Loading...
HomeMy WebLinkAbout1395A (7) � WORKERS•�oMPENSAT�oN oE��RAT�oN � � APPLICATION FOR. PERMIT � I hereby'afircm thcl I have a certiFico�e of consent to self insur�,or a certifcate of Workers'Compensation Inwrance,. HEATING - VENTILATING - AIR CONDITIONING or a certifi d topy thereof(Sec.3800, ob.C.) )6A35<C . I/�Z71 • cE-aiecaev.ioiei) � P❑olity ompeny /�i . _. .. _ . . Certified copy is hereby furnishe . COUNTY OF LOS ANGELES - BUILDING AND SAFETY ��Certified copy is filed with the touny building inspeo- FOR APPLICANT TO FILL IN Bui�oiNG � s' ���, �'i hon depor men1. /,�J (pRIM OR TYPE ONtY) AD�RESS � �Dat�I�� ' APPlicant '✓ � c LOCALITY (.�257 � NO. TYPE OF APPLIANCE OR EQUIPMENT � FEE � CERTIFICATE OF EXEMPTION FROM WORKERS' � NEaREST �� � � COMPENSATIONINSURANCE' � CROSSST. � (Thif�ectton naod not be tomplefed if fhe work involvad 6y _ ABSORPTION UNIT,BTU �iS�R�Ci ruo. Prsoc[ss[o ar the parmif Is ior one hundred dol�ars(SI00)or lass.) 1 D �Q\p�� AIR HAN�IING UNIT,CFM L I cerlify that in the performonce of the work for which this.. - � permil is issued,I shall not employ any person'in ony manner gOILER,BtU - — so as to become tubjecl lo Ihe Workers'Compensa�ion laws. _ 'I .+crcovnis DAtE INSpEQOR'S SIGNATURE . COMPRESSOR,BTU Y���� /� ROUGH y a Date Applicant � NOTICE TO APPLICANT: I(, ofler moking this Certificote of�� VENTILATION SVSTEM iINAL r2 c� �G- Exemption, you shoold become'sabject ro the Worke�s' _ Compensotion prbvisions cf tho labor Ccde,ycv musl fcrfh- �/qFpRqiiV[COOLER VAUDATION �winc �omply with soch provisions or this permit shall be deemedrevOked. � - � � � - FURNA�E: FAU_Gq�A1�JY /T . � � � LIGENSED CONTRACTORS DECLARATION FtooR BTU �o v . I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: . SUSPENDED � UNIT_ � ' .'(commencing with$eUion 700D)of Division 3 of�he Business WA« and Professions Code,and my license is in t�ll forc ond effetl. } �1�.3�1 '? Z °u Litense Number Lia Class� � . ► �1 3 9•5 Ci ri:��- � Contractor Dale �• • • • •£j 0 V � I om exempt under Sec.� � _ - - � - � � - � • ��J.zi,C Jr a Plan check fee �n B.&P.C.for ihis reason _. PERMIT ISSUING FEE S !d e o ^5�,?_5� � Daie: TOTAL FEE_ S3 Z� 0 9.0 7—8 8 Signature OWNER-BUILDER DECLARATION � PIAN CHECK APPLICANT . � I hereby offirm that I am eaempt from the Contraclor's License . ► Law for the foilowing reason(Section 7031.5,Business and NAME Professions Code): - ' - � � - -- ❑ I, as owner of the propery, or my employees with ADDRE55 -� �woges as their sole compensotion,will do the work ahd �in, � TE� NO � the structure is not intended or ofiered for sole(Section - 7044,Business and Professions Code). � �. OWNER ��� � ❑ I,as owner of the property,am exclosively contrading �� / ^/ with licensed conlrat�ors to conshutf Ihe project(Sec• � ADDRE55 � tion 7044,6usiness and Professions Code). ' CONSTRUCTION IENDING AGENCY � - ` �Itt ' - " f� .�NO.� - �,� I hereby affirm�hal there is a tonstruttion lending agenty for fhe performance of the work for which�his permit is issued � �ONTRACTOR � � � �� , . (Sec.3097,Civ.C.). ._._ . . . . -. .". -.- . ... . � ADDRESS. . __ � . ._. _ ... .. .. .. . _. �.. _ -t. . .. . . _ _ _ Lender's Nome - CITY . . . TEL NO.'l� - - �- - � - Lender's Address STniE ( ��/�.(� UC. q � � I certify that I have read Ihis application ond state thal Iha IICENSE rv0.