The URL can be used to link to this page

Home My WebLink About1589A (9) R'ORKI�RS'CO\iPENSATIOYUL'CLARA'I�ION ��1364C � ( herchy atfirm that [ have a cettificate of cnnsent tn self �E-$,6,2flo, APPLICATIORI FOR PERPf�I insurc,orncertificatentNorkers'Compensationlnsurance,or HEATING-VENTILATING-l11R CONDITIONING a cenifed cmopY,thre�,re�ot(Sec.7800^,7La�b.C.)l� P��IicY Vo._CL�2��.+ Cnmpany._��."S� V 11i� �Q� • � certified copy is ncreby furnishrd. COUNTY OF LOS A'VGELES f3UILDING AND SAFETY � Q�-r�.ZOO `f�a= (—'iT/�rrtifieA copy is fited«'hl�ihe county building inipeetinn ' . 6UILDiNG�� e��_(`,1 �\`�_.— r��p men� A FOR APPLICANT TO FILL IN nooness �'�U y Date�--�lL�-�VA��cant�y.�. —' — (PRINT OR TYPE ONLV) �j_ U LOCALITY /�� `yi,� CISRTIPICA7E OF[KE�1P710N FKO�f\VOIiKIiRS' NO. TVPE OF APPLIANCE OR E�UIPMENT FEE �_I_V"'1�`� ""�_' CO�iFfNSATI04 INSURANCIC NEAREST } CROSS ST. a (ThiS sfctiOn need not be campleted if the ��Otk involved AOSORPTION UNiT,sTU Q by the permit is for one hundred dollars (5100)or Icss.) oisrnicrr+o. ouecesseoov U 1 ceriify that in the performonce of(he.rork for�chich ihis AIR HANDLING UNIT,CF67 � � — — pzrmit is issued,1 shali nn�empl��y�ny narson in any manner - -- p so ss tn bernme subj:tt[o the 1Vorkets'Compensation Laws. BOILER,eTU AQPFOVALS DATE ��asv� �on'szm"i>TUAe U (��(� /� p7j W p3te AP('��Can[ I COMPFESSOR,6TV—�Ol-`�`�"' �/ qpU[�,�{ � Z NOTfCfi TO APPLICANT:If,a(ler m�kin6 Ihis Ctr[ificate nf VENTILATION SVSTEM I FINAL 'C"� f _ � — Lxemp[ion, you shou�d become suhject to ihe 15'nrAers' Cnmpcncatinn pro��icionx of liie I.abnr Cnde,ynu muct(nrth- - EVAVORAYIVE COOLER VALIDATIOiJ �vith romply �vith s��ch P��'��ns nr this permit shall be � . deeme.d re�'�Aecl. FURNACE: FAVl---.GiIAViTY__ ^ 00 - LICENSfDCONTRACTORSDECLARATION F�ooR� gTu_so,00_a� �� !4ereby a(firm th�t 1 am licensed under provisionsof Chaptcr HEATER: SUSPE:VDEO UNIT �(cnmmencing�vith Section 7000)of Divisinn 3 of the Ousi- t7ALL and Pmfession+Code,and my license ix in tull force and �� U�=`� ��"]S Sfec[. ?�/ �J Li�se-Num6er...27�Z�—{. Lic.Ciass�� Contrsc�nrl(V�1'(el�Cs Ilate_�� 1 am exempt from the licensing requfrcments as �am a - � :�.� 5 8.9 A �icensed architcct or a r.gisiered profexsional rnainerr plan check fee 25°0 of above. atling in my profrssional capacity (Section ^ost, Dus- p�pMIT ISSUING FEE S '� s� �� 8 iness and Professions Code). � I.ic.or Reg.No. Oate TOTAL FEE J a I • •5325 � ]10`dti 0�5'NP:R�DUII.DER DECLARAT[ON pLAN CHECK APPLICANT •�. .)�.IJc=i 1 hereby affirrtf thst I am esempt frum-[he C��rac�nr's NAME - License Ls}v fot the follo��^:ng reason (Settion 703�.5.F3usi- ness�nd Profecainns Cndr}�. ADOR[SS � O 5..3 O—�J ` � I, as on•ner of Ihe property.will dn the�vork and the C17Y TEL.NO. � structure is nnt intended nr uCfered for s�le (Secttun , 7044,Ousiness and Professions CodC). ,,��//�� ❑ OINNER ry,T �(,"Q� , s _ " . 1,as owner of ihe properq�,am exclusively contrarting I '�`�1— ry � .