HomeMy WebLinkAbout0529A (4) ,R'OIiK1i1t5'Cq11P1'NSATIOND['CLARATION 7sA3saC
1 herehy affi Jn [hst I ha��e a'certi(icatc of consent [o self CE-fiifl(2801 A�P L IC�T I O fV FO R P E R M IT , �
insure,or a certi(icate of\�'orkrrs'Comprnsatinn Insurance,or HEATING-V ENTILATING-AIR GONDITIONING
:i eerl:fieJ tnnj;y-�re�f;}��{3/A0.I.a���ma�J�
/ I/��r 1 ! /F�
Pnlicy NiGV4 (bmp�ny__ 'f � •
I ❑ CertifieA mpy is harehy furnishrd, � h COUNTY OF LOS ANGELES B L ING AN A ETY
� � ��*,7� � �'01�c��`�� �
J Ce tifie�cop)•is filed�a�ith the c�uniq F+uiiJing inspection FOR APPLICANT TO FILL IN BUILDING/' �
. dr�ir- enf��./ AODRE55 /�1t7�T � �
Da[e'r��_l1-Applicam � (PRINT OR TVPC-ONLV) (�;`"��T-�-(——.--
LOCALITY ,/J//Z p�Q�// ��
CIiRTIf1G�Tl!Ol'liC1i91PT10N rR0\t ll'OR1CIiRS' NO. TYPE OF APPLIANC[OR EQUIPM17ENT F[E ��-�/�J��! F
CO�IPICVS:ITIOV INSUItAtiCG - NE'AREST �.
i
(This <ection necd not 6e completed iF the work im•ohrd A[7SOf�PT10N UNIT,BTV caoss sr��E� �q/�'j(�.��j�-�J O
by tLe permit is for one hundred doilars (S1Q0)or IrssJ OISTRICTNO. PROCESSEOPI' V
1 cerfify thet in Ihe prrfnrmance nf lhe�vurk(nr�vhich this AIR HANDLING UNIT,CFM `O �� �
permit is issued,1 shdi not employ sm�prrson in any mannrr . ' �� �
co a�to becume subjact tn Ihe��'urkrrs'Comprnsation Laws. ROILER,6TU �-
q(� /, /� AF'�'ftOVALS DAT I� TOR'S .GN/+Tt�� (J ,
����� `�P�����"t /� COMPFESSOR,ATUo�/ v 0�_���a�V� ROUGH i� � �
NO"CICIi TD ANPLIC.\NT:IG a(ter making this Certificatr of VENTILATION SYSTER1 I FINAL �� Z
Errmptinn, y�nu should hetnme zubjer[ [o �he \1'nrkers' -
Cnmpent�tion provi�inns o(thc Lahnr Code,you must Gxih�
���ith romply aith such proricions or ihis parmit xhall be �V:.^CR:,TIVC CCOLER i � � �au�a�tbi�
deemed re+�oked. FURNACE: FAU— tt,V T ! .
LIC��SI:OCOtiTRACTORSDl:C7,ARATIOV / FLOOR: a7u l/d�a�/:O� �
I hrrehy affirm that 1 am licensed imder pm��ialuns of Chspter NEA7[R: SUSPENOE�'� UNIT . �
9 (commencing�eith Sretion 7000)nf Uivicinn 3 nf the Ousi� LVALL
ne�c and Profr.�inn5 Cudr,:nd my liren5e is in full(nrce and
effrct. 11/ �/ )
Li�-n�e N/�'•'mh��O��� Lic.Ci�ss��`-'
�arac�.`.-"/�� rlN�a[e—!f-✓-� .
� 1 am ezemp[ from�he licencin;requiremrnts as I am a
Iicensed architect or s regictered profrcci��nsl rnginrrr p�an eheck fee 7.5°6 Of 3bOve.
actin� in my profeaaion3l capacity (Seniun 7051. Rus- �
inrasand��rnfes�innsCode). PERM11171SSUING FEE S
Lic.orRrc.N��. D3te TOTALF[E �_ �'� •
HO\SC OR'N}iR-I3UILDLR DLCI,.4RATIOV � pLAN CHECK APPLICANT
1 here6)' affirm th�t 1 am erem��t from'the C�>ntractor's NAh7E
I.icense Law for the (ulln�eing reasnn (Section 703L5,pusi-
nc�s and I'rn(cs�i�ins C�ic!e): AODR[SS ,
� I. as n:•:r.:: r,f thc p:npr.,.•.�ill Co 1l�::�a:l:ar.J tlic ��57 Q A
x[ruc�urr is not in[ended or offered (or ssle (Section CITY TEL.�JO.
7044,Rusinesc:mdProfcssionsCodc). ,�j/�/ #�'"�• • •8
f,as n�rner ot the m rr[ sm eKNusively contractin OWNER ��j/ � L� •
❑ � P Y'. S O��! ! �l�G��� 9_-'� �I�•488.50
��'ith licensed caniractors to construct [he projtct A4P.IL ['-
(Section 7044,Ducinevs snd Profrssi�ins Code). AODRESS ��J � _��--� •4 8 a 5 O U
,{7 �.