��y 1"....5 7 CLA55 �r�W -� �-� -- � ---� --------- - -- -- ------- - � � above information is mrrect.1 agree to mmply wiih all County . ordinantes and Sto�e laws rela�ing to building constrodion, _ ,� _ . . . . .. ..._. . - . ' . . and hereby oothorize representatives of Ihis Coanty to enier . . apon e obove-men�:aned property for inspedion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE zr— Siq oture ot A plicont or Agent ��e � � . . . . .. . . . . . . . ... . __ -_� ,- --,... � i , . , , � : � � I�'.` . . �� ' y' . . _ `'� �� ' ' � � . . ,' , � . _ i, . _ . - i. ��; � , _.' � , N . r,� ��.' � �I .I`,t '- —_�I ,f.• . . .,`r _ . . "0 ^ .�i � ' � . ; . .. . fl . . , . ! � ' _ r' ,.. ... � . . , . N , ' 1�' , . . � � �, -- , J. � . t^ ` . N . � . � ' . � . � . . , � '� - � . . � i � . . . ' . � ' . , . . . �. . � 'I . ... •• . ' '� " � . ! ,�.- -- ... - i .. . _ . .. ` � . . .. . ..-- ^ '" . i i , ._ . . " ` ' . ' _ . �-- �- . . '� . ; � 1� - � ��,�: �, _ . . j ' [.r 'I ' . ,` 1 , ' , 1 R 1 j ' ' ' , � .� , j 1, ' ,�' . N .. i � I',� I ` . �. �I� ,j � � { . 7r7 1 . • - i . .. � � N � � � � � . ' .. , I O � f . � ,. . � � � .. ' , . N , t ; • , � �� '� . � . . .. - . } . . '�� . -- -. - , _ • ' ', :i � ., ��, _ . _ �� •, . ��. ..•: �� � • � � - � � , � , , .� , . . . . _. , , � . . . . ' ..... .__.� . _ � � 3�� o � c' � T . �" � o � �o.N��n f1 � � � m , � ; � ; , : � f o,'�^� � ��.+ �� " a 3 m m ��m m v . � � � i , . � � •.7 O 3 7 � �..�.IL , .. N Q N�O m �, . . n o v,_ n� n ?.T- � � �-� . �. , " . O LD�� ��Q �0 Tp a'.^ '. ,�'N O p_sb'�p� O� O K.� O�V�p.0 1p a��j � Q• ;� .. , : O n R°- 3 'i , n a-'_ y,� q - �.ma `-'° �c �° o °°.gNav � � °- _. - - - _ �.. _' m' ;� X , ?0 0.�,A f r p c m o � N-� m,�,,o a���:o o .-_'Q N 3.o ° 3._. � - � . - - � i - � -�. �. . �� fJ . 0 a� �n M S,tl '' ro�O +o�.r�m '^. � • ' O a�7'- m ii fl � '� �7 O _ . r� " . � . - - . p '..� O �^ � omn.� 'O �NhO � £ v, � -�. a�.�XSQ �.N � COO � � G �. � , . -� � o" cc < �-N • o n m'o-�_r-m � o � o,a r- , • �- c � � � m � � � s°°-a�O � a '-° ° 3� • o.a °-N m N'� g Q . � • �'ro o N m ra o °-^m o u. a r._ ..� .�.i,�'" � f-o c - n� � rn . . _ � c��c � > j °'< � � aO,. oaf Ha`H° 'o;v�.� °-oo'� Wn� �'o. �.�a•m� '� �'� o o T c Nn ,� � a ,S 's s oa,a � '� o, v _ ��o � C7 • - � u' i �° � °�3fl T� 3 �° �-� o0 oa-' 3 o ❑ m e' .D rT' - l o ' cm+ o ��'a o� `� vo _ wvN - ° vDt= �.�° .�. 3o Din n - '�I ' � . . 7 . � p 4.D O �l-. ..¢ C � :"� 'W ii' O,� 3.O 7".,. .w-N t0 3 O w. � " . � � �� , - � �i �S.mv co ov c o.c �.�.� o K '0-3'� � v, ,o° o � o o � ', � ' ; =° ;`�'N a'c� v �-c o • 'O � `� f A � <_ ,� c �- 3 ' ' 3 D' , - . _ _ . . ;� I �„ o ' � �4 . .a�'c .�.. - M � m a m ' , . - 1 •�C � ��„ �:�..1p'�,O G� 3'7.�O.� �C p-p 7 p tf 'N.C, O vf 7� -�1 � ' , I -� ° ^ n o `m' o cLo n.o a o o;:.. �.� g o a ° K.� �'°' •O 0- .� 3 <, � �u J ` _ , .' " • j 4 �o o.? � °o �� . � �� !o o ����a. �o N co� c �o :Z , . . N �-f m'^ % � �� �-3D�---r°� < �_ona> > o � �' ?.. - . � . c � --« ^ m . " . , ' � n.� '�'-�^- � �9 �'3o Q.� �o,m�, f =.� T�� � o.° 3� op - ' _ ' ' ' . - � . . � ,. '.'O O p Q �.in � S ID C �n ��O..O �F ';'O'�O'O� 'O'-�'U. O �'�.�_,p. . - . ' . ' � � � .. � .�, �,�.n CJ:O • � O [1� m 0.�� a'p + O �j�. _.� � 7?�'n�n ' ' . . . . , . . - _ � O �� �V�G .. N; �p � ^� n �•� d�� �N �'� _ ot_� � o � � .. - . . � 1, i a'.'" � a m o c�a o �-�c • . , . . . ~ � n � d . -� , .. -. - . _ O �G