Loading...
HomeMy WebLinkAbout1589A �5'OIiKF.RS'CO\iPENSATIOY UI?CLAR.�7'ION 7G�36aC . I hereby affirm that I have a certific�te nt cnnsent to self �E-$,B�z.flo, . A P P L IC AT I O R! FO R PE R Pf�IT - insurc,orncertiticatentNorkers'Compensationlnsurance,or HEATING-VENTILATINGl11R CONDITIONING � a cenif�ed c{n�py�ihre�,re�ot(Sec.7800^,7Lab.C.) � P��IicY Vo._[.L�2��.+ Cnmpan5'—C_—t�\�� � � � U111� �Q� � Certified copy is hcreby furnished. ^, ��O COUNTY OF LOS A�VGELES EiUILDING AND SqFETY � � UI ���' r'/�/�rrtified cn is filed with ihe county buildin �1�" . PY �inspection � d�e v�m��n�t 1n` FOR APPLICANT TO FILL-IN 6UILDING Date�G`L�}.Appiicant�.1�_ _ _ (PRINT OR TYPE ONLY) AD�RESS,g�5 �ea�Q���LS___ �� LOCALITY �;/� _n� {�/;�f CI?RTIPICATE OF[XE�IPTION FKO'�t\VOIiKFiRS' NO. TYPE OF APPLIANCE OR E�UIPMENT FEE V•"<�� �—+��1 CO)iFFNSA7l04 iNSURANCIC NEAftEST (T]115 SFcCtOn nee� not �C camplefed 1(t�tC n'O[k It1Y0�VCt1 AOSORPTION UNIT,BTU CROSS ST. d by the permit is for�one hundred dollars (5100)or Iess.) oisrnicrrvo. Puecesseoov � U I cer�i(y Ih�t in the performqnce of Ihe�vork for n�hich�his AIR HANDLING UNIT,CFM � • � — pzrmit is issued,1 shali nnt empiny any person in any manner p xo sx to bernme subjzct to the 1Vorkets'Compensation Laws. BO�LER,sTu - -- � — � APPROVALS DATE iNsv� �on'SSiG"�ATURE („) /��y� /� W D3te Ap(�IlCan[ I COMPFESSOR,6TV—OL�+v`� �/ qOUGN �' ��_ N NOTICG TO APPLIC.ANT:]f,aRer makind Ihis Ctt[ificate nf VENTILATION SVSTEM p�� — .� Z Lxemption, you shou�d become suhject io the 15'nrkers' � FINAL —�'-'.t/ f _ Cnmpencatian procicionx of�he Labor Cnde,ynu must fmth- � w��h romply �vith s���n n���ivo�s or �ncs permit <nan ne evnvoRnTive coo�eR VALIDATiOiJ deemed revnked. FURNACE: FAUs�GRAVITY � 00 ' LICENSfDCONTRACTORSDECLARATION F�OOR� eTU_S-0��0_6— � 1 hereby affirm[hat t am lirensed under prnvisionsoCChapter HEATER: SUSPENDED UNIT �nmmencing�vith Section 7000)of Divisinn 3 of the pusi- ' , t7ALL i and Pmfrssione Code,and my license is in full force and y �,, 7S fect. ?��/� �� �3 (/1,��[�� �� Li�<e-Num6er...2�—?z��'{. Lic.Ciass�_ Contrac�nrl(V�1'(eI��S pate_�Z�� � 1 am exempt from the licensing requfrcments as 1 am a Iicensed architCCt or a regislered professionai rnginrrr ''� `5 H.9 A ���.n .� n. Plan check fee 25°0 of above. g profrssional capacity (Section '051, Dus- iness and 1'rofescions Code). PERMIT ISSUING FEE S '� s� �` � ' '-�8 � I.ic,or Reg.No. Oate TOTAL FEE � a r " • • � ]IO`dti 0�5'NF.R�➢UII.DER DECLAR.qT[ON pLAN CHECK APPLICANT � �� � 5 v 2 J 1 hereby affirm that I am exemp[ (rom-the C��ntractnr's NAh7E • • •)��7 J� License Latv fot the follow�ing reason (Settion 7031.5.I3usi- - ness and Professionc Code): ADDR6SS 0�'.3��—�J �t � f, as on•ner of the property,will do the�vork and the CITY TEL.NO. - J structurc is nnt intendtd or nCfered for s�le (Section 7044,pusiness and Professions CodC). Ck , _ 01NNER �^ � I,as owner ot the property,am exclusively contraeting _��V� � , �rith licensed con�rac[urs to conshuct the project MAIL �j�� /'�^� ,^ � (Section 7044,i3uzines5�nd Yrntessinns Cnde). AOORESS �"J `� ee�.K,Ce.