Loading...
HomeMy WebLinkAbout1412A (7) WORKERr�oMPENSAT�oNOE��ARAT�oN ;. �APPLICATION FOR PERMIT � , �hereby'affkrrm thai I have a tertifimta of conseN fo selF insure,or a certificate of Workeri Compensaron Insuronce, HEATING - VENTILATING - AIR CONDITIONING or a certi(ed copy the eo (Sec.3800,� b.C.) , � ���� � � � � , �'n �I�� �CE.8I8(REV.10/81) . . - � . � ' � . �� P❑oli�cy��a� ompany � � � ertified copy is hereby fumished. - COUNTY OF LOS ANGELE$ - - BUILDING AND SAFETY �Certified topy is filed w�th the counry building tnspec- FOR APPLICANT TO FILL IN BUIIDING� f`f lion depar�lm'e/N. (PRINT OR TYPE ONLY) ADDRESS � �i� . �� Date��/� V a �APPIimM� A��� LOCAIITY �Z NO. TYPE OF AP7LIANCE OR EOUIPMEM - � fEE NEAREST /� CERTIFICATE OF EXEMPTION FROAM1 WORKERS' - � CROSS Si. �L�Y � / /y( COMPENSATION INSURANCE - ABSORFTION UNI7,B7U ,(This settlon naed no}be complated if fhe work Involved by DiSfRiCi NO. PaOCE55ED BY �he permit Is for one hundrad dollars(f100)or leta.) y � � ` AIR HANDLING UNIT,CFM � I certify thol in ihe performance of the work for which ihis-�-- , , � Q���(� � - — pe�mit is issued,I shall not employ any person in any manner BOitER,BTU - � so as to become subjeU to the Workers'Compensation Laws. ,_ naaRovnis onT[ MSPECfOR'S SIGNATURE Date Applitant COMVRESSOR,BTU � C� ROUGH �6 C . NOTICE-TO APPUCANT: If,-aRer making ihis Certificote of vENTitATiON SYSTEM FINAL .��� �'Q_� - -Exemption, yoo should become subject to�the Workers' � Compensotion provisions of the lcbor Code,you must forth- Eyqppttqirve cOOtER ' VALIDATION � Wifh comply with such provisions or this permit shall be deemed ravoked.- � � � �. � � � • � FURNACE: FAU_GRAV _- n �� . LICENSED CONTRACTORS DECLARATION - FLOOR BTU (J '� I hereby affirm that I am licensed onder provisions of Chopter 9 HEA�R, SVSPENDED UNIT_ -- - '�(commendng wilh Seclion 7000)of Division 3 of the Business WAtI and Professions Code,ond my license is in f�li force and effect. . / p�, �n'� /1 rq �,$ ?141,2A o License Number ����Lic.Class� W �- . . �" �- - " �� " � � V � � , ,ym . . . aS O Contrador � � Dote � • •4 4�7� V ❑ W I am exempt under Sed PIa�CIt@CIC fBB ' • ^ •[�n, �`J� y � B.BP.C.for fhis reoson� � � 2 PERMIT ISSUING FEE S ;O �me: 09�07-88 TOTALfEE Signat�re OWNER-BUILDER DECLARATION� � PIAN CHECK APPlIC.4NT I hereby affirm thot I om exempt from the Conhadar's License � - Law for the following reason(Sedion 7031.5,Bostness�and NAME - Professions Code): . - - � . . � ❑ I, as owner of the properfy, or my employees with aDDRE55 � - � wages as their sole mmpensaiion,will do the work and - � ��rv � TEL.NO. the slrocWre is nat intended or ofiered for sale(SeUion � � 7044,B�siness and Prafessions Code). - �y�FR ❑ I,as owner of�he properfy,am eadusively mntracting �L ��.I- - with licensed contractors to conslrocf ihe project(Ser AD�RE55 � � !�{�' tion 7044,Bosiness and Professions Code). . CONSTRUCTION IENDING AGENCY � : CITY � n'�S T L NO. i � I hereby affirm that there is a cons�ruction lending agency for the performpn[e of 1he work for which this permit is issued� - CONTRACTOR ( �- - � " � - � ► (Sec.3097,Civ.C.). . . . .. .' .. .' .. .. . . . ADDRE55 � �-� - � � - Lender's Name � . . . OTY_. � .. TEL NO. �L��(/�� ._ . __ _ . . LendeisAddress - - .. �� .. ..