��ith license� con�rac[urs to ��nctruct the Pmject MAIL �/_Q p� r�/� r�G2 (Sectinn 7044,Dusinr�s�nd iRofessinns Code}. AOORESS ��p �Q ` �ee�bC��S CONSTRUCTION LCNUINC AGtiNCY CITY � e `(� TEL.NO. I hereby afCirm �h�[ thete is a construc�ion IenJin6 36ency CONTRACTOR -` �^ � (q' , �� for [he perforn�ance nf �he n'ork for �chith [his permit is _�,��'V�J� v � � icsueA(Scc.1097.Civ.CJ. � � ' l.ender'SNamr nooness �?�� _Q�C�CO � Lender'SAAdres� CITV 1�,(��h�`� TEL.NO. 3�I^��I� � � ��1__' ' l cr[tify Ih�t I hare read this applicatinn anJ state ihat [he STATE ,'Gry�j� UC. �O . . .. � above infnrm�ti��i�is mrrect.1 agree ro comply�cith a�l County LICENSE NO. � CLASS � ' orAinances and StatC I��'s rrp,ulating Heating,Venlilvting ind Air Conditioning,and hereby authorire representatives of this S�G RIVERSE POR EXPLANATO1tY LANGUAGh: Cuun�y m enter upon the aboce�mentioned praPerly for II15rPC11(lll{1LIf��S2{. . —l3 ��n� ��2�f-Fr� Si¢nat r �i Permit[ec Uate � � - �..� . ._. I 1 r--. -.; -- .� . . .. � L , � Z _ N . . ._ 'O ' . m . � � _ o .._. p . � t!N __.. . x � _ � o -- a - m . . N • �- 1 � - I_ `. - � � -- m . . � � a . -. ,. � 9 _ _ � - • � . � . � z �, � . ;� ;, :. • . _ ` r..,., . _ _ tJ r' C''� C�Y R r .. ^ ei.�.o�' ~�� ^�C.i�"~ !_� �� d �i .. � ...p �� ' � �' -�,t�: � �p' .G ^' e�`o v"`�' i. -� �C.4 �.� �ti " r❑: -� G �-. r, v' 'r'�� A r' i :., C� p � ^.�-V 7'C t_" C � � _`� C n ^ C--ry`.O y c�. -'. O ''' H�="•-� ` �� . ^� Y�C'7 i :•0' c v ��G•n �ro N�r� -' v:`'�_ ..=. � 5^ ..+ . � '.. � rrf:"C ,'" �^�r'F. �, �.r; n �'r �f r' c+ n ,��,` C . r, "'' r :.4: "' ` . N ,v. " r, �n ^ S. O � Y~ _ ^ :..� � . � � ,-� N " y t^.�r ��_ 'G.�.. [T,,, ,,, - „. N'� p' n `�-c.^ n __C_n n' � .-� 'r v � �. � `-�.S, {„'1 �.� ... ._=, ... �, "� :' Li - ...�. V.C t= :. � C A�'. � i;^�.. L_�:; ... _ "' _ . C-� � �i ' . r. �^ r. ` c =. n - ' ��,N �'=.. = o�, c� ; G,� .:. � � � �� f: f� n ...<> .� � C`•� l.�'" � a ^... G CJ r ; ry 'n �,, �� ,�s � , � c -. �. c� �, ..�� `� �. c �: � �� r'. . , • i _ - Q _ Gc F. _ ��c ° �uG,noo �„in= �';�^ n�3 � D _- . C `- ^ 4. ='-7, ,.,, C �. , .: ,y C ,._i ,� C n a �y "' `^'C � ^'- � ... t',� '" � r; �G� • .'-. ... �,r-. ' ^� r�'- c: ('� ' � ±, ' ^. `� ,^" ^ � C'�' �. C.=. v' -t ..3 � � ' O�„^� •' ''�" 4% .-n [�' , r N i r C�n N..� �"��" p�. �. �n L_i` <, f,�,.�-c= �,,,.7 C .�--+ • . (: '� "' ' _'_ R, �'Cty. C` C �-. -=.• c� v' [N ` i�`C: � M1`G-w CV G" 6 + i ,."' � c!7 �t-.~" C -t' r 1 c ^'� ._ r, n v�.^.` i N _ -r „ ..,- . c, =.'a .. r'�c: 'b z: c -'^�' � ' " h � �-- i� �2- :� rr� i: .�+.-'. O .� . G r.^•^%. 'y .r �'' G, o 'n n ^ .'.,�,� e^y C� .. (� C r. q � ,r, • .. : � ..: C .r-'i .. "`[� R --"' .. �l _ � C C.. . �C r'�-��'— P`. � �=.'�M �O'�N.� O _•� C ��L O�n��L�Q w� � , L- r C n Jn (:.' b C C,` [;,," `• `I� U p CU I-, C� C'�� O �"O � • r t p X ` O �-.� Y i C "a G �Y r...,`� r.:. �r v. . p _ � R_•• � � � : T �� . . . R C �i'' `�c�� L,'f"! v U - � `G�-' . .... — O � �-` � C '" ... . . �--_� P.:'�v. � "' ic, .. G r . � j � � N�� _''_ f'' 't n�!'. '�'• "" -.""�t'� ~ _ . ��.,.,�= n ;� � n _��- �, , J `��,,,�.�.+� ' _ —�rr —�'� �+��