� ���� CONSTRUCTION LBNUINC AGLNCY CITY � e `(� TEL.NO. I hereby afCirm �h�t there is a consVuc�ion IenJing a6ency �J • for [he erfonnance nf ihe n�ork for whith tliis rmit is CONTRACTOR ^ I . � re __i v�����S� � � � . . � issued(Sec.3097,Civ.CJ. � - Lender'SNamr AOORE55 �? �.,o �, Qc�e �co Lender'SAAdress CITV 1� �hQ`� TEL.NO. 3�I—��I� � 1 crrtify thst I havr read this applicatiun anJ state ih�t [hr . STATE' + ,�t7r`i� UC. �� . . .. above inform�tiun is mrrect.1 agree to comply�cith ail County LICENSE NO. �1,.J CS CLASS � ' orAinances and State I�t��s rrp,ulating Heating,Venlilating;�nd - Air Conditioning,and hereby authori+e representatives of this S�G RLVERSE POR EXPLANATOItY LANGUAGh: Cuunty to enter upon the aboce�mentioned properiy for � - inspection pnrpnsrs. ��.�rv� ��2�(—Fr� Si¢nat r �i Permittee Date i � � � � �'�� � � �� --� i �. . ,; � _. . . .;; � - z � � - . N � 'O . ' m - j , - o . ' .. � ' -- . f!y Z � - , 0 _ _. _ � , m � N -__ . , ! r .� . _ p.- _ t` _ ' z ' '. N _. b m . - - - � ' O - . 31 - , N ' t � O • - � - _-- m - �n _ !; _ ' _ . r,. " -- • - _� � . -..� �. =c������=�r- n M� t�= ^ o� = ^,; .. � . , ... r,� _' f_j•'��^,, �`^4 .`_.�' �.� :_ ? (�s„❑«n ��.=,i: �- C���..� �. r v Q � C' C � � � '�� C.^� r, � � C, :� � '^ �w' � � '�' L, i v �� c�.�'�� c .;o; ° '" � c� -��;o � o. � ;; � ' F '7. ... � �, � F _n,. ..�� � '" o a. � �� �, = o � ^.._� :, • ` � �4 � . . - � � _' 7^�,,,,F *-•t�� '" C'°`" ..,oc�,�. � ~T . V G � � - r. r��_�.� ,a. -. c = �� � Gv ��-..y, ^ _ �-` n 5^ r �_ ��. c: Y^� r =-•,Y '�'- s 'Ci-- _ � � _ ... �..; - �o - 4'. ^. = �=- � f: C n l. � �.. ...'c„� _ ._. . •.,�.,,��• , r .. � � C t�.�. "�n � � O�,�y `�" N,,y c'io�`-�.•` .�: c� � H io � _- ' „%i f"') ^ n ,r� `t C-;� -� - - t'' � •�4 v,c �:'c.n ... [' � t�~ 3�� � � ..,_C r C ,,,,�N c, �., � .�.. .a c c.� � .� _ C w'. � m -` y '^ .^�.cn O_' r�'J ^ in .�. , ' � � � ^ N q G C. F _ C� p ' n f' o C �" . C'q , r' _ C L�% � c C F , � ",i� �� � C�G r' O t� �"'� � :� .+' � f�,�. (; r �- .-. c ^ � _. ci-� � .. ti r.� � n� e :_ n c � i: C_� � i; c ^ r�'� ' ? '^ C �-�~ � ~� n �u: � d j�. � C ^��O n -� _ t C'� v'' ^ y � ^L O'^.� � C ^� !TI ' � "'t ; :,,i..� - �c.: - �, .�._c r 2� � � n � � = ` n C` ^ G'� .-�, O»�C "' t` � - � i: �'' "' r+ / ry P",S. .�.T 'v ..r� L`'i C' �.. r ' ��' -C. r � "'� r^�- f7 " C .<^. . i' C a �t.�v U c: n G h �� � n � 7 C �- <' ^-C -�� - _.~ ti �Ty C -� i .�3 P� ��-,:, G" C ... - �' N . �, r r'��"•. ., 'J�.. c� r:'�- " = �"� •-'rj - . �� C ^� IC� p�J � � h C�- r��G ''J � � ^ � ~-I. l � C�,n f-_ ✓1 � o - ' �'' " -.t'i ....�,�': O �" �- "' �o�. � - ' �� c�.- U ' . �' �,C n^ .'� � � "' ^'M1.A F� � � � O�v,,� � I �i � � =� � � � %. . C � � � C C,C �ry . �. � ; ��r � N V�� �` .. . = Q %c-^.:c � �r`o C i p �..'c � O� �' R O" C`.:.*.n � c ^�O '_-_ . [a � 'yI�% .`; "+.C�r. �' � ' T � ^ � 'i =" ^ cE.. :'�v � � _ �� r. �-•d�` 0 t ^C,i � i �-�' c �- ti ' , `G�' � • . ._ . ' . f`' r 'i n� .. G. _.. � ^ _ G � ,. - . � �. �.��,. ^ �� �`,� R'"'�� . - .__. G C�V '» "� i'^`�' � . .. ' l^.r��`-. ' ' . � •� - .����_..�--- `�+��'�_��'����� .�—.