HomeMy WebLinkAbout1313A (7) \VORi<IIRS'COh1PIiN5ATl01�1)F.CLAR.AT[ON 76A364C �
1 hereby-af(irm Ihat I hare a certificate uf consent to srlt CE-818(2�8D) A p P L ICl�T I O N �O R P E R M IT
insure,uracerti(icateolR'orkers'Cnmpensationlnsurance,oi HEATING-VENTILATING-AIR CONDITIDNING
�certified copy thereof(Sec.3800,Lafi.CJ �
Policy No. Compan}• '
COUNTV OF LOS ANGELES BUILDING AND SAFETY
� ❑ Cer(ifird cnpy is hereby furnished. � �
� Crttified cnpy is filed w�ith the cnunty building insPection
departmcnt. FOR APPUCANT TO FI LL IN ttui�oirve, /�� � � .�
Da[e A�pli[nnt (PFiINT OR TYP[ONLY) A�DR[SS u
LOCAIITY �/�
CIiRTIFICAT£OF EXF.!.11'7ION FRO\t R'ORKi;RS' NO, TVPE OF APALIANCE OR EQUIPA9ENT FEE
CO\iPENSATfON INSURANCG NEAREST _ �,
(Tlus 5ectiOn need not be Completcd if ihe tsoik involved ABSORPTION UNIT,6TU CROSS ST. � O
6y thc permit is fnr nnc hnndred dnllars ($]00) or Icss.) CISTR!CTNO. _PPCCESSE�BY V
f cer�ify ihnt in the performance oC the avnrk(or which this AIR NANDLING UNIT,CFM /a �� �
permit is issueJ,I 5hail�ol employ any ners n'n any m�nnet �
so as to hecome subje[t tn the y"qrh�s o ^ �is�tion La�vs. Q i��i,6TU_���_M� ! �(Q�� F
�� �/,� ; - � � I .APPROVALS DATE tNSPECToa'SSiGvnrUBE W
Date�,�(;___ 4pplicant/t" •- � COMPRESSOR,BTV ROUGH �'
�
M1OTIC[TO 1'CLICA�IT:Jf,after ma,.�g this CertiCcute of VENTILATION SVSTEM FINA� z
F.xemp�inn, yuu should become suhject to Ihe R'arAers' —
Cnmpensatinn prrn�iai�ms of the Labor Code,ynu must for[fi-
�.�i�n com � ���im sucn permit shan ne EVAPORATIVE COOL[ft VALIDATION
P y provisionc or Ihis
deemed revnked. � � FURNl10E: Fl�U_GRAVITY_ .
LICIiNSLDCONTRACTORSDIfCLARA7iON FLOORr BTU
I hereby aftirm tiiat!um licenzed under provisions otChaFt�� HEATER: SUSPENDED UNIT -
9 (commencing with Section 7000)of Division 3 af the�usi- wALI �
neas and 1'rnfessions Code,znd my license is in full torce and
effcct. �
i�License Numlier��`�� 1.ia Class�7`
Cnniractor L�'��o��Date_�l�_��
� 1 am exempt from the licensing reyuiremen[s as I am a �
Iicensed�architect nr a regictcred profrssional engineer p�an check fee 25°6 of above. $1 3 1�.3�A
actin; in my proRscionsl eapacity (Sec[ion 7051, Dus-
iness and�rofessions Cnde). PERMIT ISSUING FEE S � sp `/L � ,� ' /� $� a
D �p��.✓'` • . . . • '..
I.ic.orxeg.No. natc TOTAL FEE o'f0 S� / �� (Y`
I • •2Q50
HO'�11i 05CYGk�[�UILf7F.R DtiCLARATIDN pLAN CHECK APPLICANT ' � ,
�Pf.• • •20.5��
1 hereby affitm that I am exempt from-the Cnntrattor's NAME . .��� • •
License l.aw fnr the fallo�cing re�son (Section 7031.5,F3usi� O��.S O�S'A
necs nnd Professinns Cnde): ADDRESS .
� I, as oi��ner of the pr<iperty.��'ill do the aork and the
structure is not intended or offered (or sale (Section CITY 7EL.NO.
O7044,F3usiness and Pmfessions CoJe). ��r���
1,as owner of the property, sm exclusively contr:�cting 05NNER `
«•ith licrnsrd contractors [o ronstruct �he prnject MAIL i ^� �/�(\
(Section 7044,0usinec5 and Prolr�sions CodeJ. AODFlESS^\ `�t� � \�r����� Ceinyoun
COVSTI2UCTIONLI:NDINCAGINCY '�, CITV 4 ��^�n,._�_l ��,TEL•NC��1 ��a� �
�—• c���[L1`�_
I hereby affirm Iha[ [here is a cunstructiun lending a4ency
fot �he perCormsnce of[he �vpr4: fur n�hich�[his permit is CONTF7ACTO��Q���rY C (ls - .
i5sued(Sea 3097,Civ,C.). ��— �
Lender'sName AODRE55 �0,4� �ri�� ���j^0 �
_.�„�
Lender'sAAdress CITV �)�1��� TEL.NO.� �'I,.l.l
1 certity ihat 1 havc re�d this apFlication and state ihat the � �
ahovc informstion is corcett.I aercc to cnmph�.rith all County LICE SE NO. �����a�ASS _ _
ordinances and State laws re4uluting Hesting,Ventila�ing and
Aif Conditinning,and hzreh a�thorize representa�ires oC this SGG KIiVCItSti GOR GXYLANATORY I.ANCUAGIC � �
r y cntcr u ro t�e �osa�mrntiunrd roperly or -
iape [i�,�iurpo s. �� .
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