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HomeMy WebLinkAbout1814A (10) \t'OItF:F.KS'COA1PliNSA'ffOV DiiCLAftATION � '��q36aC . - � � he«�>. ��F��m �h�< < �,��� a'ccrtificate o���„s��< <o���� �E-s,8�2-$0, A I'P L IC�T I O(�d FO R P E R f��IT insurc,or a certificate of 1':orkers'Compensatinn Insunnce,oi - � � HEATING-VENTILATING-AIR CONDITIONING u certified c�n,/,nf�vytQhe�reo!(SQryc�.4800,La' Poli.5'�-/L._.[l�GU�n�� � . .. . . . . . � � , . � . '� ' . I �Ccrtiei�d co � COUNTY OF LOS ANGELES Fy c}hcr�h furnuh�d. BUI LDING AND SAFETY Cectificd cop}�is(iled�eith the county building inspactinn FOR APPLICANTTO FILL IN F1UIL�ING��/� dep�rtmrnL � �' � - AD�RESS l)a[e Appiicant ' (PRINT OF TYPE ONLYI��� / /� - - - LOCALITY////,�//__�� CF:RT11'ICATG OG EXESfPTION FRO�t WOEtF:lItS' NO. TVPE OF APPLIANCG OR EQUIPMENT - FEE (.vG�/Z/JLt COhiF'I::�SAT101 lNSUR.4N(:1: - NEAR ' (T}IIS SCCUOf1 nCC� !10[ bC COrtIjlletEd if t�1e 1VOtk III�O�V'CQ - AE3SORPTION UNIT,BTU � CRO � � p}, • by thc permit is tor onc hundred dollars (St00) or ICSS.� ' DISTRICTNO. GPOCESSE�Bv V ' I ce�tif}�th�t in the performan�e�if the t��ork far���hich ihis AIR HANDLING UNIT,CFM - � �� t/ permit is issued,f shall not empiuy any person in ony manner ' �j � so as to tiecome subject to the tVorkers�Compens�tinn Laws. 901LER,eTU . 1-- � � � APPROVALS DATE INSPECTOF.SIG44TURE Z„) � Date ' Ap��licant COP,APRESSOF7,6TU � ROUGH ', a y NOTICE TD ANNLICANi:If,a(ter making this Ccrti(i.utr of VENTILATtON SYSTLM � � ',�� �S I:xemption, yau shuuld brcnme suhject to the 1Sorkers' � FINAL � �_ Cnm�ensati<�n pro�'isinns af ihe Labor Code,ynu must f��rth� EVAPORATIVE COOLER �vith cnmply w�ith sucli pruvisions or [liis permit shall be � VALI�ATI� � deemed�evoked. FURNACE: FAU�Gi7AVITY._.__� �� . . . LICENSkiU CONTRAC70IZ5 DECLARATION FLOOR� Fi7U , �. . - � �I herel�y affirm tliat I am licens�d under prn��isions of Cha�ter HEATEFi: SUSPENDE� . .UNIT ��. � � 9 (c<�mmencing with Section 7000)of Divisian 3 of the Ausi� WALL � � � ness and Professions Code,nnd my licensr is in full forC�•�and ���� Q�� '� � � � '�. - � �� � � � � effecL '/ 2 � � � . Liccnse Nun�r��f��J��.i�J.��(''assa/+��G � • .. . � . . .. . . Con[raaGi��%�i�r�-rJ/�S�YKy(—t/-/D=fJ-/ _ ' ._ _I . � ] n mp�thr licentiing reyuiremzMs as 1 um a - � � . licenscd architect or a rt�istered professional engincer Plan check fee 259�of above. ' � � - � �� � � . acting in my pwfetsional cap'aci[y (S�'dion 7051, Dus� — ' �'1 �'�,Q�{ ��ess und�'roecSslons Code). PERMIT ISSUING FEE S ��'�� -/��� tr:. . . .,.g I.ic.or�crg.No. nace TOTAL FEE'' �(� . PLAN CHECK APPLICANT - , ��'"� - }IO�lE O\VNGR-[3UIL[)ER D[:CLARATIOti . . . . �� '. �' �S.��.�G�.c.. V I . I hereby affirm lhat 1 am exempl from�the Contractor's NAME� � � � . I . � � � License Law for the follnwing reason (Section 7071.5, Busi- '. , ness anJ Prnfessinns Code): ADDRE55 �� �. � 1. as o�vner of tLe prnpertY.«'ill do tha�eork and the� . . , � structure is nn[ intended or offereA for sale (Section ��T� 7EL.NO. � � 7044,Buxiness and Nrnfussinas Code). . � . _�i.