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HomeMy WebLinkAbout1704A uoatit:tcs�co�i��i:vs.�TumoE.cc:�r,.ru�, �en3eac ,I.';pPLICATIOfJ FOR PERf�IT I hereby affirm �hat 1 ha��e a certifieate of consent tn self CE-816(2-80) . � insure,oracertificareotubrk�•rs'Comp�'ns�tionlnsuranc�,or HEATING-VENTILl�TING•AIR CONDITIONING u eertified/c�j'�y Iher/aa�f�Sra 3fl00.l.�.i/--J��/'}1+- �/ + �+� , , POIiCY NO.F'-��Y_�)RP�rt3V-�/T/-�.---['-✓�-�[_ �. I ❑ CerNiied copy i4 herchs'�urn�s�i�•d. COUNTY OF LOS ANGELES BUILDING AND SAFETY �Certified eop3�is filed�vith the count5' �ildine in:pectin� FOR APPLICANT TO FI L'L IfJ BUILoiNG I�,c, f �jJ� �lepartmcnt. �f��� qpORE55 �/���C �Jv✓/ �� ' t)atr A{+plicant. ( (P171NT OR TVPE ONLY) -/�- / � LOCALITY /� �y)� � �j� CL:IiTIf�ICATC:01 L'XI:�iF'710\f�1:0\11�'0121i1:1:S' NO. TYPE OF hPPLIANCE OR[QUIPMENT FEE �[�jj[y/V COSIPFNSATIO`IN5URAKCL NEAREST ���� �} (This scction necd not bc complctcd if the «�ork imohcd nB50RPTION UN�T,6TU CROSS ST. O by the permit is for one ]mndrrd doilaa (5100) or Icss.) , visrRicTr�o. v�oeesseoo/v U , 1 eertify Ihat in tl:� per(armance�if th<<t�urF f�>r��liicli[his FIR HAN�LING UNIT,CFM /O ` �/ . O permit i5 issued.I shail no[emplo��anp Verson in�ny mannrr ��-���=��� so as to bemme subjrct to[he 1Corkers'CnmP�'��satinn La�t�s. _�F.OIL[R,6TU � � py�O� APPROVAL. O�1TE INSVECTOR'SS�GYnTURF W �7�SC �[�{1�1�3(II �/�/ G ICOMFFES�OR,6TU_� OO pOUGH y C— - NOTICG TO A}'PLfC.ANT:If.:iftcr making[hi.+Cer[ificalc��f VEM1lTILATION SYSTEM FINAL �D Z k:xemption, you shuuid brcnme schje:t tn the 1Cnrkers' , ComO�'nsa[ian prnri,iuns nf�hc Lahor Cude.Ynu must Yurth- . . .. � . �w�i� compir ���cn sucn �r���i;io�� or eni, >>rrm�c sn,u n,� evnronanve co,�o7��e.�� n VALIDATION deemed re�okecl. - _� FUFivACE: FAS�:..7"�QrAVITV� 'y� LICIiNSEU CO\TI?:\CTOI:S 1)ECL:IRAT70` FLOOR: LT� � v �Q I lierehy af(iIm th;�t I am IicenseS un�ler�rt�vi.ions[i(Cha{�ter HEATER: SUSPENOEO UNIT � � � 9 (commencing�vith Section 700D)nf Divie,inn 3 of the Flusi- 4VALL ' I ness and Professions CoJe,nnd m}'licensc ic in fWi furee anJ � , � . ' ef(ect. P,I' . . License Num/h�e��d2�J_Q i,ic Cl:us�� � Contmcror<����,�f�4��Z��'� . . . ❑ , , I�m exempt G��in the licensing rayuirements as 1 xm a� llccnsed arcYiitcct or a reg�stered profz.siun�l cncinccr Plan check fee 25ii of above. � �{ nnin� in my profcssionsl capaciry (Sectiun 7051, I3u;�� pERMIT ISSUING FE�$ d ��r''�1�a,5� � iness and Yrofessior.s Code). _ _ � � � •3U,50� �ic,�,��te�.N��. n:,te TOTAL FEE Q -Q p 2 2 3—g 4 �. fI0\IE O�'�NI:12-FiU11.D1'.IL DI�('LAI:.\TIOti p�AN CHECY,Af'PLiCANT' � I hercbY af(inn Ihat 1 um exemp[ trom�tAe C���tractnr's NnME � l,icense Law Fnr ihe (ollowin;:rcason (Szeti��r 70J1.5, FSusi- . ness en�Pratessicins C��de): - ApDRESS � � 1, us ownrr of ihe propercc.�rill dn tlir�vorA and thr structurr is n<�t ir.tended ur offerrd fur sale (Section ��TY TEL.NO. - 70a4.Buciness;�nd PrnVessions Code). _�'�_� . . � � OWf.IER �, l,�s owner of[he proparty,am txciusively conte�cting /iVl . �vith licensed eontractnrs tn consfruct the prol�c[ MAIL �/� p(— -tl../���� ��nr (5�•cti�n 7074.D�isincss and i'rMe.