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HomeMy WebLinkAbout1805A (10) ��oahLas�co�u']:NSATIOti DI;CLARpT10N �EA e;g°�2.eo, A P P L IC AT 1 O t�! FO R P E R f��IT 1 hrreby nffirm that 1 ha��e a certificate of consen� to sclf � . � insurc,oracertificateot�t'orkeriCompensationlnsurance.o� �HEATING-VENTILATING-AIR CONDITIONING a certified cap>'[herenf(Sec.3&00,L: .) � � • �,��<��;�>.l���J��3-�. - - � , I u(� Crrtifi�d c��py iv hereby tumished. . COUPJTY OF LOS ANGELES_ BUILDING AND SAFETY /` � c�r��t�ca co�y is ri�ca�,i���ihe cnuntp buildins inspection FOR APPUCANT TO FILL�N eui�olNG ��'t depar[ment. � � � � � ADDRESS `�36 �� Ua[e Applicant (PRINT OR TYPE O�JLY) /J LOCALITY/JJ C[:RTIi'ICAT[:0I'[Xf:�1!'710N 1'ROtit�5'pRKI�:ILS' NO. TYPE OF APPLIANCE OFt EQUIPRIENT FEE W COhif`ER5:ITIDN IT:SVRAKCL � NEARES J� � } (71115 SCCtIOn ❑CCt� 710[ bC CUfil(11Et¢(� If t�12 NOik 171�"O��Cc� A850flPTION UNIT,QTU � . CFlOSS '�; O hy the permi[ is far one Lundrrd daIlars (5100)or less.) � oisTnicino. . �VROCESSEOBY V . ] eertify that in [he prrformance�t[he�vnrk for�vhich tt�is AIFl HANDI.ING UNIT,CFM � q . ��� � permit is issued,1 shall not empiny any person in any manner �� O �so ris tn 6rcome subjeet to the\4'orAers�Compensation La�as. 001LER,8TU � � �"' . . . 4 APPROVF�L.S DATE �NSPECTO'SSIGNaTURE U Date A licant � W FF' COMPRESSOR,BTU I ROUGH y NOTICL TO APPLIC.4NT:[(,afler making thi�Certificate of VENTILATION SYSTEM z I?xemption, ynu should become subjec[ to the �Vorkers' FINAL_�� �7� — Compens�tion provi5ions of tht I.�bor Code,}'nu must(o�tl�- EVAPOFtATIVE COOLER � '� VALIDATIC� �vith comply with sucL provisions or this permit shall be — deemedrevoAcd. FURNACC: FAU—GRAVI7Y_ .. . � � � ' - -' - � - - � LICEKSL'UCOVTELACTORSDGCLANA710ti FLOOR� o7U , � � � � . I hereby af(irm thal I am licemed under prnvis'ionsofChaptcr Q HEATER: SUSPENDE� UNIT �, . 9 (cummencing wi�h Srction 7000)u(Divisian 3 of the Busi- lj�� I WA�LL /.�/f . � . . . . . . ness and Professi ns Code,and my liccnse is in full forre and I L(` J.J��QZ�, ��'",' . .� . . . effecL /�f // � Licrnxc Num�/�V�Lic.Class����_ � � '. � � �. � � - � � - . Contrv� • �te_��O—V� _ _ . __ , . . __ , , . . . . .. . . . . . . . � � 1 a,. _. . ,. om the licensing requircments as f am a � licensed archi�ect ur a reFistered�professional engineer Plan CheCk fCe 25'0 of above. �. . �1 8 p.5 F adinF in my prof.ssional capacity (Section 7051, Bus- � . � � ' iness and Professions Code). - - PERMIT ISSUING FEE$ � . . . . _ ��'�(a'�.��� . . � I.ic.or Reg.Nn. Date TOT�1l.FEE �'��� � �. ���•'�2 3 5� IIOM1iL'0�5'NL:It-BUILDF.It DECLARATIO;� pLAN CHECK APPLICANT� ' � � ' ' Mc •2350� 1 hereby affam that I am exempt trom�the Cnntractor's . NAME . �-�. . . . .. � ��f.�_Vq.� Liccnsc Law for Ihc foliowing rcason (Seetinn 70J1.5, Ausi� . , ' , ness and Professio s Code): AODFtESS � � � i, as owner of ihe properh',w'ill dn the work and ihr . . . �.. . . stnicture is nol intended nr offereC for s�lu (Sectinn CITY TE�.NO. , 7044,F3usinasc ond Profcssinns Code). � .. . �, ❑ . OWNER �� � ) ' '. ' 1,as ow�ner of Ihe property,um exclusively cantracting �� ��!G�%4-���. wilh lirensed contrectors to cons[ruct [he project MAIL . � (Section 7044,Elusiness and I'rofessions Code). ADDRE55 _ CO?ISTRUCTIO\LLNllIKC ACENCY C�TY�����t"_`_'r_/ �L.NO. �GGL . ,,. . 