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HomeMy WebLinkAbout1817A (10) \':ORKCRS'CO�IPF.NSATIOYDLiCLARAT]ON� ' � 76A�G4C . � 1 hereby affirm that [ have u'cer�ificate otconsant to sr,� . .�E-$,e�2-Bo, .. . . .AP6'L.IG�TIOf�! FOR PERf�iIT � insure,oracertificateo({4i�rkers'Compensationlnsurence,oi HEATING-VENTILATINGAIR CONDITIONING a certifizd cnpp thereof(Sec.3800�,L•/�j_yJ � P�',l�ifc�1�c�-/Q��Com�an>'�.c/i'^-�=� - : . . .. � �(Ccrtitird covy is herchy turnished. � COUNTY OF LOS ANGELES _ BUILDING AND SAFETY i � � (:ertified ec�py i5 filed k�ith the councy'buildinF�nspeetion ' .. 6UILDING department. FOR APPLICANT TO FI LL IN .Date Applican[ (PRINT OR TYPE ON�Y) ADDRE55 ��/ _ _ � LOCALITY�Il _ C112T[FICATE OG EkL'�1PTION I'RO\I\COIi}:E;RS' NO. TVPE OF APPLIANCE OFl EQUIPMFNT FEE (/L/ CO��IPEN5:ITION INSURANCC � NE } ('I�hii SeCtion neCd not be completed if the work invOlvCd ABSORPTION UNIT,6TU -by thc permit is for one�hundred dollars (S10D) or ICSS.� � OISfFlICTNO VROCESSED9'! (J � 1 certify that in the performance of the���ork far«hicl�Ihis AIR HANOLING UNIT,CFM � '. � , ��'/ 1 7 � permit is issued,1 shall not employ ony parson in any manner . I � � � � so as[o Lecome subjecl to tl�e 1�'orkers�Com�+ensotian Laws. BOILER,8TU I F- ' ' " � � � APPROVAL, DATE iNSVECTC�'SSiGNnTUAE U Date Applicant COMPftE5S0�2,�TU a ROUGH ' y NOTICL TO AYNLIC.ANT: If,af[er making�his Ccr[ific�ta ot VENTILATION SYSTEM - FINAL �_ z lixempti��n, pou should become subjec[ [o the L5'orAers' - � Compens�[ion provisinns of the Labor Code,you muxt forih- � � � - -�� �� �� . - �lnn compiy w��n s�c�, pro��t�o�u o� u,�, permit SI18II n� evaPo�nnve coo�ea VALIDATILN deemeA revoked. � � ' ' FURNACE: FAU_GiIAVITY.. - LICI:NS}?pCONTRqCTORS�ECI.ARATIOV FLOOFi� BTU_ . . 1 hereby affirm that 1 am licensed undtr provisiuns otChapter HEATER: SUSPEND[O . UNIT 9 (cnmmincing�vith S¢ction 7000)of Uivisinn 3 of Ihe f3usi- bV4LL �� � �- � � - � � ness and PrnPossiuns Code.and my license is in full force and � S�_e�J1r.SGf�/� - effect. �J �, � � � � - � O� License Numbe(���`]Lic.Cl�sz��y1- ��. . „����Z����LVlLL�yJ Dutz_Y/i-(/�— ��C��J�f�� . . . . . . . . . . . . Contrac ❑ ' n en�rl�p[�lri'1��ensing reyuiremen[s at I am a licensed arehitect oi a registered proCessionat engincer Plan ChCCk 1ee 25°'0 of nbOVC. ' ' acting in my professionsl capacity (Scctiun 7051, Dus- � � � +�_-�• � ' � � � � � � -� - � � inrss e�d 7�rot'cssions c�>ec). PERMIT ISSUING FEE S �`� � �i•�=" _ � Lic.or Eteg.Nu. D�tu TOTAL FEE � . � � fIOAIIi O\5'NER-DUILUC.R DF:CI,ARATION . . ���D . ... . . ' . - . . . , PLAN CHECK APPLICANT �181.7A 1 hereby af(irm that I am exemp[ from-ihe Conir�c[or's . NAME � .. . � �!��ie k 'e •8 ' License Law fur the fullo�ving mason (Section 7031.S,�Busi- ' ness and Professions C��de): A�DRESS 'I`',���.v 0 . � 1, us owner ot the proprrtY��t�ill do Ihc work and Ihe . . . . , sVucturr iti no[ intendtd or offered for sale (Section CITY TEL.NO, ��., ;�G 3��� 7044,Busines.und Profcssions Code). . � � ' ' OO W N E R � '., .•1 F�.E�s� i H� [,as ov.