�. � ... .. . -- �� -- �- STA1E / ��L � LIC. /'_7\ � ' I certify that I have reod this opplitation and stale that the-- LICENSE NO.K � -- C1A55- �� �•��� �- -� .. _.. .._ . ._. ... _. . _ .. . above information is corred.I ogree to comply with all County . , - ordinances and State laws reloling to bvilding conslroction, _; _ . . ' and hereby aulhorize representatives of this Counly to en er . - � up the ab�e-nfantioned properry for ins�jection pvrp es. SEE REVERSE fOR EXPLANATORY LANGUAGE l /G� _ Signarure o Applimnf or Agem � - ��e . . . .. .. . -. . ._ . . .. . - . . - . . . . . - t --�� � � . ' :` __11--i � � i .4 r. . '� �, � �`� + . � 11 ' � 4 . . 'i � ,`i 4 1� 1`'} 14 J . I i` 11� 1 _ 1, � �i " � � �i�,;� !% � , �i _ ,� . � �"���}' ;�,��- ``'� ' '�`�, ♦��f ,1,�4 '�`/ s f., _ - 4 • .. '� � ; . - � . j • � � � �l � �!i� �'� � � `.��� - _ . tn .. " . . � ` �''� � . 1, �� _ . O � ,��, ,'`+ '' � �t'� • ''`�1"t '�� � NN ' 1 • . 1 z ; 1 � � � � I - - - ,.� . i �., , „ . en � �� � � •.��., • - �.. �� ' 1 . . ...- . " ' �S ' j . � !. , � . ....`..-. ' � � . t � . ,. . . .. - , � . , ' . � �t � ' � • --�'_ 1 r._ - ' ' i/ .- ,1 �, .. � -,- ; , _ ', , ,, i� � . � � 'i '�' � � , ', � + �: ,tt ' ,/ ,1 + i .•+ �1 .' �} rt . . 1 ' , ' ' �,� � ,, �r" � u� - � ' - ' ' Z �� �,. _ . ' O _ . � ' '� N ; � ��� � � �-_ � ��� �;' ' Y�. ,',� �, . -- i �. � � �. , � � i�� — - �, �- - � • � �:� . - . � .. , �1 . . - r �. . � , ` �, _ . �'o � m� � T � '1 � _ � - _�,n3 c. �_N � a - - ,� � n.o o� o-n ??m � � �'u � 6,� , "` ' - _ . -,. . .tn�3' O �w N N'D �p-U ,G .. � ���O N ' O O."� O N.N r � O . . �- , 0 7 S�`_� � o u,s.n 7 n 's: � o £� C .. . .. ' , ' Np� �'�� � Fp .�,...1 ❑in O-O'-� OR`�0�. � [f'O-� L . . . . � - . . � � � �. 1 �^'O N � � C� p �3.C� �n �N O,o.��O.a_l'i, �,,,� � � O � �- Rt - ' 1 , cp r ' p T, �'v�'Q Q.io a.9 � �� o o^ � � o . r- N N 3.0 . � 70 . � � � Sp 3 ' �'fl c,� � f — o`—m o ;� �'�.m N'°�.`=a �c�.�..,`� ^ �� o•`� c° � ' - . . :p � �� ,,. p �.��. �,cL y 0 �O�,r.H f " .p v ;o O �m .^.. '^_. .. C ' ' - � � -.X C A 0.N S�n � � � . � �'� ? t0'.'U �i < R N � �'� O r' ' . 7_ fl �, c� w C f N o m � x s . � o o � o �1 ' ' . Q . . � ^ Or'NADb 'KN � 03dN. �� a �D'IDN �.d:V� {� H.N0�3 . m _ . � ' � � �-f13� m � � ° TciR°c�o� � � s •'�'-'-�.m ' �c =.'° �0.9.� � ', - • 5. _ c ` r..-"v o N m co � o a N n a'a p `°.o o�.'',n�.9 0 :-�.,0 3 ' O • . . . . 7 n 7' � . _ /� . .. . . �� . � � - • .. N ' Q,. � p".O� N ?n" '^ O W ?N,u 3- � �a;'C� D 'Q.3 3...�..� ? A -O�D�'D' � 1• . � _ : � c� � o ° ,�'a�.m ?�ou°_�,� �°b '.oy�?•T.,� 3 � °� N :,, �,. v N .v N . .� m � �--. o " oo' .-U � ' ' ' o m , a -'' � oo,°v -`°aco = ,�,'o•�o°,,,Z �o'.3" maia.�.aN- 3 �. � 3 ➢ n - ,. �- ,1 �' - 7 � , . �L.�n �� W O'�O � n.� S T 7.0 N � � !D �%'� �„�n �W �' in'b�?t/�T • � . .. . ; . , � ".O '�< N N �-O � W �2 3'O 3'(1 6.� '.S C ��O � �� Q�Q � � n � � O �. � _ _ � o � o'c.� �Q �-a3oa a ,nrr_ 3 „ 3o � � mo n - Z � . � � . , . . � �_j p.a f, ❑ �-p O,n < �� � o � ».^�-��-p 3t0�a t0�m a,j � ? . - . . . ~ _ �.0.0 �N.� p n ' � T''. •p � -� N p�'p.3 > > q Q m K,+�p . � .. ' ' � �, � � o T3. � � a,� N �^3 0; - = ' NT� m c 'r. o� 3 �a � � � � � f TW v+W'c�np � Q °Two .. . . . fD O p �� G vtQ'O Q'N O'O"(1' � � a,m 6"O Q m �^ �,�' N '.' . .. ` ' _ '9 � 'C�'ry �G " c O�� t�'�O'�' `Q �'� Q �n.�, �.p � S • . , r . . � O� O �{ ' ..�� � � C.� ^� � �=� v� � . ,. . '_ ' . - � � . �.-�.-4� O.� 0.S O� Ow 7'�C , .. . . . - ��.. -m e io � Q-co . _ , . .. .. . - � o..� � � �