPLICANTi-If, aNer making this Certifimte of VENTIIATION SYS7EM" " �� � ���- � FiNAt Ezemption, you should become�su6jecl ta ihe Workers' - . � - CompenSalion provisions-of ff�e Lobor Code,you musYforth- EVAPORliTIVE COOLER � �//�I.��EITION _ .. . . - with comPiy wiih such�.pravisions�or fhis permit shall be � . deemed revoked. . FURNACE: FAU-��-_GRAv7Y�"� - . . ..: . . �� . - � � . � - ---� � LICENSED�CONTRACTORSDECLARATION �- � � FLOOe � - BTU � � - . � - -� � I hereby affirm thot I am li<ensed under provisions�of Chapter 9 HEaTER: - SU57ENDED --�-- -UNI'f--_ '(�ommencing wiih Section 7000)of Divisio�3 of the Business ' WA�� and Professions Code,and my license is in full force and effect. - - � � � � - � ,,!c�r 2i � �x i e"?J� i)�+c�r:�.:� � License Number"�!�� L c Class .. . ` _ � -� �, � - Conrra<tor��!��/.-t'�.. � .�C�r 6—I?-�� l� - - - � � i At�UDa�e f ' � . i?r(.�1k�� &i �' G 'c i ifl OCZ v I am enempt under Sec. �..: � � Plcn check fee , y B.&P.C.for this reason� - � � ' - PERMIT ISSUING FEE$ (O 4 a Dote: _ ....__. - 5ig�or�,e TOTAL FEE � ` OWNER-BUILDER DECLARATION�-.� � PtAn�CHeCK AaPLiCANT -�-� - � � - I hereby affirm ihat I am e_empt from ihe Conirocto�s License '`.- �� � `��' _ � ► Law for ihe following reason(Sec�ion 7031.5, Business and tiAME � Professions Code!: - � . . .. -. . ,..-.:•. .� ....-- --•._ :. ❑ I, os owner oP the property, or my employees with %C�JRESS- , � .. . �'� �G:U,q - waqesastheirsolecompensotion,willdotheworkand CITY Tel�hl0 � � � ;'�� -- � - ihe strudure is nol in�ended or offered for sale-(Seciion� - _ _ -�'-'� �� - 704d,Business and Profess�ons Code?. - . � . . A� ` ' - - - ❑ I,as owner of the property,om exdusivelv conirpcfing OWNER �G 7� . w'i�.�%f 7�3�� f e e,S j,%F � with licensed coniractors ta construct rhe project;Sec-� � MAIL" � , �- ' . �--- - � � g ; .,�y- ♦ion 7044,Business and Profess ons Code). ADDRESS Z 3�.� $, ��.�'"-+�L f��.�%:.> �(� _ �" "� � -=--�=> CONSTRUCTION LENDING AGENCY CiiY ie-,�y0 �� . Q�.� ']—.H 7 I hereby affirm ihat there s a ronstruct on lending agency for � �" �'�� ���� . - - -.��.. the performon<e of�he work 4or which this perm t is'ssued_ CONTRACrOR �AL.(„�-5 � �LS�-„�L�l-�� �{{'�i , _ (Sec.3097,Civ.C.�. �/�% . . . � . � ADDRESS I7J� .�51 1'���� �ti. . �. . ... � � . . Lender's�Name �.-- - . arv � Ct� T<< No `73�{-S'�S� Lender'sAddress -- - � --- ------_ - ` � �- -`: �.. STATE� - /� L1C. ' . . . I ceriify ihot 1 have read ihis applicqtion ond stote ihot the LICENSE NO. /f'/j �� CLA55 �� . _... .. a6ove informafion is correct.I agree to comply with oll Counry - . -- � ordinances and S1afe lows reloting fo building construciion, � - � � . � � � _ . and hereby authorize representatives of ihis Counfv to enter � � ,�.� , --``: . '"�.�'-�"� . .. +, ..«.�,., _+,-.. .;k .. ..y..<.. u an the obo e + d property for inspedion purposes. - "'"`"""�"` '��'-� � - - � . SEE RE1/�RSE FOR�EXPLANA�ORY LANGUAGE _t� ,� � 9—J7-$? � Signat�ke�of-A IcaniorAaen� Dare � . . , ,.. .._ ��.. ::. . . .. ,-:: ,..,:: , �. _ . ... ... . . . . . . . . . . . . .... . . ... �.1`'au,�x -� :.. - - - -�,t�.,- _ � _ii .