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HomeMy WebLinkAbout1811A (10) K'ORKGRS'COSiPLNSAT10hU1;CLARA710Y 7GA364C /;PPLICl�TIO�I FOR PERPJII' , I hrrehy affirm [ha[ I Bave a certificate of rnnsent to seif CE-616(2601 . /7 7� insure,or a certificste of SVurkers'Compensatinn Insurance,ui HEATING-\�ENTIL�TING-AIR CONDITIONING a certifie%d,/' pY pih?ereQnf..�(Sre.3800,L� C'1 ���.j./ � � Polic�Jl.��1rJ�' CJinp����_Y...��./�{'.P . . ... . � .. ',� , I ❑ Certified copy ic hereby t�rnished. COUfJTY OF LOS ANGELES, _ BUILDING AND SAFETY � Cenified eopy is tiled wilh ihe county building inspection BUILDING ' dzp:,rtmo�t. FOR APPLICANT 70 FILL IN qooaess f^3/L�r� Date Appiican[ � IPRINT OR TVPE ONLY1 �1 _ —. ~~� LOCA�ITY//l/ � C1�:FLT[I�1C'ATl�:Oi�I:Xk�.�if'TIOIM1 I'{(O�t N'OftI:GILS' NO. TYPE OF APP�IANCE OR EQUIPMENT FEE- LL/ CO�iPC.NSAT10`IM1SUItA1CF'. N[ARE ' � 1, (Thiti SCCtIOrt ncc� nat hc cortlP��tfd 1�tltl• WOrG inYO(YCt� AQSORPTION UNIT,6TU CRO",_ �. by the permit is (oz onc hundred dolisrs (5100) or Icss.) � oisrP�cr No. - vr+ocess=_o ov l cer[ify th�t in th�prrf<irmance n(the���arA for�vhi<h ihis AIR MAN�I.ING UNIT,CFM �� I s< ,�,y � permi[is issued,]shall not employ any person in any manner � - �. Q so�s to becume subjtc[[o the\5'orker5�(;nmrensution La��•s. 801LER,6TU - � F ' ' ' - APPROVAI,`�� DATE- IVSPECTO'SSIGNATVRE W Date .APPIi[an� � COMPfiESSOR.87U ROUGH� ' d N NOTICIL TO APPLICANT:If,afler moAing[his Certificate of VEN7ILATION SYSTEM � z Gxemptlnn, yau should become suhject to �he ltlorkers' FINAL � ��� �,�. Compensation pnrvisions of the Labor Code,you must fnr[h� � —Q ��� �c�en c��m�,ty �vim suci� prov�s��,nz �,r chit permii si,au hz EVAPOFATIVE COOL[R VALIDATION deemed revnked. -- -- . '. . .. '� . . LICh:N51:UCOVTRACTORSDF.CLAIaAT[OV FI.ODRCF. FAUtiT—GRAVITY__. ' ; , , " ' I hereby affirm�tliat 1 am IicenseS under�rnvisions of Cha{+[cr� HEATER: SUSPENDED UNIT ' 9 (commencing�v�th Section 7000)of Dirision 3 of[he�usi� NfALL � ,' ness and Ymfess�uns Code.and my license rc in tuil furce and -�- � � --� � �� � �� � � � � effect. � />n-_�'� I � . �c3�—6-`-,� �l��r3 =-- —L/Jr!'r�s.,G� . Licensc Num •� ic.Class . . . .. . . .. . . c / � Contrac ;f��/ _ • __ _. . _ ._ _ . ' . � . . . _. . .. , ... . _ /_ / � I am ,i��yt ��o�u v�c liccnsing rtywrcments as 1 am a licensed architect ur'a reFistercd professional engineer P�3n Check fee 25°0 of 8bo7e. � '� - '� � ��� � � � -� �"� � ' --" � acting in my professinn�l capaei�y (Seetion 7051, llus- ' ' inrss and Nrofessinns Cnde). FER(VI�T�SSUING FEE$ � �� 8���.R Lic.nr Iteb.No. Dute � TOTAL FEE /�I dv . ,� . ${� .,e • •8 . l -V Ir��1350 IlO�ti:014'Nl'R�DUII,DT;R DI:(,LAR.4T'IO:V � pLAN CHECK APPLICANT - - , I hzreby affirm that I am exempl from�the Contr�ctoPs NAME . .. . . . e�•� 3�'Q� License Law fvr Ihe fuilowing ressan (Sectinn 703I.5,Ausi- I � . ness and F'rofe�sions Co1e): ADOHESS � 1+�O�'�L�i � 1,as�>�.�ner ��f tl�e prop�rty,�vili do the���ork and the CIT� �TEL.NO. � structure is nol intended or ufFereJ for sal: (Sactian � 7044,Ruciness und Yrnfessions Coda). � ❑ OVJNEfi �/�_ —�_�� �� / - �, �. . 1.as owner of thr proper�7'��m exdusively wntraclinS �����vJ_/�{�Cll� with licensed contrac[e�rs ta canstruet ihe project MAIL �J ��-��. jjj I . (Sectinn 70a4,6usiness and Professiuns Codc). AODRESS n ��'��� _y�✓ '� �. � C0.1'STRL1CT10�1 Lti\DIN(;AGlNCY � CITY Q y � 'v L.NO. �Gj�� ; � ' [ hereby affirm that therr �.