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HomeMy WebLinkAbout1812A ' , 76A364C. f �,�a,:�:as�������:NSAT�o�ot:�4,,k,�7�ov �E-e,a�Z.ao� !�P P L IC,��T I O R FO R P E R f+�IT � , 1 hrraby affirm that 1 ha��e a certificatc of consent to self ; �nsure,or a c�rnt�c�te of wo�kc�s'c:omprnsation[nsurancc.or H[ATING•VENTILATIAIG-AIR CONDITIONING � a certit`ie�dfco�fn�y{tyh'e-�n((Sec.3B00,L. .C.) `P.�OIrfCY�,"��/.lYV��pa '_. _ �riZs�. . . . . . . . . I �[f Certificd c�py i,heceay-rucnisnrd. COUNTY OF LOS ANGELES _ BUILDING AND SAFETY /� o�Certi(ied copy is filed with[hr counq'building inspection FOR APPLICANT TO FILL IN' �UiLOING r�� �t rtmen[. � � ��y,����/ � lla[e p, Applicant IPRINT OR TYPE ONLYI ' AOD(iE55�v/ v- � LOCALITY/��— CI'.RTII�ICATl�.Of�i:XL\lPTIO\7'RO\i l�'ORI:I�:Ii$' NO. TVPE OF APPL��+NCE OF EQUIPMENT ��� r[[ {/�� � COAINENSAT10NpNSURAVCI; RA_=. � I�/� p (TLis section nced not be com icted if(he a�orA imolvcd ABSORPTION UNIT,OTU by thc permit is for one hundred dotlars (5100)or Icss.) . . of;�H�crrvo. �� raocesscoor V 1 eertify [hat in the perf<�rmance of the�rork fur which Ihis AIR NANDLING UNIT,CFM /�jy � permit is isxued,f sha11 nM emplo5�ny person in any Nanner - ��'� � � � O . so az�o hncomr xubject to ILe 1Vnrkers'Compensation La�es. BOILER,eYU '� � � F -- � - APPR'JVAL$ �DATE �NSPECTf�'SSIGNATURE `U Uate APP��cant COMPRESSOR,BTU� ROUGH � y NOTICl:TO APf'LICANT:If,afler maAing this('cr[ificat�•nf VENTILATION SYSTEM FINl1L � c�G_g/ Z liacmptinn, you shnuld Areomr. subja[t tn ihc \Yurkers' - Compensation prnvisions�t�ne 1.snor coae,vou mus[Potth- EVAPORATIVE COOLER ' � VALIDATI N �vith mmply with such provirions nr Ihie permit shall he � deemed revo};r�, , � FURNACE: FAV—GRAVITV�_' . . . , , L(CC.KSGUCONTRACT025f�ECLARATION FLOOR� BTU . ... , _. . . _ � . . 1 herehy affirm th�t 1 am licensedundcr provislonsofCh��ter HEATER: SUSPENDEp UNIT . _ ' 9 (romme�cing with Sretion 7000)nf Division 3 af the Husi� WALI '�I ness nnd f'rofcssions Code,and my Iicensr it in full force and �4G��� �I�j��O' effecL //� /�y �J _ v . License Numbe���E�J ,ia Clsss.�!/��_ . , . .. ... . . . .-.. . Contracto�e . �[e_IO`�V^�/ _�✓ . . _ . — . . . . . . .. , . ,. . . .. � 1 am er,.0 p� ��un [he licensing requirements ax I om a , . . . .. . .. liccnsed architect or a regisrered professional engineer p��n check fee 25°6 OT 3boVe. � � actin� in my professionai cspacity (Settion 7051, 6us �� � inessand ProfessionsCade). � - PERMIT ISSUING FEE S ' ,��, � � � . - �� � -- yyy :1fi1.2F, � Lic,or Re�.No. 1>�t� TOTAL FEE Q!yu � . 6 __ � /..V—v� �;� •�►�} - }IO\II:O�I'NI�;R-flUILDf;R DF�(:LARA710N pLAN CHECK APPLICANT � � ' '- . ;G••l•�1 6 S 0 ' I hereby affirm that f am ezempt frum'Ihe Cnntract�r'S NAME � � ' � � � . � � • � � License I,aw fur Ihe folb}ving rcasun (Sec[ion 7031.5, n�sc� ' ^? 1 Q 5 C�i� s an�Vrofessir�ns Cndc): (�DDRESS - � . � � 1, as owner of the prnpert5'.�+�i1i do the�cark and the . . . � t`�"!.�'1 1�� structure is nnt intended or<�fftred for sale (Sectiun CITY . TEL.NO. -�, 7044,flusiness and Profcsvons Code). ��J���� // � � � � � OVJ N E R4� ���' ' —'�-�+�-- . 1,os owntr of ihe proFartY'.�m cxclusivclY contrscting � with licensed cantractnrs to cons(ruet the prnject MAIL � , � (Section 7044,Llusiness and Nrnfessions Cade). A�OR/E5�5 6 .J �^.. // CONSTKUCTIOYLb:NUINGAGENCY CI7Y/�J' - .-L.�X.