HomeMy WebLinkAboutNo Permit Number (8) �40RKG:RS'C0�1VIiNSA7IOVDfCLAIiATION � � �En91flC(2B0) APPLICATION FOR PERMIT y'
I heTeby affirm'that I Inve a ccrtificate nf consent to self ��
insure,or a ceriificate of Il'orkers'Compensatlon Insurance,oi HEATING-V ENTILATING-AIR CONDITIONING lJ
U certified cnpy tliereof(Set.JB00,I.ab.C.)
Pn1iEy N�P._WCI.08855Zr��v_Hom�lns
� ❑ Certitied rnpy iz fiereby fumkhed. COUNTY OF LOS ANGELES BUILDING AND SAFETY
� Certified copy is fileJ�vith the county buitding inepection FOR APPLICANT TO flLt IPJ 6U1�DING
ae arnnenl. AD�RESS �406 S._Lemon_P+venu
Da[e�c.4-83._ApPlicsnt�ClfltlOC]O A�C (PRINT OR TYPE ONLY) � � .
LOCALITITR. 30893-A Lot 2 R.H.
CF:RTIFICATIi Oi'GXGAIPTION 1'RO\I 1VORKF:RS' NO, TYPE OF APPLIANCE OR E�UIPAIENT FEE
N[AREST }
Cp�1PGN5ATION 113SURAtiCIi Cf1055 ST, n'
(This SeCtiOn need not bC com➢�eted if lltC ��'ork im'ol�'ed AOSORPT�ON UNIT,�7U Colima Rd & Rapidview I'• Q
by thc permit is for one hundreJ doltars (510D) or less.) D�SiRICT�iO. P�CCE'SSE�B� U
!cerlify that in ihe pettormance o(the wnrk fnr ichich ihis AIP HANDL�NG UNIT,CFh7 �r'/a/��� O
permi[is is5ued,1 shail nn[empiny any prrsnn in any manner � F-�
sn as lo hernme subject tn the tVorkcrs'Compens;�[inn L:����s. BO��EFi.OTU , qpPFiOVALS OATE, IN<�_�Tpq'SSIf,NATUfiE W
Da[e Applicsnt - � COMPRESSOR,BTU_C.P-Q K��I �_Q � qOUGH a
N
NOTiCE TO.41'1'I-7Cr\NT:IL a(ter maAing lhis Ccciificatr nf VENTILATION SYSTEM �.� Z
livam{�tion, you shoWd hecnme suhject tn tlie Norkers' FWAL � �-
CompznsiHnn prm•itions of the La6or Code,you must f��rth- EVnaonATlvE Coo�ER � VAUDATION
�vith comply with stich provisions nr fhis pefmit sh311 he
deemed re��okrd. FURNACE: FAU- GR,QvITV
I.IC1iKSLDCONTRACTOR5DFC1.:11tAT10V FLOOF' �� —Zf�-1""` `�
I herehy affirm thal[am licensed under prrn�iaions of Chapter HEATER: SUSPENDED UNIT _ �
9 (cnmmencing���i�h Srctinn 7000)n(Disisinn J nf the D��si- LNALL _
ness and Pm(essions Cnde,and my licence is in fuli foree and � —�^'1 ``+.,,� �.�� 5� �
effect. (eJ 1�—I-a`'
License vumber-Z69496_ L�c.C�ass C_20 - " `
� Contf�ctor.�ontiago�A/_C na:�_8-4=83
� I am exempt from[he licensing requirements as I am a `
�p licensrd architect or � registered professional engineer plan th0ek fe2 25°0 of�hovC. ;1
\� sctinF in my professionsl cap�eity (Section 7051, E3us- pERMIT ISSUING FEE$ j Q �0 �
1 iness and Prnfes.inns Code).-
I.ie.or Re4.No. Dutr , TOTAL FEE ��O :?�,� I!.7 A
110\tIi 0�5'NER�R1JILpt?R DLCI.ARATIOPI PLAN CHECK APPLICANT
:ii�•..'.• • .�
I herehy atfirm that 1 am esempt frnm-the Contr3ctor's NAME
License l.aw for�he follo«?ng reason (Sr�tion 7031.5.IIusi-
:�.• •::ll}n
ness and Yro[essinns Code): AOO�E55 �f
�j :, as ;::�r�er of �z Vrnpcils��.iii uu ii�e.vurk anJ iiie CITY TEL.NO. .e�• n;1^.l�l��� �
atruciute is not��intendeA or offered fot sale (Scction
7043,Auxinesc;ind Prnfessions Code). ' ��� L-`�j
Q OWNER presley �
I,as ownrr nP�he prnperly,am esdusivCly cnntrat[ing
+vi1h licensed contractors to conciruct the prnject ti�AIL
(Seclion 7034,[ivainess snd YToCccsions Code). ADDRESS 4600_Campus_Dr
CITY TEL.NO.
COVSTItUCT10N LIiNU1NG AGENCY � NEWPO[Y BedCll
1 herchy affirm [hat there is a •>ns[rudion Iendin6 neency CONTAACTOFI � -
for the performance of ihe�vork for a'hith Ihis permit is SdIlt1O O AIC Conditioning , �
istued(Sec.3097. 'i�'-C.). �
Lender's Name_�one aooness 50o W. Rowland
f.ender's AdJres� CITV Santa Ana TE'-."o.957-6560 - -
1 cctiify ih�[I hu��r rcad Ihis application and st.�te th�t ihe STATE L�C.
ahnve informslinn is correcL I agcee to mmply�v'ith all County uceNSE No.269496 CLASS C�Zd � -
nrdinancr5 and Stste I��ez reguiatlna Heating,Ven[i�:rting and
Ait Conditinning,and hrreby aulhnrise represen[stices nf tl�is SF•.L R7:VF.IiSIS S�OR FXPI,.4NATO1iY LANGUAGF. � � � �
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