Loading...
HomeMy WebLinkAbout0783A 45'OF2Iik.ki5�(�(J�I!'I�:NS:�IIU�U[CL�R.\TION � CE�81812-80) �►rPL��/���0�� FO� ��R��'� [ herehy affirm [h�t I hare u' certificate nf consen[ to self � insure,ur a certi(ic•s[e ot��brkers'Cumprnsalion Insurance,nr HEv,TiNG•VENTILi,TItrsG-r,IR C�NDITIONiiVG a certified copy[hereof(Sec.38U0.�L'aIh.C.) / Po(icS'No�'��'04�nm�:�ZS�" � L/l�G• py,/,/L•( t��� COUNTY OF LOS ANGELcS ❑ CertifieScupy is;�areb>furnished. BUILDING ANDSAFETY � Cer�i�i�d cepy is fileS�vith thc�oun[}'building inspeciion FOR APPLICANT TO F�LL IN �°L��L�ING��4�� rjj�p�;q:rt,:,�r,;:n�t'� �,/� y� /� q�p�;��p / � (PRINT OR TYPE ONLYI 3 AD�RE55 � 1)aI2jC.:�. I��CFt��et�Ilo'�/�/C' __ . _ _ ___q _ � 1 _,CLj��__ �f ',6�!-� � 'LOCALITY � CEftT1FIC:ITE OF'tklttitPTi :�I ItO:`.?!'J C RKk�.KS' NO. I TYPE Or APPL.IANCE OR EQUIPS1E!CT I� FEE �_/fl"/'2D�J��L CO�IYEi\S,jl1U�ItiSGRAtiCb I � ^;EAREST, (This sec[ion need not he cvmpEe[ed i� [he work imolved !aRsoaPTieN uNiT,oTu � ;CROSS 5T.�� � � ,� a by [he permit is for one hundred dotlars (S100) ur less.) i ,,;rF��c1 au P�*oce,sEu�� � U ! cc:�if', th,,[ in the p�rforn,�u��uf t��c«��,rk f��r whieh ehfti 'ain Hnn;o�i.��urv�r,cr-^.^... . --- . I pernd[ia istiued.I Shall nuc rmplu� a�y person ia any manne. ! I 1O � � so us to become suli;ecl tn[he ll'orkers'Comprns„tion La�eo. �BOILER.6TL'------ --- -- ' ; - ' � ; . ' � AF'I+ROVALS � DATE � I`+SPcCT0��55:G".A?u1tE U I � Uatr Apptic�n�_'_._._. _ __.. _ PCOMPRESSOR,BTV—""_.."_'__. , n� � —_ ! — _ W — � , 4 i � a i �_....:.., �/�- •---1._.... � z NOTICF.'I�O:\PPLIC4VT: tf,atter makinF[his Certific:itd nf 'VEN?iLP.TION SYSTEt.I � � —E F�NA� �� iL����__ � � 17 z//3o F:remptiun, you ciiuuiu he�n:nr sahject tn Ihr 1�'rrzkers' � I �T �" f�`�-�(P __—�y C�imptrs�[ic�:i tir:nisi�>E:.�;:[h�L�li:�[C�,�e.Y��u mu�t f��fih. � i � b i wiih iomp!y wi[h ' � ' `EVAPOHATNL°COOLER � � � � ai.�ch ['ruyisu�ri; ��r ehi. permi[ shull 1�- � � _.......___—._�--_—� V _�[�laT�[:�I decmcd rCvokrU, � �FURNACE� FAU_GRAVITY_' � � Lli'h.titiF:U CUlV7H�t IUH.�I�h.C'LARA"CiON i}— FLOOR� _BTU._ '._ _—__ � � i he:c`nt ;.fft rt rf [ I,m t' -� t. � �.t�SaJ:::�r.`f,::�,i:r i —' 'HEF.TEH: SJSF �.i�ED �'.1l ' � `7 (cummrncm. i��S c i n 4GU)<t U'u�i n.7�t[:i:H.�r � WAIL . � ncti�and i'r�fac ri„t i1 and r 1� --— - --- ----- - -- ---- - - - _._ �ti1�2 1.II]rul��J ..!t;� ��J � tt��<�. �G�Z�2�. �rL°I---- ��--�-��``-T;a� o�e__�;s�T_��� Lieeine IWumber ic CI;15S— j � ,r�! 20-� ` rlu�.> S 4 sr�rr i � Cuntraccor�D N/�TG.tr �j�:��_ -- �_ �j ; � I am e�en;pt Trom thc licer:mg rey:iirements as 1 am� �� _ _---_'..._'____'___ ' : i � .. licensed architect nr � reki�tered pruftssiun3l cn�ine:r •e p{an che.ck fer,25��Of�beve. ��—_�� actine iu my� prnfe.sionat ca�e..ity Lti��rtion 70.7. f3ua� .1------...-...... ... ... ._....--_ __-.-. .-..---�--- � B �nc„and��r:;t:s:.i;;,^.s C:;;i,:�. ' PERMt7 ISSO!�u FwE S; ��r ' .------ --------- ' �--------- - � tia nr I.r�.Nu.----,----,--Dat�— ¢ TOTFIL PEE ���� -�-----�----- -1.---..�_� HU\iL USitiLR-8i'il.i)I.li DECL;�I2ATICiV PLnN^HECK APPLICAN7 p I herth: affirm tltat I am e•r�.npt f�un� [he C"oniracum'� �--- —_"�—'—_'_—' � . I.icema La�+ fo: [pe fui!uµ'±;rK rrus;.;n (Sci.tion 7031.e. Rusi- �• [ � ness and Profcssi��ns Cud�): AD�RESS + �0 7�3 P, � � ,� � li �', i:� F .. . as m.r.:: ;'th� ��,;;G:crt:. ,. •,.ork ard th�� structure i.r not int:ndrd ar uffered,for ;�le (Section ��GTY TEL.