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HomeMy WebLinkAbout1588A R'ORKERS'COAIPF:NSATION Df[CLARA7ION � 7fiA�G4C � � hereby a(rrm Ihat 1 have a certificate of cnnsent tn selt CE-818(2�801 A PP L IC AT I O N FO R P E R I�l1 t � insure,oracertifcateof\Vorkers'Compensationlnwrance,oi � HEATING-VENT�LATING-AIR CONDITIONI�lG a cer[ified(c�opIy rth'e�r-/enf(Sec.3800^,7L�a,b.�CJ 1 cI I'olicy Nn.CL'�V-IcL(:om��ny—LS�r���� - . .. . ... �1�T l�s I ❑ Certitied copy is hrreby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY �lc� `I0� y 5.[��/ Certified copy is filed u•ith ihe county building inspection - f3Ut�DING a par� z c `(�,r l/ ����/� FOR APPLICANT TO FILL�N Aooaess ��3 (-��e_efi,_I Da(r���Ap,P���ant�UL��"�" � ` ' (PiiINT OR TVPE ONLYI � � n (� LOCALITY �'1(7_nl1�..IlN 1�'�,� CI�:RTIFICATE OF EXE�IPT[ON FRO]1\VORKIiILS' NO. TYPE OF APP�IANCE OFi EQUIPM17ENT FEE 1�"11'"'Y`4� C061PENSATION INSUItANCG � NEAREST } (This section need not be completed if the work involved A�SORPTION UNIT,6TU cRoss s7. o- O by thc permit is for one hundred dollars (S10D) or less.) oista�cr wo. �f eHeces�o sr V 1 certity ihat in the perfnrmance of[he�eork for�vhich this AIR HANDLING UNIT,CFA4 / �j� � permit is issutd,I shall not employ any person in any menner �Y � — so ss in hemme su6ject to the\Cnrkers'Compenaation Lsws. BOILER,BTU �"� /� QO APPFiOVALS ❑ATE IN�._CTOF'$SIGNnTUFE W , Dste Applican[ COMPRESSOR,OTU_' _f_""'� O ROLIGH a �_• _ — Vl NOTICL TO APPLICANT:If,aftrr making Ihis Certificatr of VENTILATION SYST[M � Z LsemOtion, you should becnme sahject to the \Vorkerc' F-INAL �— Cn^t �_ti•�.^. �cc�^.=!on<..f the L,h�r rnAo,yn�,�mir.t F�rih- �EVAPOftATIVE COOLER VHLIDFaTIV� �� . ���ith„Comply ��ith 5uth PrO�'�sions <ir this permit shall 6e deemeA revnked. � FURNACE: FAU RAVITV_ � � , LiCLtiSEDCONTRACTORSDICCI,AR4TIOV FLOOR• 6TU—��OOn Q I hereby atfirm thnt 1 am licen�ed undrr procisions nfChapter HEATER: SUSPENDED UNIT 9 (cammencing�vith Section 7000)nf Division 3 of ihe�usi� WALL ness and Professions CoJe,and my licrnse is in full force snd • I 50 effect. ...���_,,..� ' �_�O - L " E _ . License Number ��1�, ���� Lic.Class__ �ntrsctor�l V I`��(�Date �~Z�� . : . . . . 1 am exempt (rom the licensing requltements as!am a ���1 5&8 A lirensed archilect or s registered profession�l engineer plan check fee 2540 of above. a �acting in my prnfes5ional c3pscily (Section 7051, IIus- � {�. • •�e s 8 inesx and Frofcssions Cadc). PERMI7 ISSUING FEE$ ���_.,_ Lic.or lieg.Nn. Date TOTAI FEE �n� ,�"'�5��� HOVF,OR'?1ER-BUfLDFR DGCLAItAT10N - p�qN CHECK APPLICANT •�°•°J�O O� 1 hereby affirm thst 1 am esempt frnm-the Cnntractnr's NAM11E License Law for the toliowing reason (Section 7071.5, I3usi- O b.J O—H J necc�nd Professions Cbda): ADORE55 _ � �, as nwner of ihe property,��•ill do[he�a�ork and the TEL NO. --� structure is not intended or offered�for sale (Section CITY 7044,Business and Professions Code). . \ • ^ _O C� �� OOPJNER v \G(' � , � 1,as awner of ihz properi5'�am exclusiveiy contracting V� /� r �� with licensed conlractors to cnnstruct the projzc[ nOORE55�����_����1�� 1 � (SeMion 7044,Dusiness and Protessionx Code). � CONSTiLUC7lON LLNDiNG AGCNCY CITY 2��(^ TEL.NO. �.� 1 hereby affirm that there is a construction Iending agencY CONTFiACTOF � � � � (or tl�e per(ormance of[he worA fnr �vhich Ihis permit is ���� _ . issueA(Src.9097,Civ.C.). � Lender's Nsme A�DftESS t 1�O� Pa�t-�1�� I,ender's Address CITY (��he i,,,,` TEL.NO.����_�' - .. . . 1 rer�ify iha[i have read ihis applicstinn and state that ihe STATE 7 ���� C_�7O above informa�ion is Correc[.1 agree�o comply�s�ith all County L�CENSE NO. ��(�� CLnSS � . urdinancrs and St�tr 1����s rcgulating HeatinF.Ventilsting and � Air C�mditinning,and hcreUy nuthorire representati��es of[his SLG REV[RSE FOR EXPLANATORY LA'JGl1AGE � � County to rnfer upon the nbove-mentioned properly fnr incpe ron u pnrs. �����. �'Zy-� Siqnati� f Permi[[ee Da[e . i � r� . .. 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