�ssinnc Cndc). AOC�RESS �- VO J /7 e+ 'IG= � CITY ,�y T[L.NO; coNsraucno��.i:nnihc�c;�:���Y _D��n1oN�� I� fZ__ �� �Lt( 1 hereb7' affirin [h�t thrrr i� a cunstructi��n Iendint :�grncy� CONTRACTOR� ��S ��1� .. . . � fur the performsnce of thz ivorA f�v which ihis prnni� i, issued(Sec.3097.Civ.C.). y--n . Lender's hame ADDRESS�!/ A,��J/J/.1� : c�7 v/�t.c� Hi LenJer's Address C�TY�O�/N/�.. 7EL.ND:���=J�� - � 1 Cerlif!' fliat 1 h�ve tcael fliis ui`l'li�'�ti�>n�n:i st�t�Ilt�l Ihe STATE �/� ��� � ,above informution is currect.I agree to cumpiy�vith all founty uCGNSF NO. f7 CLA55 � � ordinancrs and State la��'s rteuiating H�uting.4'entileting aud � Air Cunditioning,und hereUy mnhnriz.rcpre.en�ati��rs uf�his SI;1;RI;VIiRSE 1'OR EC\7'LANATORY'LAhGUAGt: . . � County to ente� upun �hr abovr-mentiuuzd prnprn)' for a;� .. � 1�1 CSl�if rlil � 'S. ,�� .�:.� / �/�� , �— _� f� 9 � �t�rcofPc.,��uee U�.r . . . . . I _ . � , - . - . � � INSPECTOR'S FlOTES � � � (3�;tiFI'_L'1iiI.DEF.D�CLAI:A'fIQN .. ` I�I;:rL6�.,ftirr^Y�'�'�^m esempt�`ritm[h��•Can[ractor'S - Li:ensc 12:c fo: il:e Collo�vinc reason/Sertio+� 7091.5, , .B+esin:sa m�d Frnfcssi�ns Co;eJ: Anv citY m rour,ty � . , . . _ ivhicR rer;uires�c pen;.it m eensrnter, u!rer. inproi•e:' . . ,. .- .. . , ' � • - .d e /s5:l;r�rrJ �m: 2!-�c1u�e.prior!0 i[s issucrice,� , � � r �- � \ cls� r<�vi�es-th��at pticerrr fo� r��cl� pennit to jile o �, -'• � - � , - . . . , si�r,ed stctemer.: tl;c; l�,e ir liccics^d pursumn to the . � prorisiats oJ tSr Ca.trcator's Licerzte Lcw/Chapter 9 . 1�. -' � ' (co�.^.m.;ri.i;n� uiN: ,�.�tiurt i000J oJ Li��isia: 3 oj dte . � ' � - , � fiusi,verr r.rxd Fro;rscL�r:s Codc/ or th.at he ir exempr ' . thrre,lrcnr.mrd fke 6etiii�fur tl,e clle�ed exernt�fiar.Any. .. .. — ri;?:;eion.of S,cti;��:703L.5 bymtyofr;�li�mirforaPerr�rit � �- � , � � . s:�bjecrs tli.applrcar,r to a ciri!perralt}�of rtat rnore diart . � - . . fire h�iridrrd c.':rIlu-.c/SS00;.: „ - .., .. . ' - � . . ❑ l.as u�vncr oI ILc prapenp u�ill du ILc�corA,anS � _ . tlie stmen�re is not int.�ded n:o(Irred fo�sala: - (S�c. 701�, i;u!r7�e;;r.c:l Frt;Fessrnre; Cnde: 7he Cat- � h;:rn,r's lir�ruc Lcw rloes not aPPlp ro w: o�rner nj P��P•��U'*�����b.'rid;or iuq>rnr^s!!irr�or.,mrd rvfro dccs � 5uclr r.•or,C I�in•se.'J procided thot t!�ck inrp�oven:ents . , _ . . \ crc not irucnde;!or affered fur sa1:. If, P:oroever. tf;e � � � b«ildi�:; or •'»tpro��Cme�r! is so1J «id�in oue 3'car of . m+npletiort, rHe o�-nrcrLuild^r tdil! I�m•e the burde+� , of pre��rn� that !re did nur Guild o�irr.prove fw tHe � pim��se of srla J � _ ' � l, xS o�aner uf[he irtop;ertc,ap ecclusive:y ron- - [rr.:liu�:u�il?i.li;en;:J c�rn::a�to:a U�c:in:t;ru�t ihc prujcct � ' �i(Sc21i1;r70�?:E:si1r'ssoi�l•/'iof,s;i:m�'Cb:!.�:�7hcCon- . ' rrcrtor's I.icc�r.:c I.air dae.c r.cr appt�• fu m: owner oj � property wh.n 6ui(.,'s nr ir;proves tkereon. and �aim I 1'. .. ,. _ cairtrnets jor siicfi ;o-u,':ctt�drL a ronvice:or(:J (irensed . p:ustmnt 1u iAr Cur��tr.rrnr's Lirenrc LQ�.y. i - _ -, r,; I:nn e�crr:pt undcr S�c. I�s&Y.C.for t�ii�s rrasar �.� I . . _ - - I)�te — ,� � ' - ,� l � Owner �� `��' < - +• �i i INSPECTOR'SNOTES � - � . , �� ��. � ' - � ��j - • . .. . -��� . ..'\� . .- . ..t .,��, �