�J-GC-'U� ; ❑ OWNER I,as o���ner of ihe property,am esclusiveiy contracting ��ith licensed contr�ctnrs lo eonstruct thi• projcct MAIL _. ' J . , (Sectian 7044,pusinessand Profcssions Coda), ADDR/E�5�5� 6, ,yy�� C045TRUCTION LLINUING ACICNCY CITy JJ��� ��no ' ����I' , I I�zr�by� affirm tiiu[ there is �ci�nstruc[iiin lei��inb a£rncy' CONT AC70 //�/nt� � fur the performance of the uorA for �rhich this permit is fT�y� � - ' � ' -- -� � is.0 d(Sec.3097,Cn.C.). - � � - � - � � ' Lender'shame AODRE�Q�Gj' ��.�/_;�' �. ' � � - � ' � � 'hGpia/ �� � Lendcr'S Adtlress � ��Z. TEL.N � ', . . .. . . . . . 1 certif� that I here resd ihis urplication and s[ate th:�� the -� �� ��' _ .. . . . S ATE LIC. ahoce informatiun is correct.I a;trec to rompiy�ri[h all County �ICFN�����9 CLasF���� . . � . . . . . . ordinonces und State Is�vs rzgulating}3euting,\'rntilating and � l � �� � Air Conditioning.mid hereby aulhoriee represen[atives uf this S6F.RF,VEItSG I�OK I:XI'LANA70RY L:4,1'GI;AGI' . . , . . . . . . Coun[y tu entrr upan the above�mentioncd propeny fnr � � �� � - ` . ' � � ' L�!�.S�i,.[i , [�UfD()Sl'S. . ,. . -m�-c�-�l°?�-�'-1��-�� g .iturrnf"Yermi[tre D�te . , . . .. . . _ ' . . _ . . . .. _ . .:.. . ... .. . .. . . . ... . � � . INSPECTOR'S NOTES � OWKGR-6UILDER DLCLARATION " `�I 6creby aEfirm that�I am e�emp[G�m the Contrattor's . � Liccnsc Law for thc follou�ing rcason(Sertiorr 7031.5;' � , � - . . . . Business and Profersiorss CodeJ� Any city or couttry � . ... �vhtd� requires a permit 10 corts�n+ct. c7ter. tmprove. ' -- ` .. � � ' � - � . demolr,rh,or repair any srrt�eture,prior to itr issuance, � - �a7so requires the applic¢n� for such pe.�mir ro fi!r a � �.. .. ..- ... � - � signed smtemenr diat he is lrcensed pursuanf to Ure � provisians of�he ContraPtor��I.iccii.cc Lcx��Cl�aptcr 9 - • . . � � ' �• . ` . � , (commenci��g �ri�h Sectian 7000J of Dirisiorr 3 oj die , � , �� � � ' IJusirtess and I'rnjessrons CoJeJ o� Jfmt He i.c excrnpt � Urerefrom and the baris Jor 1he afleged exernp7ia�.Any . . .. � � - . � violation of Secrion 703/.5 6v unl'ayPlicm+t foiaPenni� - � � se�bjerts rhe applicanr m o civil pe�mlr��of not more�f�an •` fire fu�r�dred da!(ars(SSOOJ.: . . . ❑ 1,as owncr ot[hc property u�ill dn thc�cock,and t - . � the structurc is not intcnded or offcred tor sale. � � �- —� _ , "�;:- ... -..��•' - (Sec. 70-t-0. Busincsr end Professim�s Code.• TLc Car. . `��� , � tractor's Licen.ce l.ew does not apply to an o�rner of • � property wlro builds or improrra�th^reon,end who does ' � szrch work hrrnselj pro�'rded tlmr surh imprm�ements . a�e not intended or offcred fur sa(e. !f iwx•erer, d�c � � buifdb:g o� inrprorenrenr is sold wrdiin one year of � comp7etian, the m�vrerbuilder wil/ liare rhe burden � - � �� of pro��in� 11�ar he did not b++ifd or impm��e for tlre � '- • `t • _ . . _nurpose oJsalc.) : s '•t, � .�'Q l,as b•,s�ner nf thc peoperev,am exciusively eon- � . . _ � . . �trac[inG tvitG liccnsid cOniraqnrs to cnnstruCt thC projec[ � � � � � � �;(Sec7iori,7044..6usi�rrss a+id Proj.ssions Code:�Tke Con• � - ' bactor's Licensr Law docs rio7 npy!}��=tu�mr owncr oJ � � , . proper7y u�ho buifds or inrprores thercon, and uho � . � , coniracts for such p�ojerts wirh a coirtracror(sJ li�e�ised � )�:,..�'�•. ptvcuant m�he Cnntreerur'c Licertse LaivJ. . � •J'p,-i.,'.��� . . I am ezempt under Sec. , � E fi P.C.for tliis reason �, Date -- . Owner ,``j .`� 1 INSPECTOR'S NOTES -� � •� � �1 �^ - � . . _.. � � - . ' � .. � . - - �. .— �\,