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HomeMy WebLinkAbout1808A K'ORK6RS'CO\fPEN5ATIOKDLCLrV2�T(ON � �6A364C . . 1 herehy afCirm thst I ha��e a cer[i(icute of consent to seif �E;8,8�2-8oy . .�AT'LICATiOh! FOR PERfr�71T � incure,oracertificutentLSbrkcts'Compensationlnsurance,oi � HEATING-VENTILATING-AIR CONDITIONING a certified cnpy thercof(Sec.3500,L��.)�. ��,r���0�'�s3c�sO�.�c��%ll��.-C/� � Crrtiticd copy i�hrraby turnizhrd. COUNTY OF LOS ANGELES, _ BUILDING AND SAFETY Certified enpy is fiied witl�the county'building insprctinn . . � �VILDING deparnncnt. FOR APPLICANT TO FILL lN noo�tEss f3/6 Uate Appiieant � � - ' (PRINT OR TVL'E ONLV) -�— - - — LOCALITY�`� CI:12TI1�1CATL OF[XI:AIPTION I'ItU11�5'ORkl'RS' NO. TYPE OF ApPLtANCE OR EnUIPMENT-' FEE 4� _ _. . CO'1(PF.NSAT10?l.lNSURANCE � NEARE - ` ��ij'i��s/ -U . (This section need not bc completed if Ihe work involveJ AOSORPTION UN17,87U �R�G''_. by U�e permit is Cor one�hundred dol(srs (5(00)or IcssJ V oisrnic*No. ��. PAocesseoor V 1 [ertify,Ih�t in the prrformance af�lie wurk fnr��'hich this AIR HAN�LING UNIT,CFM11 � �`/ O permit is issued.I shall nu[employ any person in any manner i ! so as to becume subject�o tht R'otkers'Compensation Laws. BOILER,RTU APPROVALS DATE IYSPEC'.��SSiGYATURE W . Date Applicant ICOMPRESSOR,OTU ROUGH y � NOTtCG TO APPLIGWT:If,a(ter making this Certifica[r of VENTILATION SVS7EM � �� !� Z FINAL � h:zemptinn, you should become subject to Ihe 1Yorkers' �_.�17 - — � L'ompensation provisions uf thc Lsbor Code,you must forth- - wilh cnmpiy with such Drn�'isions or [his permit shall he EVAPORATIVL COOLER �'.VALIDATI N deemedrevoke�. � . FURNACE:� FAU—GRAVITY'' , - . , LICENSIiU CO4TRACT0125[IECLARATIO`7 FLOORr BTU � - � ' � i here69 affirm that 1 um licensed under provisionsofChapier � HEATER: SVSPENDLO UNIT i . 9 (commencing�vith Sretinn 7000)of bivision J of[he Busi� r�L NJALL � , ness and Yrnkssions Codr,and mY'licrnse is in fuli foree and �� ��,y��/J /J /}/}f� - . effec[. �.5 _d�� . _lIC�L�JJ—l/�'i'l./—�O� .(/V�" . License Nun���^���.�.,{ic..Clasa_ 1//��j�}3-- _ .. �.. . . . . . . Con ��'����.��.''yyy�����T,""-'f✓xtc_.�v�.�.�`/ . .. _ _ _. . � . ... . �� . .. . . . .. �f 1�����°�mpi Trnm[he licensing requirrments as I am a � __ � _ IicenseJ architect or o re6istered proCession�l enginrer Plan cheek fCB 25$0 of abov0. ' . � actin� in my professional capacity (Scction 7051, Uus- iness Und I'rofessions Code). � PERMIT{SSUING FEE S Q:�'�I - .. . . . [> > [�c.or Krg.No. D�te TOTAL FEE / I�-y� ?1 F5 O�F !�,O_V i �? }IOh�F 0�1'NGR-FIUILDLR DlCLARATION pLAN-CHECK ACFLICANT ' �- ,�[t'��j����j 1 hereUy affirm [hat I nm exempt frc�m'tl�e Contractor's . NAME � � � - � �� - � 'r'��r �Q�J,(� � License Law for thc lollowing re�son(Section 703L,5, Busi- . . � 1!.O Gt 7'-O 1� ness and Profes.sions Code): ADDRESS � . � I, as ou•ner of tlie property,will do the u•ork and the - - �. slructurr i nert inten�td or uffered F�r s�le (Sectiun CITY TEL.NO. 7044,Iiusines�and Prnfessions Cnde). ' �J ', ❑ OWNER f.,.(��,^ J ` 1,as owner of the property,�m esdusivety contncting �_��'.f�v/lL�Y � ���ith licensed contractors to Gonstruct Ihe pr<ilz�t MAIL '(J� � , ADORESS ($ection 704C,6usinrss and Professions Code). �r _ i[f - � ' COtiST1:UCTION LfCNU1NG AG6:NCY' CIT�' /-�J �+ EL.NO. Q��1/' 1 hrrshq afFinn [h�t therr is u �roshaction lending agency ���� �jf���J �� �l ' for [he performance o( t6e ���ork fur which Ihis permit is CONTFACTO . i""„„""-"=. .. . . . . . . .. . _ . �sued(Se<.3097,Civ.CJ. /� ����.