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HomeMy WebLinkAbout1809A (10) ��oa�:rRs•co»r�:vs.aTio�veci..aan7�orr '6A'64� /�PPLIGATIO��1 FOR I'ERf�iIT I frereby affirm that 1 hare a'certificatr of consen�to self CE-81C(2�801 . � � insure.or a certificateoF\5'orkers'Compensation Insurance,oi � � � " HEATING-VENTILATING-AIR CONDITIONING a certiiitd co y therenf(Sac.380D,L�b C.) >�I��8�3�5�4����-�� I �cCertified copy iz henhy furnlshrd, COUNTY OF LOS ANGELES BUILOING AND SAFETY �� Certified cnpy is fiied with�he counb�buifding inspection 6UI LD W G d�p�rtmen�. FOR APPLICANTTO FlILIN �O� d�� Uate .pppiicant' � IPRINT OR TYPE ONLY) // AODRES" . LOCALITY//f— CfLRTf3'ICATE.OP IiXIChIPTION i'RO?7�5'OILKI:RS' NO. TYPE OF APPLIANCE OR Ef1UIPM[N7 FEE ��/ - COSIP1iN5ATION INSURARCE � NEARf �I/7 '� /JJ � (This section necd not be compieted it thc anrk invob•ed A�SOFiPTION UMT,CTU ����" 14 i(LC US` 6y tl�c permit is !or one hunJrcd dollars (5100)or IcssJ � oisTnicTtio.�- � v�ocesseoev V 1 certif}'[I�af I��the Verformance nf[he wnrA for wliich thi5 Alq HANDLING UNI7.CFM � , �'� � permi[is issued,-I shali n��t empl��y�any person in any manner � � � p , sn as to becume subj�et tn the 1Vqrkets'Compen5�tion La�vs. HOILER,6TU r � � � � - -- � APPROVALS DATE wsvect .rsSiG�+arua[ V W Uaie AppliC]nt COM7RESSOR;RTU_ ROUGH � n- I N T�DTIC�E 70 AY!'LICANT:lf.aPter making Ihis Cer[i(icate of vENTII.ATION SYSTEA^� -�- - � FINAL ���L Z �:xemp[ion, you shouid become suhject in the U'orkers' . Cnmpensation prorisinn>uf the I,ahnr Code,ynu must forth� � -J ��un comply w;u, su�n �rov�tions or ���is �+erm�� sh:,u n� EVAPORnTIVECOOLER � ` VALIDATIC'.V deenlecl revnked. FUqNACE: FAU—GFSAVITY� . - � - � � I,ICGKSIiD CONTKACTORS DI!CLAF2ATIOV FLOOR� 07'u � �� � � � I hereby affirm tha�f nm ii:ense�l under prnvisions of Chartcr HEq7ER: SUSPENO[D UNIT J . 9 (cnmmencin6��'ilh Section 7000)of Divisinn 3 of[he Busi� � WA�L � � . ness and Prufrssions Uoilr,and my license is in Cull(orce and ///fff � �--�� '� � -���- ��- - effcct. ' � I � _ _�1� i�� License Numb3���- �� - � . ���- . � �. . . . LI�Cf.C�I315��Q ��� �OII[f,. '-asd._�/,.7---kJ—f—�'—�� � . � 1/�.,u�the licensmg reyuirements as I am a � � ( . . .. . . . .. . . liceased architect nr a reFisterod prufessional engineer Plan CheCk feC 25°0 0(above. � - � � - � aetinF in my prnfessional capaeity (Saetion 7051, Ous� , u � ' � inessand ProfessionsCode). � PERMI'�ISSUING FEE$ {�j� . _ . . �, .. . . . Lic.or Keg.Nn. pate TOTAL FEE �T� HOSif;O\t'�G2�6UILDF:R DLCLARATION PLAN CHECK F.PPL�CANT � ' � � ' � �� s Q���� .tt.�ya a �1� I hereby af(irm that 1 am exempt from-[he Convactor's NAME . � � License Law r��me rouo,��tnF.r:,s�� �s«t��,n 703t.S, 6usi- f��'•�1.3 5 p ness antl Profession.s Coda): ApoRESS � . � . � 4 as owner of the o � . . e y' °� 3��` pr prr[Y,«�ili do the�cork•nd ihc CITV TEL NO. strucfurc is not intended or oCfarrd fur s:Je {Sectiun �. �, � • ' 7044,F3usincsc and Protessions Code). - /JL/� , �� '�Q�F�j� OWNER /`ft � � 7,as owncr of ihe proprrty,am e�clusively cnntmcting. _ /_/ _� �� � ��ifh lirensed conlractors to conshuct tNe project MAIL � � �. (Section70q4,DusincssundProfessionsCodc).� /aD�RE�5�56��f_' �� �. COYSTRl1CT10N LLNUIKG AGGNCY CITY1//,/]!