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�cor.�;2:xs•co�,�ri:�s:�iionm.cL.��cnnoti '�"'64C APf'L'ICp,TlO�I FOR PERfJ�IT CE-81[3(=-801 �7 ] hereby� affirm that 1 hace a'certificnte of consent to self �Y . ti� �nsure,or a c�•rNri��t�ot u'orkars'cnmpr��s:�tio�Incur�nce,or . ` HEi'.TING-VENTILATING-AIR CONDITIONING �� u eertified mpy therenC(Sre.3300,Luh.C.) - � PulicS"No. Company ' I ❑ c�n�r._d c�,P��;n�•«n>•r�����i:�•a. COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ dep��n�,�����v>"r�i�d«�w m�•�„u��>i>�,;ia�„f•i��spor����n FOR APPLICANTTO FILL'IN eui�oiNc / n n AODRE55 . ����� flf'����ynt (PRINT OR TVPE ONL�'1 " � - ��—`�� � � LOCALITY CEE2TII�ICATG.OI'f XE11P�f1D\FItO\S 1':OItRE;kS' NO. TYPE OF APPLIANC[OR�QUIPMENT FEE CO.',11'I�;\5:11�10��I`cl;Ii.\VCL.: NEAREST j� -` }� (This sccfion nccd not i�c comptated if ihc �rork incnlvcd ABSORPTION UNIT,6TU � CFO55 ST. ,Cs�f��_ O ��y' i�le FL`lt(:If IS [n( O[IC �ILI�1�Ii'l� �D�l?IS ($(nn)Ui �CSS.� DISTFlICTNO. VROCESSE� (� 1 cCrlify tll.it ii� [tiC (�crfnrn��n�'i•i�f(I�C�t'ur{;fnr��I:iCh tl:i5 AIR HANDLING UNIT,CFM �O ��R�/ � � (�CIfI1tI Iti I.ti�4��.�ti�1;1��Iltil�'R1��I��1'J11)'iJt`f5n(�1I1:IItY R1�t1��f . Q so as��he���me suhj,�ct to tti�\5'�r4:ers'C�amp�•nc�[i��n L��s�s. eOILEfi,8TU F - APPROVALS �ATE INSPECTO�'SS�GNATUflE �U f)ate .�}�rli�,:�n[ COMPRESSOR,BTU � ROUGH NOTICIS TO APF'LICANT: If,oYtcr makinr this Crr[ificate nf VENTILATION SYSTEM ' z i�;xem�tion. S'r�u vl�<,ulil I,r����n�• ��hjc��t lri Ihe \t'nrV:erc' � FINAL .— ComP�ns��linn prncisian;of ihe LuLnr Cade,you must fnrth- �, �v��n cnn,niy� ��i�n sud, �ro.;����„ o: ����s r�•�m�c sn,u ne EVAPOFATIVE COOLER VALIDATION deemed re��n{:c�e1.' FURNACE: FAU—GRAVITY_ LIC1�:fiSI;UCO.^lTR.ACTOI:SDSiCI,:VtATIO?1 FLOOR: oT�V 1 herchy affirr.n[ti�t!am licens^d und�•r��rr���i:ir.�nt of Cha�ter F{EATEf7: SUSPENOE❑ UNIT . 9(cnmmcneing witt�,S.•cti��n^COOJ��f I)ivi,inn 3 of the I3usi- WALL ness;md Prnf<s,ionc CoJe,and mr licen;e is in Tull faree.and � ef(ec�. �/� �'J �=.'_"�� ' C1 U Litense M1umber��J�� Lic.Class , � . � . Contraclor_/,�%��/`K�.�i_�IJate�'.��v�'" � ' . - � 1 am e.�emp[ from the licemirg require�rients�s I am a � ❑ct-�son ,��nn«e o� a r�;�s;rrea profc�siunal enF�������r plan eheck fee 25�b of above. ' actint in my profcssional capacity (Scctiun 7051. Dus- . inesa�nd Prote,e�iono Codr). PERMIT ISSUING FEE$ fp [ic.or R.•y.Ro. D�te TOTAL FEE /L— :>p �1 6 9.3�A ' If0\fi:01'r�1;P,�fi1711,[)f.K D1�:('1.AI:A710\ pLAN CHECK APPLICANT �. ' � . �;�.�.��• •8 ' 1 herriiy aCfirm that f am ece�n��t f��m'tlie (;un�rac[or's N{1M[ � � - . LiCensc I.a��for:hc fuflr��cinF rcason (Scr[ion 10J1.5.Dusi- . �.�''�.�.� �5� � neSs:mJP��r��,.�<,��.,c��a��� nooc�ess �: �.;:'.�� 650� � l,as u�vntt uf ihe propari)',�vill do the�cork and the s:ructure is not intendrd ur o(fercd for sale (Sec[ion CITY TEL.NO. O 3.O�-8'P 70G4.Bu.ine��s�nd Nrr�t�c,i�in.('�>d�). : � - _~OWNER l/,Y �� �G � I,ac n�vner of the propertY. ���� esclusivelY'eontractinv _��jV/J���� � . ���ith li�eii.:eel cr��tra�tnrs to cnnxtruct the prul�ct MAIL �� /a (S�c[iun iG�1.7.Iiusir�.