^�O. � ���� � �'�8 7U44,liu.ines�yn�l tq��.�fessinn=,('�,:i_), � ❑ -06VNER D S v, � I-• • � Cl S O I,�s owncr uf the prnper[y. am esclucivzi}' con[racfing Ki[h licensed cnntractors to cunstruct the prOj2c[ MAIL ,�Q�� � (Scctior.?CJd,IIu,i�:c;.a arii�Froteaaiunti Cudej. ADDRESS � SD _��D� /7�/�i ; �• • • � Li,F�U 3 CITY /. 1�— TEL.NO. COtiSTRGC:IIOtiLI':�UI\G:IGLNCY � W�.1LV 9�Y-�`yy/ � I L24�81 I hcreb3' dffirm tha[ [harr ia u cunstructiun lending uXtncy for the perfurn:anec nf the �i�nrk fnr �rl�ich tf�is p2r�tti[ iti CONTRACTOFI !`A,. .. 1 /Lr�1�///L �(��- issued(Scc.?U9?.Cic.C.). �/ l��M /TL /Y .f�N•� • Lendcr's Nou,r .._.........._ ..... _ ❑A�RESS 7 G �SJ�`�J� s Linder'sA�liiie.>_ _ i � t��v� � � GTY D.l�dv/�.iL TEL.NO. ��7 : /`_ �T ? 7 CCfLI(Y Ihal 1 hnl'C l��J lhl;ap�llliatt�J�l 3fld SIJte Lhel ihe $TQTE /- ---�-� LIC. /r f 0 . . �bu�t infurmu[iun is c�irri-et.1 agree lu cuinVly�ci[h a�Il Coun15 1 ICENSE NO. 10SZ�Z C�ASS V �� , otdinancec and Stute latcs regWartin�Hca[in�.�'rntiln[ing:mti Air Condi[iuning,:m,l hcrcby :wd�orirc rrVr��,tnta[i��es of this 51�6 RkVFKSt;FOR FXPI.ANA?O;?."LANGC.\GI. Countl' [o enter upun [hv uhucr�man[iuucJ prupert} fur � iutipec � �ur n•, �::,'�'I��:/l�- ��2b ��r :.:(::fi::l l`:fii1- 22 u3�� -�.�--.._. .+ '�"S� o� < j O,C 3 = °'O d� u�'�J L' .°'- � N � �'r .p C O q y � �T„ G''� 3 0� O -p ' c C y �F... _ T�+ o �.r�3 �J v � �O^+ i.6r-. � -u . � e,a' S C'� i� y c, j � :, i� y Y a �U•.�O o O � . - >,o_': � � w,,,,,�°' "a.i p 4�- c 3 yc.c �' � ✓ Y t.�i � a � 3 oa .-�c ^ C � c" G,�� � crr-.$ o� °' C' C ' ti .. a C' �'� > L. ` G � >,s =.a.� .+M p fl.� ,CM O v � Cy.... �+ a... :.. �O� ti �� O� �(J ="' ��"` O � ✓•'C C ^Sv •�S' O . A J �' O-O. 6 C . C O ... • M � .. ^. o+ cre - « "' „ 3°s � `� ��vr.; �Rj �� N .F���y� � d � � c o o`y -,� �� „�o a s �e .. ^ � t � 3�,..a c!� �, � • V c.r �•n p a d 'G��.0�, � u :, a C .. L 6�l-. � �+ r G— % ` .^. :l �' J =. Y i V] V . S� � v� ^ C d ��J� .� C�.J ~�-,v� � .+ G,�� '1 'W'y � �. �.U � t� t O :,," „w._,'. 'C1..-� .:'� ` V� j.,�, c. .~+ � ^�,�. � � G L L u v � ca = y �`"., v s' ' o' = �;C, � � G `^ " '� p � v . , '�" N�. = F v �~O��r•'' �`J� ^ t C�M'..'.C' �'^.`, �„'G` CS� � C f+' "� YQ! O G�%'r- O � .. a��� C = v i�..� �'` � � Uj�,1 . £ �n'wC � y...' : O :J ="? a C . C b ^ C' > � c +, �^GC O1� w v % �• Y 'S p ^' = a o � _ �:u y N,Y, cp Y � y�.C_ o o . � :� u � O �« � G- �c � � n� O tJ V, n s oL ;, p'6� `r'w c `,.-.^ N� A�`a y�3Q'� ,"�',t u f„o-.O E ob �+ W ':� �� �naov �a ��'^ V c � o, AEv_F. "'= a ���" ,,, � � � � p A�°�� azv wv o. 'v_ m. = o`, ,..,�', � N. T� =c} � � U ;, c.. " r o>" G'r �a c 3 � v C Y= o = '� ��, r j'G a � 3 L� e� O � 3 ". ' �' � C` a � %"y �_' d'r~"�.�,�e„'C n��.-.o,��._^e j� i 3 =�ydQ4?N n �v CS. �. �"' ,a'i^. N..� � � a � _ _^' � O GS :O w.-.2 .�+-- u% .r 3� � °:- � � � .., 00 � � Hu � � � �, t � o z• �o A � e�,s Q V' s E o�d V e�GO u �b p,:. a 3. •>T.a vf ." .�,. d,•.z3•. �. 'c' _ ,,— C� ,H, c=�--'o� o �° °��� �,�-- �, i��.� o+Q'f�., d� -�� �� N w r 0 2 N � F � � W - N � Z � . , � � N W O Z � , . . d O � � � a� � . 2 . " � , . � . /__'—�_..