HomeMy WebLinkAbout1586A (9) NORKGRS'CO�IPLNSATION Di:CLARATION - 76q�64� A P 1 L IC�T I O�� FO 1'C P�fY M� I �
I htreby affirm that I have a•certiCcate nf consent to self CE-818(2-801
nsure,oracertificsteoiNnrker.s'Compensationlnsursnce,oi HEATING-VENTILATING-AIFZ CONDITIONING
i certifed(cyo7py there�/of(Sea 3800,Lab.C.1 ,1
�olicY Nn.l'�=��(6 Comp3nY��'�.�-f " ' V��� L��D5
� ccrt�ned rnpy is hereny�urnis��ee. COUNTY OF LOS ANGELES BUILDING AND SAFE7Y
C'1 Ob `(50,Y
-/y�,�c.er�ified capy is filed with[he countp building inspec[inn FOR APPLICANT TO FI LL IN RUILDitaG u
� d ir n (� �^11,�1�11^� �/� � ADDRESS `q�� �Q�I_I 1�1�_�
)ate����1pp����nt_N0_�l�L.�.Y�`+•W`!\_ . (PRINT OR TYPE ONLY)
LOCAL�TY (���
ClRTIPICATE OF[XLNPTION FR0�1\1'pRKI4R5' NO. TVPE OF APPLIANC[OR EQUIPh1ENT PEE J�'l�Y-`
COAINLNSATION fNSUR.ANCG � NEAREST . , }
T�11S SPC�1Otl neec� nn[ he COIiI(1�Cfed I((�1C \CO[�C InvO�VPd ABSORPTION UNIT,BTU CROSS ST. O
�y the permit is for one hundred doi�ars(S100)or iess.) oisrAicra�o. Pnoce seoev V
cer[ify that in �he prrformancr of the�rork(or�chich Ihis A�R HANOLING UNIT,CFA1 � �j �
1•rmi[is issued,I shali not em In an � -
p y y permn in any manner �L �
n t��become subject to the 14'nrkers'Compensation Lswe. 601LER,6TU V
(�r� f� � APPROVALS DATE 1' :ECTOF'SSIGNATU�E W
ite Applicant- - � COMPRESSOR,BTU_�ulvV�' �V ROVGH P-i _�� �
�TICii TO APPLIGINT:I(,aRer making this Certificate of VENTILA710N SYSTEM� �� �/>-�. Z
m�tion, you should he[nme subject to the \\'orkc�s' FINAL ��_�v.3 �� �-
nprnsafion pro��isinnt of ihe Lahor Code,you must(nrth� -
�, �v:,�oF%.nve C06LE: VALIDATION
�i �umply �vi�h sucn provisinnc <�r this permit shall be
'ned revnY.ed. FURNACE: FAU GRAVITY �O �� '
} I.1CF;N5h:DCONTRACTORSDGCLARATION F���A' ATU-��IC��
�rehy affirm that 1 am licensed under provis{�ns n(Chop[er H[ATER: SUSPENDED UNIT - . �
�rnmmencing�rith Sec�io�7000)of[]ivisinn 3 of the Pusi� WALL
ns and Profecsions Cnde,anA my license is in full(orce and �� i�� � � � Sp .
�fPcL 11 �h ,
�cense` ��er3`�5z�y Lic.Cl�ss�'r`-' . �
)niract�r � e �'� Datc�-(��
� 1 am exempt fmm ihe licensing requirements a5[am a �� Jr 8�6�
licensed arehitect or a registcred prnfessionsi engineer Plan CheCk fee 2Ei°b of above. �
xtin; irt my protrtsional coPacitY (Srction 7051. Ilus- SD �{�• •�•�• •a
, inesc and Profescions Code). PERMIT ISSUING FEE$ '�� ^I.•'•5�0 O
� o
�c,or Res�No. � Date TOTAL FEE • •-^J��O O�
� IIOt��O1t'VP:IL-I3UILDFR pF.CLARATION pLAN CHECK APPUCANT -
�hereby affirm that ! nm exempt from�Ihe Contractor'.s NAM11E 0�£?3 0�-8 3
cense Law fut Ihe (ollowinK reason (Section 7031.5, flusi�
�ess and Prntessinns Cnde): ADORESS
[f.-�� I,as o�vner-of ihe pro�crty,�vill dn!he���ork nd �he TEL.NO. � -�
{� structure is not intended or otfered for sale (Seetion CITY �
� 7041,Business and Professions Code). �� �J �.
06VNER —��`O�1}�.�_S_
1,as owntr nf the propertl'.�m esclusively contracting
with Iicensed contractors to con<truct the Froject MAII �i /1�y /�',,,�/�ep�(��`� ,���/)—
(Sectiun70JA,[lusinessandProfrssionsCode), AOORESS �"1�� `t ��� l _1
CITV p�. TEL.NO.
CONSTRUCTIDN LLNDING AG1iNCY �-��+ �
ereb}• affirm that Ihrre is a tons�ruction lending agency ,1�, .