�nar of the property,am exclusively contracting �. with licensed conlrac[ors to consttuct the praject MAIL � . , (Sectian 7034,Elusiness�nd Profesnions Code). ADDF1E55 ' COM1STILUCTION LL'NUING AGI;NCY' CITY � T[L.NO. . � � [ hercl y affirm that thrre is a eunatruction lendmg agency �� -,� f`��� . - . _ v i�ii i� . � . .. ... � ur the perCorm�nce of the aorA tur a�hich this prrout is CONTFlAC � - - � issucd(Sec.3097,Civ.CJ. ,J � . . . � �� �� � . � Lrnder's Neme A�ORES �� �'{� '- ' ' � - ' --"� ' - Lendrr'sAddrect � CITV ip _T.. ��(� TEL.Nv��� . �, , . ..., .__ Lc�W — � 1 certify tliat 1 have read th�s appi�tution and statc Ihat thr STAT[ �L10. � � . � ab��c infnrm�tian is correcl.[aPrcc.In compl>����ith ull Count�� LICFNSF �G CLnSS . ,. . . . . . . . .. . ordinances and Stete la�cs rrgul�ting}ievting,VrnulaUng and � Air Conditinninc,ond hereby authoriee representulivas of this SI:f.RI:�'6KSG FOR tikPI.ANATORY I,AtM1C7UAGIS � • . .. . . . .. _ . . Counry m entrr upon ihe aUhve-mentioned propert>� for � � � � � � n purpnsrjs. � /� L s`,��=��-�1�.��� � INSPECTOfi'S NOTES ' � . , , OWNER-I3UILDER DLCLARATION � � - ��i hercLy afCirm that 1 am cscmpt from thc Controctor's . License La��• toc thc following rcason(Seetiorr 7031.5, � 6usiners and Ao(esriont Codt/: Ar�v city nr county _ - -�-� � x�hRfi�reqierres a permit ta cwirrrurt, alrer. Improve, '"' + - ' -� _ �` � . demalrsd,or repair aey strucn+re,prior!o ltr issumtcc, , • afso requi�es the eppfrcanr for sirch permrt to file a � , ' ' � �- � � sign:d staremenr tliQt he ir licensed Ot�rsuonr to rhe `' `� ', .a prorisiorrs of Ure Co�uraafur's License Law(ChaAter 9 -_ • � ., ,.� '> . , . .`���\� (commenriirg �rrd� Secrion 7000J of Diririan 3 af�Le _ � � � ` ' �� Businesr mtJ Professro�rs CodeJ or Umt 1ie is e.rempt . � therefront and d:e besis Jor dte al7eXed exernption.Any . _ - ` • - viofetion of Sectroir 7031.5 bp any app(icam for a permit , � . subjects the applicant ro a ciri!penalty of not more tharr . � jii•e hturdred dollarr(SS001�� - ' ' ❑ 1,as o�encr of thc property�vill do[hc�cork,and � '�� . the strucmre is mt intended or offered for sa�e. _�. �� .. -'- � . � . - (Sec. 7044. Biisi�ress arrd Projessions-Codr: Tlie Cai- � trac�or's� Lite�ae Law doer not appfv to an aw�ncr of , - property k•ho bieild.c or irnproves drereon,arrd�rGo does - tuch work iiimself proricled tlrar n�dr tmProrements are not in7enJeJ or offe�ed for sc(e. !J, ltoHrrer, thc - buildir�g or irriproremen� i.c sold wiJhir� one year oj � , , compfetion. �8e oicner�builder wi(1 ka�•e d+e be��de�� � - af p�orirtg rf�at Ire did nnt build or rmprore Jor dae . . . . � purposc of ralc.J .. , �� � - - �'� .�0 I,as ow�ncr of thc P�opertp;am'ctdusively con- � .. , . . . . _ , tncting�cith littnscd cunteacton�o nmsVuct dic project � � � . './$eciioh�70-03;�Itusiness and 1'rolPrriom�Code:Tke Con- . �trac�or's I.iceirse Law dacs rwl�appfy to eri�owuer of property u�ho bui(ds or im�rores d�e�ear, and icho � cartrac�s for sud+p�ojertr witlr a rwurarror(sJ lireiired � . {� ,. punumR(o fGe CaU�affor s LiCense LmvJ. . . "����,�•,. _ I am exempt undcr Sec. � B&P.C.for this reason � Datc Owner , INSPECTOR'S NOTES - - � � . � - . � �\. �i\ _ _ �. , �