HomeMy WebLinkAbout1592A �.
�VORRLRS'CO\tPG'JSAT]ON�GCL,,RAT,oN - - � �6A'64° � A P P L IC AT I O i�! FO R P E R Pr7 I T � � �
] herebY afrrm [hat f have a'cettifica�e of consent to self CE-819(2�80J �
insure,oracertificateMR'orkers'Compensa�innlnxurance,ni HEATING•VENTILATING-AIR CONDITIONING
a certified tnpy thereof(Sec.3800�,7Lab.CJ
PulicyNo. ��t�Cnmpany_C��\� ��\�- �l�b�
� ❑ Certified copy is heretiy fumishzd.. 1�� 3��_COUNTY OF LOS ANGELES �S�_ BUILDING AND SAFETY
�crti(ied copy is tiled with ihe counip building inspectinn .
a1+�.�� � FOR APPLICANTTO FILL IN eUILDING 1 }�'1�. � ,
Pate�L� Applicant__�O�_ (PR�NT OP T�'PE ONLV) /�ODftE55 I gs� ��� 0
��� LOCALITV '(� �?�nI�
C1iRTIFICATL'OT'IiXF:'�1NT�ON PRO}t IVORKICI2S' NO. TVPE OF APPLIANCE OR EQUIPMENT FEE 7-��w7L�� � .
C0511'F:NSATION iNSURANCG NEAREST
CIi055 5T. }
(This seclion nced not be completed if the anrk im•oh�ed � A6SORPTION UNIT,BTU a
by the permit is for one hundred dotlars (5100) or less.) OISTRiCTNO. PP.�CE$eoov V
t cerlify that in the performance of the m�ork for which this AIR HAN�LING UNIT,CFM � �/j� � —
- permi[is issued,I shall not empiny sny pers��n in any manner �F'� O
sn as�o become sufijzct tn ihe\5'orkers'C�mpensation Laws. BOILER,BTU �
`Q� APPROVALS OATE in� peroa�sscvnT�ne (�
� Date � AppliCant � COMPRESSOR,BTU�01�0 � ROUGH �'
�. N
NOTICG TO APYLICANT:If,after making Ihis Certificate nf VENTILATION SVSTEM / �� Z
F.semption, you 5hould becnme suhject to th8 1Vorke�s' FINAL ' �
Cnmpensntion prorisionc of the t.abnr('nde,ynu muct fnrth�
with cmnply with such pm�isions or Ihis prrmit shall be EVAPOftATNE COULEfi VALIDATION �
deemed re�•oked. } FURNACE: FAU— RAVITY �� . '
L(CCNSLD COtiTRACTDIiS D[iCLARATION L FLOOR� 67U_�.j�Oj�._ �b
1 hereby 3ffirm that I am lirensed under pravisions nf Chap�er HEATER: SUSPENDED UNIT
9 (cnmmencing with Srr[ion 7000)of Division 3 of the l3u5i- WALI �
ness and Pmfecsions CnAe,and my licen=e is in full force and ,S �
e(feM. �{ �p�� ^ �� e �� � �
]icrnce Number�-IS�\L,_Q�� Lic.Clasc�—^�O '
�trsctoL✓�_�1�Q1J_Qf� Da[e_6_�_!��
U 5159.?_A
I am exempt frnm the li[ensing requirements as 1 am a
licensed architect or a registered profecsional engineer plzn check fee 25°0 of aboVe.
acting in my professional c�pacity (Sect�on 7051,Bus- — O s � � � � � �8
iness and Professionc Code). PERh1IT ISSUING FEE.�i - ��
Lic.o�Res.No. D�te TOTAL FEE �3� I • •5 3.2 5
�IIO�tE 00'YHR-BUILDER DECLARpT10N pLAN CHECK APPLICANT . . e a,rj���c=.�
1 hereby aftirm that I am esempt fmm-the Coniractor's NAh1E �_8 3
License Law for the (ollmving r¢ason (Sectian 7071.5,Ilusi- �L�.J
ness and Professinns Cnde): A�ORESS � �
� l, as nwner of[he properry,will do the w�ork and ll�e CITY TE�.NO. , J �
structure is nnt intended or o(ftrcd for sale (Section �
7014,�usiness and Pr�fessions Cude). ^raGS^ < eT U*�
� I,as n.vner of the property,am exclusiveiy contrac[ina OWNER �
with IicenseJ contractors tu conshuct the prujeet h1AIL �Z�i/
(Section 704J,Fiusiness and Nrnfessians Code). A��RESS `�� -,re�. b���� �l
CITY Q� TEL.NO,
CONSTItUCTION LtiNUI4G:1GGNCY �(�
1 hereby affirm Ihat (here is a cons[ruc[ion lendine agency ;� ��� : I�,��
foi the perfnrmsnce oP Ihe «�ork fnr �5�hich �his rttmit is CONTfiACTOFi f 4
issued(Sec.3097,Civ.(;,). . �
Lender's Name ADORESS �t3o �_ .p�.���co , '
Lender'sAAdress CITY ',�„�n,�'�� T[L.NO. �2 ��,�
>>..�_ �t.v
1 certif}' that 1 have rcad lhis application and state tha[}he STATE �� �I LIQ ^� '
aboce information ic correct.1 agree to mmply n�ith all County �ICENSE NO.. ,.� ZS I CLASS �OiO - •
ordinancrs and Stste la«�s reRulatinR Heating,Ventil:�ting and �
Air ConJitianing,and hereby autliori�e repre�entatives oC this SEG REVERSIi�OR IiXNLANATOIiY 1,AtiGUAGIi
County to enter upon the aboreanentioned praperty for - � � � �
inspec�i�n urpo-�s �
��_��{..��rv� �S-2�I-��,3_
ISignawre Permittee Uste
�: � .
