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HomeMy WebLinkAbout1654A (15) ��•oiaxr�cs•co�.n�r�s:�T�o�;nrct.:�a:�'rro� 76A364C � �,r<<.�,> :�«��,,, ��,,� , �,:,t �«<<����,<<� „f��,,,«�„�t�,���f �E.e,a�z.so� APPLICATION FOR PERMI i � insure,or a certifics�a u!5ltirkers'Cnmpensation Inaurance,o� ; HEATING-V ENTILATING-AIR C�N�ITIONING a eertifieJ�c/n,yp-�s�thercof(Sec.3P00,I,ah.C-.f) i I'�Ilcy.'.'o'i7_Gg�('��mli�n��—s��/C�NNb_ � Crniticd c�py is hcreby turaish_d. ' COUNTY OF LOS ANGELES BUILDING AND SAFETY � Cer�ified cop}�ii fikd�ci[h the cnim[y building inspectinn BUILDING �rp�rim�f•nr FOR APPLICANTTO FILL IN 1)3te�=Z'`�_�":\{�j;licant_TN�y��Z_C��Ji7_ (PRINT OR TVPE ONLY) A�DRE55 3 Z55 �Dir�mcuD r�a_1�Lv>> CliRTI1lG\TL OI�LX}�_�.IPTIDti!=R0!.1 H;p(tIiGRS' i NO. TYPE OF APPLIANCE OR EQUIPM17ENT FEE LOCALITV 'D��m���� �A� CO`dPl�:1S:\TIOS 11S1!R:\\Cf. NEAREST' ry } (This sectinn need nr�t i�c cnmplcteJ iC the �eo�k im�ol�•ed aoSORP710N UNiT,O7U CRoss ST.B�t.Y} �N� �� �'�IR•�AIL 7 d Uy thc permit is for on� Iwndrrd dr,ll�r� (S1�D) ur Icss.) OISTRICTNO, PAOCESSEO v � 1 certify iL�at in ❑�e perfnrmance nf the�cur};for wliich this � AIR HAN�LING UNIT,CFM11 �Q �C`��� � permit is itsued.I sl�sll noi empiny�:my persnn in:my mannrr - O �n;ic to beeome subject m the\5'orkerc'Comprnsation Ls�as. � BOILER,6TU F— � /+,PPF{OVAL$ �ATE INS�ECTOR$SIGNATl1f1E U �ste :1Ppliecnt ' � J` ICOA7PRESSOR,OTU ��0� ROt1GH /. � .�irL � � YOTICI:TO:\P!'LICANT:If,aftar ma..im,:�his Crrtifica�e o( � ' Z i;eemptiun, ruu �hnuld hecnme schjret tn the \1'urkrrs' i VEN7ILATIONSYSTEM FWAL n��l� _ J Comprnsatinn prorisinns nf thz LaL•or Codc,ynu mus[fnrth- 1 �v���� �„�„�,y .,;u� .���� �,.���s��,�s o< <n�s �z�m�� ,n,n he (G"nPonnn��e COOLER VALIDATIO"! Jrrmed rrcoked. � FURNACE: FAU—GRAVITY . LICLXSI;DCO\Tit:\('TOf251)E;CI.:Vt:\7'10\ PLOOR� BTU I herch}�s(firm tlut I�rn iic�ensed nm!::r prnrisinns of Chsptrr i � HEATEFl: SU EN�ED UNIT 9 (cnmmrncing with c.i•tion^00�)nf I)iri�inn 3 ot Ihr Rusi- I � lV!j. /�y�-rYl Q 0 ness and Prnlr«i�+nc Cnde,and my iicencs ic in full(nrce and � efkct. g : � '��/ ��7 p0 Lirrnsc 4umher?$s��7 Lic Cl:iss_��' ! � �}� � ,n _` Cnntr�ctnr_.JfI�JG=7t.. �) �7� �C�.�_... �!-� �f� 00 � 1?ite 2�ZY_$Z r �:GM2.�`.