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HomeMy WebLinkAbout1337A \1'ORRGRS�co��i�r.tis:anounr:ct:�n:�non � cE"-si°s�iz-�m APPLICATION FOR PERMIT � I hrrebY �ffirm Ihat I hare s certificate o(mnsrn� to scl( i . � � inrure,or a certificateo}Wnrkers'Compenvtino lncurence,cir " HEATING-VENTILATING-/11R CONDITIONING a certfied cnpy Ihereof(Sec.3R00,Lah.C.) . ' Pnlicy 4n. Cnmpany � • ' ! COUNTY OF LOS ANGELES I ❑ Crrt�tied c��py is hereby turnishe�. BUI LDINC AND SAFETY � Cerlified rnpy is filyd with Ih r mnty buiidi�g inspe tion -���rr�� 6UILDING p�/tment. FOR APPLICANTTO FILL IN qODFiESS � 1)ate�f�=a�.l�irlicnnt ' _ _ _ _ IP(iINT OR TVPE ONLY) - . LOCALITY�,�L ��r CGR7IFIC:ITL OI"EXES11'TION['R0�714'ORKGRS' NO. TYPE OF APPLIANCE OR EOUIPA7ENT FEE COSIPLNSA710N INSIIttA!2CI> . N[AREST .. � � Mv� a (This section nced�not be cOmpletcd if ihe �carA involved � A650RPTION UNIT;BTU CFOSS 57. i-� b}' [he permit is for onc hundred Jollars (51(10)ur less.) �� � .. I DISTRiCTNO. PFCCESSEDEY . O 1 cerlifY����t in ihe pertnrmance ot Ihe u�ork fnr«hich�his i 111R HANO�ING UNIT,CFM11 ' /� � w `�� O permit is issued,1 shdi nnl rmpluy sny prrs��n in an�•manncr �j� 1V� so as m herome subj=ct tn the\Vnrkers'Com{+ensation La���s. BOILER,OTU I I— �� / � PPPROVALS DATE irvSrECron'SSiGvaTU�e �U Date Applicant � j ICOMPRESSOR,E3TU_b_�r�0 �� � qpUGH a NOTICI'TO AI9'LICANT:If,after maAing this Certi(ic�tr of � ��-' � F.rem tion, VENTILATIONSYSTE�4 FINAL �� ? p you should becnme suhject to thc 11'nrkers' I Compens�tion prarisinns nf ihe L�har Cnde,yn�must f��rth• [V:,PORA7IVE COOL[Ft �eith camply �cith sueh provisinna or this permit shall be I VALIDATION � dcemed recnkeJ. FURNACE: FAU_�GRAVITY_ � LICFCNSISDCOVTRACTORSpi[CLARATION Z FLOOR� t3TU_ �p�00�- �C� 1 hereby affirm that I am licenced under prmisionsofChaptcr HEF�TER: SUSPLNOED UNIT � (commencing�rith Srction 70D0)nf Divisinn 3 of the Busi- WALL - � ness anJ Professinns Code,and my license is in full(arce and �: � �rre�c. Z�7 ` �2a C�i'2/ �-- e.�►ti�rt e cS:u—����d C�- �� i Licenae Number. /�b . Lic.Class.�r _�/ , . � Conimctor i���� Date�l>�� � ❑ : . . . . . , . � . 1 am exempt from the lirensing reyuiremen�s as 1 am a licensed .vchitect or a registered profecaional enp.ineer ' Plan check fee 25 0 of above. � . actin� in my professinnsl cspscity (Section 705I, [1ns- � � inest�nd PrnFessionx Code). PERMIT ISSUING FEE S s d :=� J�7}� Lic,or Itee,Nm Datc TOTAL FEE I O� � i!°' •i+ •Cl � - H0�11i U\5'NLilt-RUILDFR DECLARA7(O*I � ALAN CHECK APPLICANT - Et ' � �i 3.F C I hereby affirm that I am exempt from�the ContractnPs NAME � ��� ��Cj���x License I.sw for ihe follo�cing reason (Sec[ion 7031.5, Pusi• . � - ne�z snA Prnfescinnc Cn�e): AOORE�S . ' 'O 9 '� '��_�, � 1,as�n��nrr of thz pmprrty,�vill dn Ihe�eorA and Il�r � s[ructure is no[ intended or offered fnr s�le (Sr�tinn CITY TEL.NO. 7044,Rusiness and Profcssion5 Cude). � � I,as o�a�ner of the property,am esclusive�y enniracting OWNER �v����S � P��� ��-ith licenstd coNractars to canstruct ihe project MAIL �'7 (Src�ion 704d,iivaine�s and i'mfr«innv CnJe). AODRE55�LDrj.�Z ('�L/MA ' CONSTItUCT10N LGNUIYG AGF.NCY CITY��QL�(�a7— TEI.�n'VO. —��a�� . ! herehy affirm [hat ihere ic a cunstrucliun lending agency' �G� /� �� for the perfnrmance nf ihr ��vrA fur �vhich �his permit is CONTFSACTOR �T±� . issucd(Sea J097,Civ.C.). ' ' � Lender's ti�me ADDRESS /�/,�� /`_ /.y� � � - - - ! [ TC.�'��J f✓ LendePs AAdress CITV� / / .1�/� TEL.NO. J� . , � 1 certify�ha� 1 haee read ihis application and s�ate �h�t �he /� t.t�'•., /7 9�z=�-�y i ❑huec information is cur�ect.t seree In romply�cilh nll Couniy L C NSE NO.��G���7 C AS:�j`�2���'� � ordinancrs anA State laa�s regulating Hesting,Ventila}ing and - � Air Com�'tinninK.������herr6y authnrize rrpresrntatives nf[his � SGG itFiVIiRSIi FOIL LXPI,ANATORY LANGUACE Cuunt fu en[er ipnn lhe •�uee-mrntinned pruperlv fnr � �. insp�.iinn purpo• >. ' � �/7-� �•n.,wrca,1'erru..ire U�te �. � ; �; . - �� -�; . � ; . • � . � ... , . ; i;' 9 .. m . ��•. . � !. � . ;s '+�; •^! f!N ., r ,` Z • ✓� , O ,a y , N ._. ,. ' �• _. " ` Z , , .. N , -p . ' _ .. � , � � . . 'S1 .ry '/ N ' .. O ' ' m N . � ' n , i n . � ` ' l: . " � � � `R $ �n � =� C�� � �. � o �.='� � � .. n �p �'C q v�� ' Q�n� �.;, .....' ....- ,`�',� � � � c�,o � � �� � !: :,C]fr�^`"� ;,cH-0-• '" �-� � • n� G�L '� -• �� n C n �� v� ', C v� y = r A V a: 'r '�� �.' =�G.�c'�v �o � � '�r � c- � = Q = " �0 = = 4 : y 1 � Y f. 4 �C +�L` �. 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