� ,. a ��, . . ., _ .,_. ...n,__ . :,r,a .IPlSPE�s@R°��P�Y�S _c�VGNi�-Bt�IL�ER UE::L�RATION .,;, . . � . ..., .... - �C hare'�y affi�m tha:�1 am x 'npt trom�he Contrac�or's - . , -. _ �. . . . . _ . _ .- .. . � L�mr,�e Lo�.� 40��ihe�fc�lowing-recson �s"eC'bn 7p31.5. . _.. . . ..�., .- . .. . .. .. . . . . . . ._ . . _ . .., _ .._. -. Bvsines•a�d?'ofiessicnsCodz)�Anyc;'yorcoun?yx�hich � . ..�. ''. . �'_._ .. . . . .,. :.�."'.:. _.- . .. ---�:. reyuirc;a pc.mif,c-un�t uc� a fer. ma;o've;demalish. . _ .. _ __ . � . . ��� .. . . - � � -.' . .. . . - or rega:�cr,y sProciur��. ,orior m�its�is;ucnce, also:e- � . � � � � � - . � -'-� _ .quires 3ha,pppliecnt lora✓th.permit to fi(E c signad s3cfe- - - � .. . ...... _ ..- . � . - - - -' - � � � menf tho#he is li:ans�dpursucn}?o fFe provisior._<of ihe � . � � � - . . Cont�acfor's c E I.gw(Chcpter�4(comri�encing-v✓i9n . ...._. ... _..-. � . - ..... .. . - � � Sece'ron 7L00�of G �slon a af-be�uu me�s ffnd Proles . . �. . - . ... . ,.. .-_ _; _.-. :.- ._.. . � - . � . s�ons Code).or tnat F.e is cxern�i ihe a*rcm end,n2,basis .. - � . � � � � , . fo Pne�q%legea exc-^�p9ron. siny vio!at;on of��S:crion '_' . ._ __... -: ..:-_.:: . . . . . . . . - . .. - 7037.5 by any aopLcdni fqr a permit s�6jec;s the app!i- . - .. . . ... . . ..�. . .. . : � can7!o a ci il pcnal[y o(not mo;a�han J�ve Aundred � . .. .-. _ . . . . ._ . . . . doPars(SSJO;.� _ ._ . ._ .. .. _ _J � - . . . ..... . . � ❑I,-as� ��e:oi'F p•uper?y x.:.�:.��1ne wcrk..ar.a ..- . . . . . - � � �. ..� . .; - � rhe struc�u:e-s o�Intand'ed cr;ofrer d a=_a�e, .. � . .,. � �" � - � � � � �(Sac.7G4'4,8us ne s crd�ofess;ons Coo�. 7haControc- .... .� _ .._ . ...� . - . �.., �._�. � � ' .. tor's Lica,se 4� does not cppfy to an owner of proper�y � � � � � � who builds o��im�.'rova ,harecn, ond Y�tio.does:s��r: � � . . - ,., ,,, - , v,.ork himse!`,c�ovided that sun5 imarovemanis are rot - . ' inseaaed cr offered?��sale.N,boweve:,fhc Suildina or - � . .. . v,--:_ .;-;,.._ - t - ...>+mproYeneN,is SOICI wi?nir,cna year�of comeletion,thz �... . . ... .. . . .. . . .- � owner-buiidx witt have tha burden of provirig ibvi he dio - . - . _ � no?bci;d or irnyrove#orfha purpose af sale:j ' � . . - . ---. � - ['j i,as owner of ihe property,om exclusive!y cor.- - '"`-- - -- �"-orac i;i 'h licens2.",cortraciers rc-cons'rucs'I-.e o-e�ed _ • ,.,,. yw�r -' -�- -� . -���� � Sec.%G44;Business cnd're/essiohs Coa'�:7'ne Con?rec- . , , � - �" �-tor's.License Law dos;nof opply to an oN�ner ol propsrfy . .. -.. . � . � � �nvho builds or i�noroves!6erson,-and�who cqnt a<ts?o; � . � - . . .. � suth prOjects vdit6 a ton}redor(s% �icenseci_pur;uani'so � ._: .._.._ __. . . .. . . . . � � � -fhe Contratlor's iicxnse Low;. � - - . -. �.-M, ..,_:�.,'_. .... .,. . _ . .. " . . . -.-' .-._.-.- ' _..t.r _,... ..-.c.��u��__ ..____. ` _'-- � . . .. __, .. _ _.. .. . . . .. ... _ . . . . . . . - - I arn exemp�unu'�r Se:l � - . _ .. . ........ .. . . . .. - . . . . . . ....._. .. .... � . . . B&P.C.for ihis recson � _.. _ ... . . . . . . . . . _ . . . _ ... Date_ . .. — : . _._.... . .....�..r __ ..._ .. . . - - . .. �xner '" , � �,�.. ,._�:_.._� �. . — ,_. .. � . .. . . - . . _-.::. .�:. INSPEGTQR'S?1QFE5 _. - r�<. ��..,. . z ' -