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HomeMy WebLinkAbout1375A \1'ORFI:RS'CO`dl'IitiS:1Tl0�:DCCI.:�RAT10,7 76A�64C 1 herchy affirm �h,� � �,:,,�r ,<<.,��f,�:,�e �r��„s,.n, ��sz�� �E.B,a�z.eo! A P P L IC AT I O N FO R P E R M IT � 9ns��rc,��r a crrti(icste n�p;nrkrra'Comprns�tion Insurance,or HEATING•VENTILATINGAIR CONDITIONING a etrtifird cnpc thcrcnt($ec.3e0a.I_!n.C.) , Pulicy Nu. Cnmp:m� � ! ❑ C.•rtificd rnpr is herehy furnisli d. COUNTY OF LOS ANGELES E3UILDING AND SAFETY � ('artificJ cnp}�i�lit=d�sith thr countr buildinc inspectinn �UILDING // � n- d�p;,r�ro����. FOR APPLICANTTO FILL IN �ooRess /�G 9 /t�.�� /.�`�• D�te :1�i;li:;�nt (PRINT OR TVPE ONLV) LOCALITV -�I- ' C}�;RTII�IC:1'Il�:()I�I:\l�..'.1!'TIC)\I'It0`,1\':Oti}:I'12S' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE F.�-��^-� CO:.iPCV;,1T10\'1\SURA?%CE NEAREST (This seciion need r.o[ i�e completr�.l if 11ie wurk invofved FlnSonPTION UNIT,�TU CROSS ST. �-¢.(.��� O 6y the p:rmif it for o�r Ivin:lrc�J dollars (S100) or Iess.) oisTaicTNo. aaeee=sr ev U I a�crtify �het in th.•p�rfnrntai�cr�if tlic��virA f��r��hich IhiS IAIR HANDLING UNIT.CFR1 /� . � permi�is issued.[sh�ll not employ any prrson in an}�m�nner / 9 I O �n as tn hrcnm±cur�j..ct�n thr^:orkcrs' 'n:npcnsatinn Laws. i�,i� :,.6TU.�/-C-'���'(J OO I- I //�� APPROVALS �nTE IN:PECTC�'SS�GNnTUnE W. 1)ati•�"3�(t1J..1��li.::n���.f� I. COA9PR[SSOR.�TU F10UGH � . 1 .'�OT1CG T():�t'I'I.iC;:1\'f: If,all<r m�iAin��[tii+C�•rfific��f V[NTILATION SYSTLM Z }:rem�tinn, rou shr,ui,f hr���me >��I�jei't tn the 11'rirkrrs' FINAL - Compcns�tinn proeicinn�e�f�h�•I.nhar C��de,}�nu must forth� ��ilh c mply ��ith .urli �r�ivi�inn� nr Ihis rermi[ �h311 he EVAPORltTIVE COOLER VALIDATION JeemeJ,rrvokrd. FURNACF: FAU_GRAVITV_ I.ICI:\SIiUCOV-fRACT�)ILS�I"CLARaT1ON FLOOR� DTU I hereh��;�f(irm Il��it 1 am lice.^..rJ un:i:•r�rn��isirinc�if Cha�ter HEATER: SUSPENDED UNIT 9 (commcncin�wilh S.ction"0�01 nf Divi�ion 7 of thc I)usi- WALL nrac:mJ 1'mfes•in.^.c C'ode.snd m� li:rns:�is in full fo«r�nd cffrct. Licensr Numher �__ I.ic CP�ss . Cnntr::ctor Datr � 1�m e�empt 1'rnm [he Iicrn.ing roquircments as 1 am a uc��ns��t ,r�n��rn �>r o r�;���c��c f p��>t�•�d����i � ��r��r Plan check fee 2590 of above. :�ctinq in ••:•� ^rofr«'.,;^�l cap:::ity (Srctinn '051, Ous� inecs�nd���oi��..too�co��e). I PERMIT 1SSUING FEE S p�s'(J ��3 Z 5 A i TOTAIFEE .�D I.ic.or Itce.\n. Date �`f ��. ... . .8 ff(]\I7;O:`:\i�;2�lil:ll.n�R I)i'('I.:\IiATInV pLAN CHECK APPLICANT f�, ���'�3 Q 5� 1 i�erei,e- �ffirm [h��t 1 .�m c��r.ip� tr��m-�hz L'ontrc[�ir's NAME � � \� ` � •�• •3Q50� l.irense I.:i�r for t6c f�qinw.:ne rc:i�nn (S.clinn 7071.5. Rusi- . nr�e,�n-1 1'r�frs�in�i�C���_l: ADDRCSS ❑ �. :i<<r.tn�� �r�i��•„ :.r.,,,;n,o, u,.., ,.p ,�� tr,e � � 0 2�3�8 4 sttucinrr i ut intenJrd �+r offrrcd fur slile (Sec�ion CITY TEL.NO. ' 703.i.H���inr�v.�n;t f'ri�fr.���,�n.!'r�de1. . . • ' . 1,as u�rncr of ihc prnperq•.:irn ecdurivrly rontrsMing OLS'NER ❑ _ er���i.aa�.,CODCCISO �,-t�n rcc�,<r,� �d�,i�:��«,�s » ��,��«�<< n,� ��„�e��� MAII (tiei�liun 70;4.Ilucir±.s an.I Profc«{��-.�Code). nDDRESS��,.�� �1 Q���R_�('` -a COI�STRL'CTIOV Lf`dDI\C.\(:I(vCY CITYO � TEL NO.q�1�-1QC�_ I herrhy :iitirm �h��t ther, is a cunstruction Irndin�_ezncy lal.rc'Ac�, � � f�ir the pc;(orm�nrc nt t'ir �•:urF; f��r i��hii�h tliis ��r�mit is CONTRACTOR • Is�ued(S�•C.JOY7.C�iv.(;.). t.en���r��:��„�• noor,�ss I.rnder's Addrett CITY TCL.NO. • 1 certify�tli�t I h.i��e r�•�i�l ihis:��,�,lii��iti�n.�nd slste that ihr STATE LIC. � ah���e infnrm��tinn i:cnrrect.1:: rer�n r�rtl'IS'��ilh all Cuunty LICENSE NO. 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