��L�C/ � I hereb>• affirm lh�t there is a construction lending agency Vr� � �'V / far the perform�nce of ihe work [ar ���I�ich this permit is CONTRACTOP./lfn�� _��'� . . .. .. .. ,. ; . ._ is�ued(Sec.3097.Civ.C.). ���� /� � ' ' Lcnder's IVame ADDR 'T,J�/q��.�/!�i�_�_ � .. . . . . . . _<l -/ 'G/L�i�`7L Lender's Address � r �. TEL.NO�����/�� .. . .. , � . _. . - 1 certi!> [ha[I h�ve read [h�i�p��l�c�ti�n and Si�te Ihat th� S�qTE � /� LIC. ����7 . ahu�e informa[ion i�correct.1 aPree to cum{i�y���ith�ll C�unt)' 1_�CENSE N ������7 CLASSa�.i1l'C� . . . .. . . . . . . - . . .� - ordinances an� S[ate I����s regulatine fiea[ing.Vrntitating and T , �Y , Air Conditioning,a��d here6Y�uthuriic representatices of this . .SF:1;Ri;V4:RSG{'OIt i'XNLANATORY LANGI�AGI�. . . , ... ... . Cuunty to enter upon the uboveanentioned pruperty !or . iu, ^cY rur�n�_C�-.iG��L� �(J�—�%� . . . . ' . . .. . . . � � J�gnature o(Yermit[ee Uute . . . . .. . . �� .. . .... ... .. . . . ._.___. . . _ .. .._... .., . .... � � INSPECTOR'S NOTES �, , 01VNLR-IIUiLDE•R DECLARATION �. .. . --'1 heicby atfirm(h5t 1 am exempt trom thc�Contractor's . i, � Liccnsc Lau• (or tlic follo�cing rcawn(Section 7031.5.".- � . . - . Llusiness and Prnfcarrorrs CodeJ: Any ci�y or county- � ; .� � � which reyuires a permir to consmrer, elrer, improre, , - .+"= . . - . .. , � demolrsir,or repair any stmc7ure,prior m i1s istumrre, � � � - � . � also requires the applrcant far sucl� permit ro Jile a � � . - �� � - - �� signed smtement d�at hc is licensed purrttant to tlrc , � ' . proeisrons oj(Ge ConJrQ2tar'a I.irense I.aw(Cliapier 9 ..,. .. .��� 1 ��,;', , , � . (rommencir�g wir1� SccNar 7000J of Dirrsror� 3 oJ dre � � � ' � � � � � �" � Btrsirress m�d Projessians CoJeJ or that Ire is exe�n/�r ,, therefrom and ihe baris far!6e aHeged exernpfiott.�In}� - � '�'•��' ' . rioletioir oj Secriar 703l.5 Ay mq•aPDlicanf lo�e Perrnrr ��� , rubjects d�e applicnnt to a ciri!penafr}•of no!more dmu . � fivc luardrrd do(la�s(5500/.: � ' ❑ 1,as owncr of thc property�ciU do tl�c unck,and Ihe structurr is not intended or utfered fnr ssle. _ ..__ -..., .. ,,�-�; '�`� � (Sec. 70d•t. Suri�icss mid I'rnfessio�i.c Cude: The Ca�• - , , . trottor's Lireitse Law does ira apply to an o�rirer of � , property adm builds or Lnproces 1Hercon,end who does sudr irorA lrin:re(f proridrd rl�nr n�dr inrproveme�rrs . arr not intrnded or nffte�ed far sa(C Ij, how�eveq 1&e buifding or improvemcnt is sold wit7rbr one yrar oj � - com;lerion, rhe o«�nc�-builder wrI! ha�•e the burderr . � of provi�tg that 1ie did not build or improre for rhe .. .., .. , .. . . . . '��� ._ .. ,'��., �, P:opose aJrale.J .". �. , ' �'- - ,�'Q I,as owncr oF the��ptnper[y,�.am�c�clusivcly con- � _ - . . ,, ., , ,--„ - � „tracting w�ith�licensed cuntrac�ors to conshuct ihe pmjec[ � ' ' ��\(Scciroa 70�4;-fJusinest und f'rvlessioi�s C�de�Thr Con• . tractor's Liceuse Lah�does nor cDPb'��tn mt oia�cr oj ' � . proyeny �t�ho buifdr or irnprnrer d�ereon, artd iclm � � con�rac�s Jor suci+ projectr w�itlr a caatrartor/s/licrnred , ,���y � � - purnraru ro/he Comrecror7 License LawJ. . . . . `�...�;`� �`"�` � . � 1 am esemp[under Sec. _ f3&P.C.for this reason bate a• � .,`,.{^ j .. Owner '� — �• � .- :;...f� . :�- ,\. " - � INSPECTOR'S NOTES � . . - .� �� . � � . , � -. —. ,., . .. _ ..\,l. ��\t_- .. � . � .. _ . :ti '. , . . l�.- -�\:.�. - . . � � ���� , _ � . . . . _ .. • ... , , .