_ _ � .M
� �' � �
. � .
q , .__
o ' � � � ,
" - _ _-
N - -
� __ .
'' O ' ; - .
R, . .
N
� ..
�� 2
- _ N
1, � . m
.' : �
- ` � Vi
� 4_ O
' R1
N
,
i _ '
} ' ..-
_ . .. .• . ` .... -� , -
Q�. �.
- v, i�C.t.... n
m �
^ ��C a w ei= " n
�.,�'.. " — _ c � _ � _ "�v F O
• p �t, p �r�ro�.c, ;°,i� r C'^�`L v n� L'�� L
� ^� 0 p C , n O n S> :� G G :'. =� -. +� _�' .c:; C �i� 'Z. .
. ,C �•i� p �� �•G,a ��rC � � -`' p G �•�.O �ca :..F�'., � � µ �y _ /�
: ; c . � �o o �fi c`'- 1 G r �,o,"'_ �..r N��� � �. G
� . �. � �� C`� d '� ��� r $'��� - % o�m �'Y_.�-� ����,�o�io %' �
..� - .' :i W`^!n . ro C � '? _.^� ... C ,_' .. ['� t1 1. � .�. .f
- w ,. :. w v ,�C �v� L ^„„� -'C^ O'^.w w �..'., p G c�� y C n^ �'� C �y'. C�
f �,�-.,:. � {t� G�-rt, ^ � � Y [�
i � � I, � C T. 1.�.� C1 C �C �-�.'�r �• [-�'_��:- �.,�� �1 H G ^~ f;v.'^ vi �� ^w
� . � ^ �� � V C ' �.n ~ G C�,��, ta H � .�v� w%+ ^ p,i:n � n �
•' � � (' � h=, a�° �' ^` ,� o '` �<. o o :, �° "'^:;. c; i �? � � '= � __
„� .� _ '"'p M' G .�-, C Y� C^= fi.'C.�;A c Q � � C^i�" �o� G f.U: �_ � .
_ � .- G r_ �5. N .. cz �=`�' �:.ry '. �G.; o r: ``°.. �r =' �� ti �, C"
.. � C .�. � n _ � �. � _. c�. .- ~. �C � +'� C �
. ^" • � A .+ � ... - ....L�. f~ � it t� "
" G �r_, N .^ �. C � ,�y,�,v _' r. O � r �. ,- •n v � :: /�
v� , J. ^ r,.� �`--. ", v� ^' ... O
� .�.. �' - C,�� t �. � .n' � (i: �'u� � `^'rt, ,C '1 - n r'
v .C/� t"�.'c C ^L'.; C� �. O.v� " �.'C'Y,.f � Y'� �,`C„rt: .�,i.G c,Y ^ r• .,r
''' � �-�� '^.�.� ti �'c . G r, n �: '..� ��'., :3�-.n n� C
. . " !: ti � �. , - R Y n�G .:,t� �_: , •. -� �O O �
:� .+ C ti,T �., T'y ^ � �- ' G C G .. ,�,� �, C ' P •-� '� `�..
_` ��r ~ �
r n _ _C .U =.`�.- ' G ��% "` C`-w.._ ^ "/'1•��.• ^C� �. � ��
1� i � �:'' '� .. .� + .R p . r r Y O� _, '^-W� � •O C �
� `� r-`M1 r �.'ti �' ''` G•Q Y Ll''" � o G L � C,"' C f:n p . .C.
.. C � � �i. �G a ,.;�-,�. ,,, i"v,
� C. p ��t:. G � —io Y O � r � r� ,_, -. _. i: , .
' C - V � i r.^ _ � c-� � ?." .��� p
_- _ .,-= ,.�� '� w ° ;� n � �.�..��' c .
�p 'Ti �• C cT p C. C 7 �
�_. ` % �!.�G � � � rt' O p - G .
. � . . ��o.;�C. _ �.,�`�`� N�~ __— ._
. �.Q`_"^","° —"
,- ���
�' .
����r_