��.s�n�1'rnfc.ssion�Cod�). ADDRESS ���[�'YL����_���Y..!/' CO\STfLUCTI(J�i LL:VUI�:(i AC;I�;NC1' ��T� TEL.NO.� I hereh�� alfinn th�� Ur:re i� a constructiun lending agtncy ���+++ � �� � ' IUr Ihe perlunnunce uf �hr �.�Urk fur whicit this pt•mit is CONTRACTOR�� ` �[� e�o . issue�(Scc.30�7.Civ.C'.). . Lender's 1�me ADDRESS �G"'U �y/�Y�.y,�/!'� _ �- Lender'�Addr���ti _ CITY I�4_L.�'C� TEL.NO.S L/GZ'I�/ � � . 1 ccrtif�� tl::i[ I h:i��e rc:i;l [his a{+;:1ic:itl��n:�n� stat�tliat Ihc �TATE LIC. � 3 abovc in(orm�[i��n i.,c��r�rci.1�;:rc�fn com��ly�t�ith�II Cuunty �LICFNSE-��(]. ���QI CLASS - - � � urdinancas aud St�tr lu�as rcS��latin,:}ie�ling.�'entiluting and � . Air Cunditinnine.und I��errbc su�huriie ret`rr+entnti��rs af this SI�:G RF:VF,}iSFC 60R F;XPLANATOIt}'l.AKGUAGE ' County� [o •nt�r u{+���� ihi. .,I »�•�m�ntic>ii�•� �ro��•rlY fur , . �. � .i�iiis� 'n�l ��ds'�"�7 u��l� I1JIC �r/'�� . . . � INSPECTQR'S NOTES ' O�'�NER•13UILDER DLCLARATION , I hcrchy affirm 1Lat 1 am cxcrnpt from thc Conrractor's � I.iccnsc La�c for tlic fullou'inc rcason(Sertion 703L5. . f>�+riness arrd Proferciotvs Cadcf: .Irty cip' nr tou��n� � � u•fridr requires a perntit to consin�ct, alte�. Lnprace, � � - .. -� . •. • . - - . ' denmfish,or rcpoir m�r strz�ctt�re,piior m its trsaancc, ._ alro rry^�ire.: dre epplicmrr for such perntit fo file a � � rigned sratemerrt tlir.r he rs licensed pwsumtt ro thr ' �- , p�nrisinus ef tl,e Cnnfru[for'c I.rcense /,aw lCGapter 9 . . . _ � .. .. . -�� /convner�ci��„ �orrh Srction 70001 �f Uh�rsion J oJ thc � � � - BusLrrss m:d Profesrio�is CodeJ or tl:at he is exen,nt 7herefront mid r1:e�Gasis fnr the vlfegrd exevrptiar..iny . . .. . ��io!ation nf S�•ctiat 70i1.5 bt'enY aPPlican7 foraVennrr '. � subjecrr dre npplicanr tn a ciril pe�to(tt�of not more tlmre - fire k�+ndred do;lars/SSOOJ.: . � 1,as o�vncr af thc pruperty��cill�u thc�aork,anJ � dic structure i�nnt imended or offered far sale. (Ser. iOY�:, 6i+siners mrd l7oJersiwu Code: The Cmi- - r�ac�ar's Licen.,e La�c dors ��ot appl�� fo mt oirrrer oj pruperfp ieho hurfdr or rmprores theremr.and�rlra daes . . � sucf: worA hirnsrlf prnridcA tLot tucli irnprr ecrnenrr orc rtot iuteirdrd nr oJftrrd for scle. If, imx�crcr, f7te bidldiug or iirrpravcmcrv it tofd within are yrur oj completior., if:e owr.crvbuifder iciil l;are lite burden oj prorirtl thuf he did irat build or intprove for 1he � ' - . . , . . _ . p�npa:stafsalc.l :.� .- . . - �1;�ac o�cncr ol Ihc prup,�ri}':.'ao1.c�clusivcly cun- Iractir.�v:i[h.li^cnsCd Cuntr9ctots[t?�oniltu[�thC prujer[ � ' `(SeCrPat�'704�,-P.usirtess arid�R�ofesrions=CbJr:Tfre Con� . t�arrnr's Licrnse I.a�r dacs �m1 onnr.� ro arr airncr oj � . properrp �rho buildr m ireprares dic�eort, m�d �rGo ronrmcfa for su./t prol�'�ts irrrli o mntmcror(s/ (rccnred � � , p�ul�iemu ro rl:e Contrarror's I.rcc�ue I.arvJ. ,.:,n., f : � � f am excmpt under Sec. , � r � ( I3 fi P.C.for this rcason --'!i:`. . . • . . - . . , , ., f � :G Datc �-. . ' - O«rer INSPECTOR'S NOTES � ' �" �' ' � • � r -� .- . . �.. � .. !