� a constructiun Icndmg agancy l!/' �-�0�! fur [he perform�ice uf the ���urk for ��liicli [his perm�f is CONTRACTO ��eO �/� - - � � . . , issued(Sec.3097,Civ.C) ��!4/�!,-✓ .J —J-f � - . Lendzr'sName ADDRESS�I � _ � . � ' �� � ' � �' �-�� [� � Lender's Addresa - ' �y/�,��� //{��� � � � - . 1 certify thu[ I Ii��e rrad this uprlic�ti��n anel state�h�t [he CI �-"`�-"'—w�•- . .TEL.NO�.2—/)�/ , , . . . UJ— f_ abo.e infurma[ion is conect.1 agree to com7>ly w�th all Cuunty . �iC NS�_�'a�0��� C ASS .D�_��� . .. . �, _ . . .. .. ordinancrs and Statc la�tis regulating Heating,Ven[ilating and .. Air Cunditioning,and hereby au[horize represen�atives of this ��SkiG R[iVI;KSF:I'OR I�XPLANATDIiy I,AftGUr�Gi: - ' � County to enter upnn �he abuveanentiuncd { perly for � � � �� � ' � � � " ' � �ti� ,,urposrs. . �. -m������—/_S��/ � �ibnsturr of Permittee U te . . . .. .. . _ . . . . .... .. . . .. . __ . .. . .._ _._ . ..__ .. . � � ' - INSPECTOR'S NOTES� � . � .. O}VhCR-BUILDCR DGCLARATIO:V . ���'' I'hcreby�5ffirm tliat T am e�emp[irom Ihc Contractbr's Licensc Law foz thc tollowing reason(Sectio�� 703I.S. . � . Burb�esr axd Profe.csionr Code/: Arry eiry or cotrnr�• . ,. � �� _ . witich reqttirea a permir to can.rrruct, vlrc�, rmpro��e, . . � --��" ' � - ;�l �'. -� , demofrrlr,or reparr m�y rtrutture,prior ta Jr.c irst�ance, � - ,�`�� afso requires tlre applicenr Jor such permi� to jile a - � ' � � �-�• - � rigned rtatemcirr diat he is lirensed pu�.n�c�u fo dre . ,� , proorsio�rs oj the Commt7or's l.iccase Law/Chapter 9 . .. - . _ . ..._ � :�.;�.�,., , , . (cornmencirrg r;rN� Searon 7000/ oJ Dirisrorr 3 oI rhe �� � � � ' �� ' ' Busine.cs and 1'rofcrrionr CodeJ or thar he ir e.rempr rherefroni and�he baris for!he alleged exemptiorr.Any . �. � �� vrolatinn of Sectron 703I.5 b��m�YaAPlicmrtloraP�'nnit � , � � sub/ects tIre appGYmv to n ciril pcimlry of iior nmre rAmr � - jire hrmdred dolfars ISSOOJ.: � � . ❑ 1,as ow�ner of thc property k�iil do thc«rork,and � �� � the StrucWre is not intrnded or offered fnr sale. .. ..._. . . ... �. . � (Sec 7044. 6usiness mid Profersio��s Code: Thc Con- � �� �ractor's Lirer�se Law does nor vppfp to mi o�tvrcr of property who Gvilds ar impsavea Urercon,and xho does . rere/t work hiuuelf prorided tliar suc1� imprm•ernen�r . . are iiot irrtended or offered for scle. !f, howrrer, the - ' . _ building or impruvemen7 is sold witirLr one year nf complctiott, tlre ow�rer-builder wrl! Im��e the burden , - ' �- � of prori��g flrat Ge did irot b+�ild or rntprore for dte , .. . ,�;•�, .-. . .. . t, . r�rpoSeofsale.) . .� . �. . 4'' - � ��� ' I..as��oicncr of[hc ro rt am c�clusivcl ron- . . . . . . . . -._. .. .. . . � ❑ . P P� S'; Y t(ae[in��ritlY licensed edntrac[ors[n construc[(he project -� - � � -� � � � � �,%Sectiari;7013.Busi�tesa and A�ojessiuns Code:The Car� tractor's I.iceiese l,aw does no�npply ro mi ow�ter of � propeay �rho btiildr or Nnpro�rs lliereorr, m�d wha � . ront�acls for such projects witlt a co�+rracror(sJ liceresed . ' ����' � P«rtumit 10 fl�e Coittrnc7or's I.ireuse Law). - i. ', 4 \\ ' (`, I,•... . • . I am exempt under Sec. � [3&P.C.for this reason - Date �` • � Owner ' �� ti� INSPECTOR'S NOTES . � , -� . - • • . _�. -.�. ,��... . . . . .. _ : . .. ._ 1. .�., � . . - .. � .\ .