�-✓�-� j � 1 nm etempt frnm the licrn<in;requiremenLc ss 1�m a � licenaed xrchitect nr a n�,ictrrr:l profca<iunal enginerr plan check fee 259b Of ebOve. :�cting in my pmlr��inn_I ripa:ity (Sectinn '051, pus� �Q �ne�.c:md��rol��ssinn<Codc). . I , PERMIT ISSUING FEE S Lic.or�tes.No. uate ; I TOTAL FEE � SD IiO.`.tF:O'S-VCR�i3GILDCR D1'CI.AR.�TIOti � PLAN CHECK APPLICANT 1 iiereh,v affirin ��i��t I :�m rxrmpl (rom�the Contr�ctor's �� �NAR1E "nhL�y �'I„4�t:V Licen4e l.u�v fot[he follm��ine rv_isun (Sec�ion 7031.5, 13uci� � . '-0�� (�rj,(j-A n^ss�n�11'r<�f:ssi�>:isC���e): . AODfiES� ��.?J knr�e_rrr�B_�Ya. {{ p ❑ �< <,�,. ,.� �.,,,r ,, , ,.. .�:;.;.:.` I, ��(tlir rtu iill ii�i�I�� �r4 nil [hn 1 ,tt'. O slrucfurr'�is n�t intrni!eJ �r��fftreJ f�rr c��le (Stction � CITV A��,�m TEL.NO.���D7�L ���. �naa,�a��.�nr.��n,i r<<�r,�.a„�,s c,�a�•a. � �I'• 13 fl 5 p � owNen , 1,as ow'ner of the prnperty,am exclusierty coMracting �V�t�J�Ct.��.i�(`��c�CHLt2CH •�• �'35�5.0-�� i�ilh licencr�l cr���trictnrc �� cnn�iruc[ the �+r�ijret I h1AIL +� . . . (Sectinn^044,Dusirest and Prnfe=�ine�Code). AODRESS l D��D7�y/D� �0224-82 COtiSTIiUCT10\LIf4DItiG A(;F:tiCY CITVa1RM�b g/¢n TEL.NO.�s�G��(� 1 hrreby :iffirm ihs[ thrrt i a cunstrucliun Icnding agenrl' � CONTR1ICTOR /7 n fnr thc perfnrinsncr oF Niclivurk for �ohich this pc•mi[ is D�us K• rf.{f.�.�/_�L_4C�NST iscued(Scc.3097,Civ.C.). I.enJet's�antr ADORESS ��g j keq_�ra�erL I�Z,v�, , � LenA:r's AdJress , � . � CI7V ����EI� TEL.NO.'�C�_O 7SZ - . I cer�ify� that 1 hace read Ihis al`I'lication snd st�te ihst the S� 7q7E LIC. f^�_+ �h���e infnrmatinn ic cc�rrrrt.l�pr����i��r��m��t�'��-ilh all Cuun[y LICENS[N0.3S�J�87 CLASS > . . . orAinances�nd Statc I�u�s re��ulatin^Hestinc.\'rntil�ting:md Air Cur tinning,;md hrrchy�uthnrivc rrprescnt:niccs af this � SIiF,RF;Vt:it$li POH IiXNLANATORY I,ANGIIAG� � � Count� n entc/r �pnn Ihe zbuvr�menfianed ��orr�iy n>� insper r�pu �y:/ • � . . .�Vrij .� Z—Z7(—b'7r � Sie .��reuf 1'r ni.tec� Da�r � ( �'r ., � � �`,� `,: `.:, �: � ' - y �,:� . J . . t.- _ � .-. • _ `- m `_ �. - . • . �. c� � . �, p . • . . . � " . . W N � ' . r� z . , tn O . " ' . m - � N ' , ' `� 1 . _' ' Z . N _ - m _ . -��1 " O . 9 N 2 : � O , m � ; � ' .' - . �.� - ;,�"''� p:.°.ry _ ar_.._ , _. � Y � _ =_ p �� 1 ^� ` �,.. � . 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