11 [ hereby uffirm [h�t there is a cnnstruction lending agency CONTRACTO � � for the performance of[hr ���orA for ��hich Ihis Fermi[ is � �� ' ' �- � -� � issued(Set.3097,Civ.C.). ����-'^� A — . . . .. , ._ . , . � . - , Lender'stM1ame ADDFlE�-" /!/t_�.� -�� � . N{K�!/ fj Lender's Address CIT _C^E��EL—��/��� p . . � . , _. . . . . .. [certify that 1 hace resd tliis applicatiun and state [ha[ ihe gTq---�� � y/�LIC. Y �� . JbOVe IIl�ofmJ[lon Iti COf�I•Ct.1 aFrrc fo comply�rith all CountY LICFNS. .��(�. / CLAS��Q��F . .. . . .. . . , . . . . . . .... .. mdinances and State la�vs rceula[ing Hcating.Ventilating and � � Air Condi[inning,und hareby authoritc represtnta[ives of this. SF.G RI:VGRS6 POR IiXPLANATORY LANG[IAC;1. - - . . .. . . . . ,. . CuuntY •� en[er upon tl�r abo�x-mrntioned prupert7' fnr . . . , ia;;�..dr� purposrs. . . . . . . . _. . . . . . .. ...� .. '_._ , . ._ .. _. . . . . C � rr�� �-/�'-�� an�ture o(Ycrmrttrc Dntc _ . _ __. �- � . � INSPECTOR'S NOTES . , OWNER-BUILDER DECLAR.ATIOti `,S . - � � . ' • �I�hercby affiim�'thaCl zm c�ecipt from tl�c Contractoi s . , � . License l.aw fnr the follo��ing rrason/Secriorc 7031.5;�, , � . . Qusiness anA Prnfession.c Code/: Art�� crry� or court�y � � � • , xdtich requires a perotit ta constract, cfrer, irnprore, -' ' -- .� .. , • . demohiA,or�epair mry strucnue,prror tn irs rssuance, � � alro requires the applicant jnr sudi permit to filc a _ �- ��'�� � �• - ' . � .cigited sfatenrent tliar he is liceiaed pur.cum7t to dre � ,�` prorisions of tGe Corrtra2lo�i License Law/Chapter 9 . ._ . ., . , . � , • � /cammeirrLrg n�irfi Secrion 7040J oJ Dirision 3 of the . � ' ' �� � � � - �' 6uriness arid Profertions Code� nr.117ar Irc is excmpr � tl+erefrom and tlie basis for the cllcgcd esernptian.Any - ' �� � � . t�iofation of Sec�iar 703f.5 by ar:y cpplicant for a permit � � � . subjects Uie applicanr ro a ciri!penofty of�rot more Nran . � - � . � � jire liundred dollarr(SSOOJ.: � � � ❑ 1,as olcncr�>f thc proprrty���ill do�hc un�k,and _ �. - tl�c steuctum is not intcndcd nr uffcred fur salc. - __ � �- - . � � � �Sec. 704d, Beuriresr arrd Prnfes�innr Code: The Co�v� � , ' rracmr's' Lireresc Lcic does not apply to o�+ oxner of t, � propeny wko buifds or imp�orrs nc��eai,mrJ wko does � sucL work lrimself prm�lded tl�nt such Irnproremen�r . � are not inter.ded or of/ered for talc. !j. frmvcrcq the . � building or improrement is sold wilFrin one year of � . conrpletiori, rke ownerbuifArr wiN Ha�•e th.e burde�r � " ,� ' ' - � oj proving tlmt l�e drA r+ot beiild or rnrp�ore Jor d�e � � . ._ ,. � y ' ,. . . ., . .. � _ •ptrrposcajsale./ ,.. �• , ,'_ . ' . - _ ' '•;Q l.�.asotvncr uf th��propi�rly:am rxdusive]y con- .-. ,., _ ,_ , .. .. _ . '�tracting with licensed cuntractprs to cunstruct the p�ojec[ � � � jSeCriwr�70-t-t,'B�uirresi,mid ProJes.rioris Codci 71:e Con- � _ , tracrar's Lrcense Lmv dors irot apply.fo aii�otrner of � ' � properry who Luilds or imprpcet diereort, med who � � _ conrrac�r for such prajecfr iriN�a em+rrector(sJ liceru�ed � � - � ' �_`. ��{,, pursuar�r Jo rhe Conrraetar's Lrce�rse Lm��J. ' �` . . . ..�.�_.:_.�:',,, 1 am exempt tmdcr Sec. _. Q b P.C.for this reason Date �;� .,�.. .. ,.: `� ' O��'ner - '�_ ``. . _ _ . INSPECTOR'S NOTES � � � • • � �- •- _ �• �� . �� . ... �. � .... . .._ ,. � � � . . . � . � . . ..,.�..., ,