/_� r[��G=l - . . iC/i«// � -!J� I herebg affinn Ihat there is u �onstructinn Iending agency � _ � .. f�r tlie �+erformsnee of tl�r �vark fur ���hicl� this petmit is CONTRAC70� .. ._. issu d(S�c.3097,Ci��.C) � - - — � �� . � Lender s Name ADDFtESS'.Z�� � � � � � � v Lendzr's Addr /� 1 certify that 1 hav �aJ[his app�ication and ctate 16a[ thr CITv iy �7. /f�� TEL.N13—r/7�J.�'/� .. ... . . . , . . .. . [flG'C-Gi'!!ti•� �x7/t i,/ uhuv�inform u n s c rrect.i�tree to comply with all Coun4- LICFNSE ������� CLAS!' ,D��3 . , __ , . , _ .. , ._ . urdin�ncrs�nd S[a[c la�rs regul�[inK H�•�ting,Vent�l�ting�nd � � � e\ir CunditioninE,and hereby authori<e rePresentulivcs a(Ihiz SIiF.Ri:VF:RSh:FOR I�:XPLANATORY L.AN('UqC:I;- � �.(111IIfY f0 CIIIt'.l�ll(1()fl IfIC �bU�'C-Itleffti�]I1Cd rY(]rCtl1' �0� . . . � . � . . . - .. . . . insn< purposes. ������������-�� 'ixnature of 1'ermrtcee D�te ' �� . . �. . ._. . .._ _. ... . _ . __. . . .. . _ _._._ ... . . � • � INSPECTOR'SNOTES � - � � OW'NER-BUILDLR DECLARATION . . .. 'f�hcreby^atfirm that i ain c.empt trom thc Contractor's' License La«� for the following rcason(Sec�ion 70i1.5;�' . . . . � 6usiness mrA Professiorts CodeJ: Any riry or co:�n+�� � ;--�ti which requires c permit to consrracr, atrer, impro�•e, � '--" � �� -� -' ' . . i -� � � - demo(islt,or rrpair any stnicnve,prior fo i�s issuance, � �._ � alro requires tl�e applicent for suclo pernrir to filr a � � - � . - . siS+�ed s7atemeirt tlmt he ic licemsed pur.ruarst to the , ��- � � - - prm•isions of tire Cor�trattor's License Law�Chaprer 9 .-. . _ . _,. _ .� , . . . _ (commencina wit6 Section 7000J oI Dirisia� 3 oj tl�e � . � � � �Busines.c and ProJessiais CodeJ or thar he is exeinpr � � . drereJrom und the batis far the ofleged exeinplion..lny - - . . - � ��iolarrott oj Sccrion 7031.5 by any applieant Jor a permir - � � , subjecfs fhe ap➢�irant 7o a ci��il penafty of nor more dien � '. Jirc Irwidred dolfars(5500/.: � � ❑ I.as m+'ner of thc p�oper�l'�cill do ILr�cnrk.and . � the structure is not intrnded or<>fferecl for salt. . - .- , ,_ � ,._ _ (Sec. 704d, Ifusiiresr a�rd ProJessinns Code: Ti+e Car . ' �- � � tractor's Lreense Lew dnet not applr 7a an ox�ner of , property wAo builds or impraces rlrercar.and wf;o daes � such wark Hi+nrclj provided rhat rudr rm,prmrmenrs . - - are not iruended or nfjered for.rofe. !f, l�o,veoer, U�e bnifding or improvement is solA x•ithLt one��ear of ' complerion, rhe oxvrervbui(der wi1! hace rhe btrcden � ' of proriag drat he did not build ar imprare far tfie - ' L.: . .. , . Pu,Poseojsalc.) .: . ;...-. � �. - � � � - . � _:Q I,a5.owncr af thc.lirnputtyram c�clusivcly con� . � -,_.- ,----�-- - � ,-� _-- - tracting t��itlrlicensed contract�*s to cimsteuM the project � � � � . � . � � � � � ������SCCf7Uli•]O-S-S,I]G.¢lttQSSQh(I f}OfP3SfOttiCodc:The Cma• - . � trac�or's License Law Jocs nor Qpplv.io arr��tvner of � . - . � properry HJio Gurldt or irnp�oves Uiereat, and who � catvoctt jor srrd� pmjrcts k•itli a canvacto�(s/ficensed � .��,i. , - � pursuanl ro tlie Contrartur's License Lme/. �•. �'� � 1 am exem�t imder Sec. B&P.C.for this reason � Date Oa�ner \'\ -.' _ INSPECTOR'SNOTES � '� � ��� ���� � .., . ,.,.. � . . � . . . � �, �.. . � . - �\;�.