�[he performance uf the work (or �rhich [hit permit is CONTRACTOR�`AG�� {-{1e;� , � � � �� � �
vrJ(Sec.3097.Civ.C.). - L14 . . •fJ
7der'sNsme AOORE55j13o £. --�",�C'��.�-��1Q
.ender'sAddress CITV {�y��y�,p� TEL.NO.��-a�l� . . .
1 1�� �1L.1_.
Certify that I have read ihis application snd 5taie tl�st�the STATE r� UC. �
b���e inlorm�[inn is corrcct.I sFree I��cnm�+ly�a�i�h al1 County LICENSF.Nn.�-!S��y_ CLASS_�_� . . ..
�rdinancrs and State Is�vs rcP.������ng Nca�in¢,Ventilating and
1ir Conditioning,�nd hereby authurize representatives o(this StiG RIiVGIiSE£OR EXPLANATORY LANGUAGIi .
7ounty tn enter upon Ihe sbove-mentiuned property fnr
�svecri� �urr s•c�
—� �-L'-��
'�i¢natur^�fl'rrmitt e Date . . . .
/�\ .
' ; ` • . � � . .-
l. � '/ �
` � �'•
Z � 1
v : .
O� ^ ._._ � •",
N ,
Z .' �
O . .
�
N
' , , � - ' �
! ', Z
, �
4 n
O
' - �
N
� z
O
'- �
. � • �.
. � . �� ' , f.• � , _
_: - ._� - +
. ., ` ' :; _' .
� ' • . r,.,i�� n^ p �, i''� � ?
, - ^:� `e., `v C' _ � ��. '.. N t'� r' O
. ^ -i �, .C�.y� � ti :� `
' �.A ^. L� A fNQrY . .r'..�-.V V - M=' L; t> V i� L
•� C � S� � � �, .�.. G C v. Y. C] -Q � � 1
L' „ � ��' i �.I r N � '"' p r �, r_ -. N `� -�"
� �`T} G n�"�.�3'C � � � h O n y�.,�.,�p ' o�`^� ' „i ��
�� ^ ^ � o ;�,; c v �� ;, n «.. ^�o ..�i,,p 'r G C:
� ti -} - �'.• o �t' ',�'� =� _ ; �,.:c� �G l G
_ u � o u "` .�; �F �'X._•- .y �� :. •�.•3'=: � ;=•;...� v o �:. ,� .
. . �,., �' � � ^' r ,V,'=-•: . ` ,,,,,O =, C..'r�' ? �� �R." (��..a.c. v� � t`�
' . . w ' ... �n v �"`G'� 'T� �.... �'=_. �� �'--^ '^ t'a Ca C ...�n �.G ia 3'�i'.�. �. D�..�._�C
f> ,� C p`�� � i + r `. S" � .G _.� �l C " ».. _' .:'in �i �
. � O V F ~fl �.'� C ���.•" ry .''. �C'-'b H r �v� C" C � ,G•'.�- S. f: �
� . � � .- : Y, ��, �,V � c" `t n�•� d
� � ���'�..� �� _.� .. � ,� �. �c ,..,� »�� c :
' � `� � t�.��,�.,N;; � ' � �'� � c��,.. �`'„'" o _,� ' `.•r. o c.��= � n
� n r., ^ � " {N p ro C, �•_i �" '", '- � G� �'a, :-m` J •,^ ~ :� .��. w �
' . "s - o Z' • cn n 'S_' �� ' '� H =' t� n`'_ p•^,�> �... -t r`�j' ~ ,.�j'
. ' � n =.y �u 7 .,� p K.- ^�....r..:. c��:. T: : n p r; `y" �:S.�� � ^ _• "�'J
'"� `' � ' 'Q` "' f�-V `--� `v. .�i. =' � ' - F.', d � r
� •J � f v. C:(,"'., r. ... v. �' r ^Q 0: ,,,,"' e.-^. .�� •- �.=�� � r�
� �- �v. �' _ ':� ,o• a' c' �,�"'Ac c y_ .c � C 'c �c •n � ^ c. �,
. U _.L'. O y y .�. ._. C F 3 �. Y . �'� �� G v n� �
n � G G " .-+
. ^ f= m �� y `:. ,� C"� R �`'i ^^ '-�^�Y �✓� �..`^ $. S= «" � ... ��- L
, � G � N_C . �� .' �. :J' � � _ � 01 u _ - ti
� _ . �,G. p'� i�, - i .,�'^- :� -� � �r�.- �J' �...,, ' (';�' p� •^• O �n
_ �.„�. . � p p ._ � � v� w � r.•O .w...
C = �' r' C.� � :i rv r -- ' " p C n �: G_''�� O . .C+
r��+ �. '� G C �� C - ' c,�
`n �'. C r-.G � G p ""'j � '�C ,� ... �o� �,,- v
- . C � R':., ' r. � '" �, 7" ., �"" ..ro �
, «. ��%' \n r F, ('� G '� � 1 .
V L �
. , ti•C] �(% ( tv� �'�''.G n '�'c O � � -
. r �..�.% � ���; b ^�....�.-
, _ , _,�y� n f ����' ..
. � :.�`-,�...... -
i.' � � _�-+"✓
.r�
, - -� � J,i--� - �
..- F ��