The URL can be used to link to this page

Home My WebLink About1306ATION WORKERS' t I have a certificate of corse APPLICATION FOR PERMIT I hereby affirm that I hove a certificate of consent to self , ir%ure,, or a certificate of Workers' Compensation Insurance, - - :-HEATING-- VENTILATING - AIR CONDITIONING or alert ed eapy th eof (Sec. 3800, Lob. C.) 76A364C w (: 0Ol 11 I -CE - 818 (REV. 10/81) - - - Policy No. }_xf Company FImpo-c ❑r=`•+nQ Certified copy Is hereby furnished. COUNTY OF LOS ANGELES - BUILDING AND SAFETY ❑ Certified copy is filed with the count building inspec- FOR APPLICANT TO FILL IN BUILDING tion department. y - (PRINT OR TYPE ONLY) ADDRESS / 3 FP,T1 FI A0reI Date 16-16-97 Applicant M• E• S • LOCALITY O t f�mon0 gR12- , C -A CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST COMPENSATION INSURANCE[7> ABSORPTION UNIT, BTU /£?i 000 CROSS ST, �� (This section need not be completed If the work Involved by olsrRlcr No. PRoc the permit is for one hundred dollars ($lop) or less.) i S I certify that in the performance o k for which this AIR HANDLING UNIT, CFM permit is issued, I shall note y any person in any manner so as to become subjec the Workers' Compensation Laws. BOILER, BTU APPRovaLs DATE Date pplicant - - COMPRESSOR, BTU ROUGH NOTICE APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL Exem on, you should become subject to the Workers' Co ensation provisions of the labor Code, you must forth- EVAPORATIVE COOLER VALIDATI w' comply with such provisions or this permit shall be deemed revoked. -- FURNACE: FAU_GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU - hereby affirm that 1 ani licensed under provisions of Chapter 9 - HEATER: SUSPENDED UNIT_ - - - '(commencing with Section 7000) of Division 3 of the Business I WALL - and Professions Code, and my license is In full force and effect. License Number 3 55 9 68 Lic, Class M• e-- S' -13 Contractor Dote Ib—/( ❑ I am exempt under Sec. - Plan check fee ' - - , B.BP.C. for this reason' PERMIT ISSUING FEE $ /o 1S0 Date: TOTAL FEE Signature y OWNER -BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License , taw for the following reason (Section 7031.5, Business and NAME - Professions Code): ❑ I, as owner of the pr y, or my employees with ADDRESS - . wages as their so mpensation, will do the work and CITY TEL. NO. the siruciur, nor intended or offered for sale (Section 7044, B ness and Professions Code). - - - - ❑ I s owner of the property,' am exclusively contracting OWNER E G C+l.t� d2T FoK with licensed contractors to construct the project (Sec- _ IL ADDRE55 1-18-12 t'Y+ iTcN6LCos'Thl - tion 7044, Business and Professions Code). CONSTRUCTIONLENDINGAGENCY - CITY I�VIIdir C• TEL, NO,-4'9��00 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued 5 3097 C' C ' - CONTRACTOR rn EGH• 1=—NER6 S Sj'�t•nS , INSPECTOR'S SIGNATURE ( 0 • •• • s �} U Q . (019-87 z ADDRESSROB/hi. tender's Name CITY ) hi D vSTR TEL, NO. Lender's Address STATE �a ♦♦ (� LIC. — Z O I certify that I have read this application and state that the LICENSE NO. SS.D�pB CLASS above information is correct. I agree to comply with all County ordinances and State laws relating 10 building construction, _ •' _ and hereby authorize representatives of this County to enter- - _ _ - -- ----- -"- -'- "- upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o Applicant orAgent Date 1 ! o y N o Q s P 0 -0, P.• •m cl N ©N O ^ J (n , O J~ 1 O A o N O'O �G O� 70 tr A J ? TO �.a.0O•N'RNm NO O.`QG7.0 ,�,�1�^O.N•li �• G ;. ' Nn O p. C 3 0^ = : m O N.• p 0 N 3• ... C O .p m .o C ;o O O "• D c �• 7 m "a �• < CD O �• „ I'A - ^ O+ q 7x u; t -P. O is QD • _ O .. O 'O fD m �• O ` 7 ✓ O m ISD n O . O N n O . m N' Q LP i N 3 u• n O 3 N j Oma, �K j • N. �£ (1 O- 0 .O .. \7\ G 1p •n .P• 7 .n £ o_ =' C d j %. W " M n O ti- D N j� 'j 0... O t) n G 'd O_ ... 9" D 'm. < ? a. tD < 6. m `' O°.3 P O O 0o LJ•.t. 0- .Ioj d N m d < f ° w m -j ° O' .3 °v \3.0..0 O• . 'fl - 0- O o p 70 o o `O Of O -, O O S '6 • S .O:v, A '�, N O'fl O n ! �1 O O O..N 3'P O m'P'm CD P O •O q{ O. O n4 i T.O.O N n W O P O •'1 N N u N .15 0 "�V � 0. O- io O ^ ZI O �,p��.N.�DO'P'�NdOP..-?wO :`;` •r��Q"m l _> n0,0 T'40... Wf 0m.tpO < �'�m•£ ' CLOG w� N 0.33 ?O:N N...p � Q ?7N f cl- T, 0, m o 3 m ',P p o 9 c P A Q° f? �?