�,,) � � , Lendrr's Name qODRF^, L� y ,���C�R�L'!= � � � �� � � Lendrr'sAddress CI7V iy�,.���y� (/— _T[L.ND,�r-./y _/J/� . _ . .�� ... ... . . .. .. . . . . y........�.� lJ(J I_=jl 1 cer[ify[liat ] havc read this upplication and s[;i[e that the S7ATE IC. . � alurc irtforntutkin Is cUrteCf.1 uptei't0 Con1P1)'K'ith alI CUunty LIGENSE ND.������f„�CLASS ���3; . . _ . .. . . . . . . . . ordinance•s and Sta[c lax�s rcKula[ing Hea[inF•��rntil;iting and . Air Cwiditioning.and hereby authorite rrpresontntives of�his SI;1;ILLVF,RSG fOR I;aPLANATORY I.A�GUAGI; . . . .. . .. . . .. .. . . . Co�un/ty to enter upon t6e ubovr-mentionrd prupeny fur� � � � � � � �.�`.� t �urposes. . . . . . . ._ _ �. . . . . _ . . �!� ���r�U�_:/��� �ign�ture��f 1'ermittrc Uate . . . . . .. .... .. . ..... :.... ..._. .,.._.. . ...._, _. _ . . I - �. . � � INSPECTOR'S NOTES � � ' ' OWNER-BUILDLR D[CLAP.ATION - ��"1 hereby affiim�Uiat I am csempt from thc Contractnr's ' � � Licensc Law fo� Ihc foilo�cing mason(Secriort 703l.S,; - � � � . . . _ Business and Projcssions CodeJ: Any rity or rounry . : � wi�icl� rcquiret a perntit ro consrrucL alter. improrc, � . . , . ' . - . >� - . .. l � demolish,or�epair arq�smrcture,prior fo iis issuancc, � � . . -�� � atro rcqurscs tire cppJirant Jor seech permit ro filc o . -� � .. .. � rigned smrement rhar f:e i.r ficensed purtumit to rlie � � L� ',� � � . pro��isions oj the Contra2ror's Licerese Law(Chaprer 9 .. � , � , , (conrmencirrg tirirh Sectio�t 7000J oJ Diririorr 3 of rhe . '`�� � � -� � � � � - Businest anA ProJersiau CodeJ or Nmr he is exenrpr the�efrom end die baris for the a7leged exernptiorr.Any . . . . . .,.`:.'. ,: vio(atian of Sce�ioer 7031.5 by urq•aPPlicarn jor a Pernrir ' - � - - � � � . . subjects tlre oppliconl to a crrrl peimltV of iro!more dtan ��� Jive hundred dollars(5500/.: � [] 1,as n�vncr of thc property H�ill da thc���ork,and � ,-�` the stmcture is not intenJed or offcred for sale. ...- _�,�...- ` 1-`.�' .. �.1:: �Sec. 703a. B��siness mrd ProJessiorts Code: THe Cmr- � ' " , tracfor's Licerue Laiv dors no� bppl�• ro au owner of � � � properry wlto builds or trnprores tlrercort,mid kJio does � sutd work hrmself prorideJ thar sarch imp�onements , are not irrlei�ded o•nffrred jor safe. Ij, ko�rrrer, tlre � bttilding or improrement is aofd wid�6e one year of completion, �he o�cner-buifder will lmee d�e Lercderi � � - t. of proving tAat he did not build or improre far tlre � ---_ ,. � . . . , ..Purposeofsale.) .. .., ., . � - . ' .� . . i`��: '.�'1.as�owncr of thc pcoperty,ain�escWsivcly con- � .. � . ,. . ., _ ,\tracting i��i�h liccnscd Contr�ctors to constmctthe projcct � ' '•,�Sectiort 7044,�.6usirtess�mrd Prnf¢s.ciana�Co'dc:�Tiee Con• � �mctor's License Lmo docs no�apply-tb�an�oivner of property wl�o builds or rmprores rLereort, and +vho � . . canrrarls for sucl+ projects witl�a tortnacturfs/licensed " ,+`� � pursumu to the Conrrocror's License Laxy. . � ' . � :.�' �� • I am exempt under Sec. B&P.C.for this resson Date _ ' _ .� Owner . _ . ,:� INSPECTOR'S NOTES � • � � ��� � �• � � , \ . . i',�� _ ... ; _, _ . . . .. . `� i,\•