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HomeMy WebLinkAbout0929A R'OIiKICRS'COSIP�VS:1T10.�'DICCLARATION I 76A3G4C APPLICATIOi�I FOR PCPMI � 1 hereFY :+ffirm [hat [ ha��e 1 certificate of consrn[io sei( CE-819(2�801 � � insure,ur u certificate of R'otkers'Cnmprnsation Insuranca,or HEATING-V FNTILATING•AIR CON�ITIONIN(�i a cerN�i�d ropy therr IlS�•r �80^ D.C'.) � ������gsc��;!�$� �. � � czr��F�.�d conr�s nrrei.>-rurn�snra. , COUNTY OF LOS ANGELES E3U1 LDING AND SAPETY � CerfifieJ eopy is filed�vith ihe eounty huilding insp:ctinn departmrnt. FOR APPLICANTTO FILL IN 6U�LDING�y � 1)��e :�ppl�cant (PfiiN70RTVPEONLY) �+DDFtE55 \�O��SN�bV�_ _ LOC/1LITV f\�.� (;I:IiTfI�IC.ATr Of'FkI�\IPTfOV TRO\11Vpiliil�iiS' NO. TYPE OF APPLIANCE OR EQUIPAI[NT F[E �`A-^M�—^'-��� � C0111'I.VS:�TION INSURAh'C[: Cno55 ST. ,�,�n�1Q,- ^\ {� a (This sectinn need not he c�mpleted iC ihC �eork ini•nlved AeSORPTION UNIT,6TU � ��+'��+�ih``�� � U}• thc permit is for one liundre�l dotlars (SI00)or,le<S.) o�sra�crn�a anocess:oev V I crr�ify ihat in the�erf�irmance nf thz«���rA fnr«'hi<h�his AIR NANOLING UNIT,CFM ,�(`�\ � prrmil ia issued,1 shall not rmploe snY Person in sny m�nncr � i 1 0 �l�X O so as In hecnme subjec[�n[f�e ltnrkers'Compens�[ion'La�vs. eOILER,OTU • - !�('i'ROVALi onTE ivSOECTeft'S51GvnTURE () W 1)a[e A��licanf ' COM1IPRESSOR,OTU qOUGH '/ � hOTICF.7'O:1P1'LIC.\?:T:If,u(Icr makinG this Crrlificite n( - VENTILATION SYSTE�1 I FINl1L /�,��+Y J� Z 1Cxemplinn, pou chould becnmr suhject tn the l4arkers' �- --- Compen�atinn pruvisionc of Ihe Lshor Code,ynu m��5t fnrth� �VAPORATIVE COOLFR VALI�A i ION ���ilh comply «•ith such prn�'icinns or �his Permit sLatl be detmedre��ol;ed. FURNACE: PAU_GRAVITV� f.ICFtiS1:DCOti'I'RACTO1iSDf�:CLARATION FLOOF�• �7TU � I herefiy affitm thst I am IiccnscJ under prmisions ot Ch:�pfer NEATE�: SUSP[NOED UNIT I � �I � (enmmencing u�ith Sectian^,000)nf Ui��isinn 7 of the Ilusi- NJALL ineu nnd Pmfe�siun� ode,�nd my lirense ic in(ul�force and ` . � I,O�� � � rffect. I � Lieencr tiumher_ ��q J Lic.Cl��ss ��� l Cnntr�-'^�[-�]/�21a_�/�(�y�e�r_��/=o�_ � i am rzempt frnm thr licensing rrquirements as 1 am a �� licensed architect ot a re�istered profaacion�l rncinerr PIOn ChCCk fee 2J°o Of 3bovC. actin� in my pm(ecxional capxity (Scctinn 70s�, Ous- ine�c�nd t�rofess�ons Cude). PERI111T ISSUING FEE S IO 5Q I,ic,ur lieg.ln. i)ste TOTAL FEE aQy� fl0?dE Ot1'VI:R�i3U11.UER DI:C1.:1itAT10V PLAN CHECK APPLICANT - `�0 9'z 9 A [ her;by affirm that 1 am eeampt from�Ihe Cuntretur's NAA1[ #�i • • a$ . I,icen�e Law far the fnilowinS re�son(Secfion ',031.5, [lusi- . ��,s:,�a r,�,rr„�„�s Cnde): 11ODRE55 � ;•2 Q 5 0 � 1, as o�vner nf Ihe propertY���'i�l do Ure u'ork snd thr I TEL.NO. •�,�� _ structure is nnt intenJrd nr offered fur sale (Section CITV •'2 a 5 0 U 7�a4,nllClflf55]II�r�(l�t'l[I(1lIC�tll�2�. � � 1,ss owncr nf ihe prupert)•,am exdusirely cuntrarting OWNER�47 ) �s��j�G.� 0�1,09+84 . r� wilh IicrnsrJ contractors to con<[tuc[ Ihe projcc[ A1AIL � (Sec[ion 7044,busincssand 1YufacsinnsCndc). AD�RE55 7�d ��f _�_{4NpN_��_/�R+__ �/ , COtiSTI2UCTION LE`QI)IYG AG[NCY ��T�����,�,D ��yy���f�� ��CC..�� T[L.NO. �7 � 1 hereby af(irm th�[ there is a ainc[nictiun irnding aeency CONTRACTOI � �/ /{�� � (nr ihe perfnrmance nf ihe wvrA far �chich Ihis prrmit is ���s,�� /�l/L(��J�C,JQ�f/p4/�Y issucJ(Src.7097.Civ.C.). y t�- '�7 . I.ender's Naine A�DF1E. ' �'�Co Ar C"'�,e,2./�.:_- t>i� Lrnder's Aiidress ��1rA-��� TEL.NO.��,�,f'�/� _ . . 1 certif• timt I ha��e read [his lication and state lhat ihe ����r�v / } aPf` ST/iTE i/��^/�.IC. nho�'e inforov�tion is ro�rect.1 ar.ree to cnmpip ai[h�II Co�inty UCENSE NO.�{J � CLASfG�a . ordin;mee5^ S�a[t lan's rcgulatin�Hc�tinF.Vrntila�in4�nd Air Condi�..mi g,and herehy aulhorirc rrpresentatices nf[his SGIi ItgVGRSG FOR 4:SNLANATORY I,ANGUAGC � Coi�y. .�ter upnn ihc abore�nentinned properU' f�r � • �;,u���s�•.. / �� niena�urc nf 1'ermii r ti�te � � L • . 1'' 1 `," . \. �•`= � _. . ' ;� J :: /J' � '` '�.� r�. � . ,..', � � � . ` , ,._ . l `" , � � ... :� �-� •_• ✓� �e i . l� ` • . ;i z . N c, :f � . `'� ;; . . m ,:� •,. �O •Y1 '` J . . � .� '"` tn 2 O� � m • • N ' tV � � � 1 V,, L n �`., � .i s � \ � ` , ` � O • ��� m , -j N ! y � •\1` , `f _ ;`,- . � . � �� �, � 4 ' ,\ � {� . , � /' ._ . �l'"' r.. . , • c. ' ' �. . 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