CONSTILUCT70'd LENUING AGHVCY CITY ��! TEL.NO. � ,
1 hrreFS' af(inn [h�t therr is a cunstructinn IendinG,gency �-rJ 1-1.0 9—8��
(or the erfonnance f Ihe �eor� r a-hich1 his �ermJ t ic CONTRACTOR-�/`ici/7�
`�G-.�^'L
icsued(Sec.Jn�-,�v. l � ✓/ / � ,y��,/ � �
I.endrr'sN�m���r�r ��-�'� GJ Ol O`� A�OftE�^ oV- !!�/!L�-✓V_�LT
Lrnder's r\Adresf�V � V�/����r �
CITY�j�����/T T[L.ND. .
r�
I ccrtify that 1 ha��c read Ihis ,.plicat on and statc that thc STAIE •'< < LtC. /'
�bovc infnrnution ia enrrecL I erce�n nmply�rith all County LICFNSE NO3�i2�3 _ CLASS(,� .
ordinancrs:mA State la��� �;ul�ting {cating,Vtntilating and
�Air Com�''nninK.������h rel autho.re l[f'�2FCf11JS1VP5 O(�M1IS sr,r arvt:issF�ro�z rxr�.,�N,aroiav i..a�.cu.�cic
Cu�m��� t• r s up n • r e�mrntionrd pn perlv fnr
��,�ne� �. �, ��ses. ���� �
Sig � 1'e .i;ee Uate
� :
� .
`.. _.
; ' � �
� ' 4 r . ,.
q � . . .1 '
in _ . � -
Q .i .
� , -� . . .
V� , . .
0 _'.�
� �
m _...
N ,
.�
, . Z
N
,t �
� 9
' , N
- ' ' .. O
. � a
'� ' ` N
�
f
.
.
� , .
. . _ • n �`` t" - �
� .. bn� � o � �+� �, �'
. . � `..';P� � _..� N-�., � �� � �
. . � �C � N f��° �. .�'.��� n � i^F'' "' p V % ./.
• O �i � rJ ry,�� i' '� � � v� ^ v�n p�.•�� . i; T�
%'� � ,,,, " C_,' �`,' -•.�a f %' ^►^.,^ " G' - o '° ^' '` �.;��p ^� " N
C l' 6 ` i.�n ..ti _ p � �n O�. � ��:,p �aa�` i� _ '�.-i+
c _ c � o '?o=a -' C y_c v� � �� .`` �n " C..:=^ G
-i ;'O .� _R . «.T t- Y ^ G.b n «�^'�'+ � v.
p n Y v.'C���y;C.7:G -C. � ��, n b^ �." =�.- �^=' ��.�q t�� '^ � �' l��i
. G u " " ^o� f u �.__' 'cn -'c, " ;. n = o-'^ moc .�4 _� �: C'1
• d � `^'-�,�: +-� � —" �� :. - �.c _a ��n�. ,n ^_� ..+" . o .�^'
S'" ° � �, t.�. .". n.�c �r;, � --�v� c � .ia —c �..��.�. �''
• O n ,r � � c � �. ' ,_ co�=�. : '^ �v,� �� y. o �^= :�Cc o .. ,;. .'G
. , �. � � ''� � �n b.. �.. :c C' r_ V C`r' p ' � p p v,O n~ " n ,�". �' � � r
' . n �, n., .. ,,._ �" � x c ^ - G...— q �v c a .• . C�
. . � T � —�.�= c. . c.=•.. n�� ='c �c-J .c��-�" =�' r�' o%r".., �'
. • ; . " i "— �% N C % �=C" � n:= ry � G' . '._n �a—�r r^^ �Y'�' c � r'
' � � � r..�p O .- r C �. =�`_ -N G-� �r'.`^ O .:n '-o v 7 � ''`r
G ^ � � V .. �„ c`^ ,,,.,^ N -• ,.�. ^Q �'t ,_,,,V G'� " = �=(' J�
, • � � v, "^ b� �.'„�� •. �t ` p ry�� `�, Y�G fl � R r.�"�•.-v .^. �;. r- •
�, G ` R f^ =y�C v. .% ` �` ~x �=� '„ , n.^. C .�..,c Y�c �,v'. S i: -� -� O C�" L
���� ^ � n ^,,. .+ C 4 ' ry C p�. .�
, , , f ^ �.'��" r 4+ C' --� p � � �~., q.�_..,,,G "(^' O N '�--+.. � p ry' �
. . ...�, ...V C G i i .�i �.��•^.� tf f � � � � � w p~ N� � w Q
~ r ~ t^ � �.: ^ _' p O !o � C`�:C. G ..
. fl � " � � f+ � G C` �� G � Y. C N v`V�
,' .� i .._.� '` C ^.G f � �q G'G � C ••� G n C " `��� �. h �c v
. . ; • c � p :'' � nfO ,,r•• � c�. :. f � y.,�� , ,o"' � �
_? " = .r-� � ,`�� n v�,�, c ....�
' • . . _..� C �.j n .r'� c a�'� � � c ` _
� . . n G'"" ryG e: "ti�C,�n �~Y f
.. . ,: C�' n �.
. = ±�C _"t'..�
. r�y C,�,�':.
� r