HomeMy WebLinkAboutNo Permit Number (9) �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 nf Il'orAers'Compensatlon Insurance,oi HEATING-V ENTILl1TING-AIR CONDITIONING lJ
U certified cnpy tliereof(Set.JB00,I.ab.C.)
Pn1iEy N�P._WCI.08855Zr��v_Hom�lns
I ❑ Certitied mpy iz fiereny furnlshed. COUNTY OF LOS ANGELES BUILDING AND SAFETY
� Certified copy is filed with the county buitding inepecti�m FOR APPLICANT TO fl�t IPJ 6U�lo�uG
ac arnnenl. AD�RESS �406 S._Lemon_P+venu
Da[e�c.4-83_ApPlicsnt�C1f1t1090 A�C (PRINT OR TYPE ONLY) � � .
LOCALITITR. 30893-A Lot 2 R.H.
CF:RTIFICATIi Oi'GXLAIPTION 1'RO\I 1VORK6RS' NO, TYPE OF APPLIANCE OR E�UIPAIENT FEE
N[AREST }
CO�IPGNSATION II3SURAtiCI: Cn055 ST, n'
(This SeCtiOn need not bC com➢�eted if lltC ��'ork im'ol�'ed AOSORPT�ON UNIT,OTU Colima Rd & Rapidview I'• Q
by the permit is for one hundreJ dollars (S10D) or 1essJ msrnic*�+o. vncce'sseoev . t„)
!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 prrson in any manner � F—�
sn as Io hernme subject to the\Vorkers'Cnmpens;�[inn L:����s. BO��EF.�TU , qpPFiOVALS OATE, IN<�_�Tpq'SSIf,NATUfiE W
Da[e Applicsnt - � COMPRESSOR,BTU_C.P-Q K�YI �_Q � qOUGH a
N
NOTiCE TO.41'1'1-7CrW7:IL a(ter maAing lhis Ccciificatr nf VENTILATION SYSTEM �.� Z
livamption, you shoWd hecnme suhject tn tlie Norkers' FWAL � �—
CompensiHnn prnritions oC the La6or Code,you must f��rth- EVnaonATlvE Coo�ER � VAUDATION
�vith comply with stich provisions nr fhis prrmit sh311 he
deemed re��okrd. FURNACE: FAU— GRp VITY
I.IC1iKSLDCONTRACTOR5DFC1.:11tAT10V FLOOF' �� —Zf�—Y"� `�
I herehy affirm thal[am licenmd under prm�iaions of Chapter HEATER: SUSPENDED UNIT . �
9 (cnmmencing��'ilh Srction 7000)n(DirSsinn J nf the�usi- WALL _
ness and Pro(essions Cnde,and my licence is in fuli foree and � M/��<��l `..,,v I.�� 5t7
effect. ��a'
License vumber—Z69496_ L�c.C�ass C_20 `
� Contfsctor�ontiago�/_C na:�_8-4=83
� I am exempt fMm[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 Req.No. Dutr , TOTAL FEE ��O ::�,� I!.7 A
110\tii 0�5'NER�RllILpGR DLCI.ARATIOPI PLAN CHECK APPLICANT
:ei�•..'.• • .�
] herehy aCfirm that 1 am evrmpt frnm�the Contr3ctor's NAME
License l.aw for�he follo«?ng reason (Srction 7031.5.IIusi-
:�.• •::ll}n
nres and Yro[essinns Code): AOO�ESS �f
u :, :;; ;::�ner of �z Vrnpcils�„iii uu ii�e.vurk anJ fiie CITY TEL.NO. .e�• n,1^.:���� �
<truciute is not��intendeA or oCfered fot sole (Scction
7043.Auxinesc;md Prnfessions Code). ' �$� L—`t j
Q OWNER presley �
I,as ownrr nP�he prnperly,am esdusivCiy rnntrat[ing
vilh licensed contractors to conciruct the prnject ti�AIL
(Seclion 7044,�uainess und Protccsions Code). ADD�ESS 4600_Campus_Dr
COVSTItUCT10N LIiNU1NG AGENCY - ��TY Newport Beach TEL.NO.
1 herchy affirm [hat there is a •>ns[ruction Irndin6,ieency CONTAACTOFI � -
for the performance of ihe work for a'hith Ihis permit is Sdf1t1O O AIC Conditioning , �
issued(Sec.3097. 'iv-C.). �
Lender's Name_�one aooness 50o W. Rowland
i.ender's A�idres� CITV Santa Ana TE'-."o.957-6560 - -
1 ctt�ifl'ih�[I hu��r rcad Ihis application and st.rte th�t ihe STATE UC.
ahnve informslion is correcL I agcee to mmply�v'ith all County ��ceNSE No.269496 CLASS C�2� � -
nrdinancrs and Stste I�o�s reguiatlna Heating,Ven[i�:rting and
Ait Conditinning,and hrreby auihnrise represen[slices nf tl�is SF•.L R7:VF.Ii51S[�OR FXPI,.4NATO1iY LANGUAGF. � � � �
Cou ty, Io rn�er upnn bu� nentioned property fnr .
insp� mi pittrnces. . . � .
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