Loading...
HomeMy WebLinkAbout1702A u'°RKERS•`°"'�E"SAT'°"°E""R"T'°" ' APPLICATION FOR PERMIT � I hrreby af(km iha�I hove a cerriiiw�e of cons=M�o sr.l(� I�Sl1IP,O!f1 CPlIiIiCO1P.Of NJOikf'�S eomAonsoti0n�nsu�ance, HEATING - VENTILATING - AIR CONDITIONING ar a cerli(ied co�y ihereof 15^c.?3 Lab.C.) � 76a]neC � ��y /�� ��� � CE-018(F'.V.10�81) Policy No�j{(W(���7Compan _{.4!1L`^�C� � Cerrfied cepy is hereby furnished. � COUNTY OF LOS ANGELES BUILDING AND SAFETY � Ccrrfied topy�s f�led w++h thc cou�ty bu�ld�ng tnspec- FOR APPLICANT TO FILL IN ^Unci"i� ��o�dP.PO/�mC��. (P71NT O4 TYf'F O4'LY) FCD�E55 ����'C P.�AS p���. .�i��`�aa����a�� � � io:nurv Di1�A1P�l.n /�R �.q Np, TVC��F AD7�IANCE CQ FQUI7!lENT FCE CERTIFICATE OF EXE�"�TION FROM11 YlO4KE NEaaEST COMPENSATION INSURI,NCE CRC55 ST. (Thls sacllon need nol 6v complaled 1!fhe work fnvolved by AM1SC��TIOV UNIT,BTU p�yi���i H�� r�p(FS'fD P.v tha parmil is For one hundred dollors(5100)or le�f.) AIR HANDIItiG UNIT,CFM � I certify ttiat in Ihe p?rformante ef the werk fer which this ( permil is issurtd,I sh�ll nol employ any perxon in any mo.^.n?r - 50 OS 10�]�COI�IP SUh�=c��o�hr.Vlorkrrs'C�mrrns�tion Laws. �10'LER,BTU P�`RCYPIS C?iE IN�MCICP"5$�CiNAi��PE ooro ^r-a���a„� co`.'PR:SSOR.BTU��� � C1 O� ucucU, }„ s � �c �S V (/. r •.�.� NOTICE TO APPLICANT: If, afrer mn4ing thls Ceril(ica!e oF VFNTIInTiO^15VSTF!.1 F�vnL S ` � `(ya)y/ Exemplion, yoo should bncome subject io the �Yorke.rs' Campenso!ion prov�s�ons ol the Lahor Codr.,ynu must fonh- FvaroaaiivE COOiE2 � VALIDATION with comply wtth such provis�ons or �h�s perm�i shnll be d^emrd rr.voked. FUcvt,CE: FAU G�,.a�v,1TY IICENSED CONTRACTORS CECI�RATION � nOOe sru}c�0_,�� l U OO I h?rrby aflirr�Ihol l om licrnsrd�ndPr provisions c(Chcr rr 9 �+cqTFR: �US�Ft�'CC17 U4�T_ � �(cemmrncin�wi�h Sec�ion 7000)ef Divisian 3 al Ihe f3usinrss � ti��A« and Professions Codc,nnd my licrnsc is in full(o�cr,and Pffatl. ' y lirense Nvmber���`�� lic.Closs "�� \ � , O I � c CoNroc Datc�� � ❑ I am exempl ndcr Sec. V Plcn check fee w ES.BP.e.io�ih�s reoson PERMIT ISSUING FEE S N Dnrr: 10 z S���o�u�c TOTAL FEE � :�1 !Q[�i OYlNER�f!UIIOER DECLARATION RAH C��FCK ACP�IUN7 i?• ' • ' '� I hrreby affirm thot I nm exemrl(rom thr.Ca^hactor's Licen�e , Law for thc lollow�nc�rrnson(S++cticn 7031.5, Rus�nrss ond nns�E � • •4�^J n pro!r.ss�cns Ccdc�: ' ❑ I, os owncr a(th�propPrty, or my ernploy�rs with �DDFE55 • • •����•5�� woges os iheir sole compensotion,w�ll do the work and �ifY ifL.NO � thr,siruciurr is not in�end^d c�effered fcr sr.lr.�S^cf�on �7'����J 70:A,�usincss a�d�rolessin�s Cnd�). ❑ O'.L'•�'FR ��� 1 I.as owner of the prep^�iy,am e.dusively cor.tracling _N w�ih litensed tont.acta.s to co�s4o:��he project(Srtc- r""� iion 7044,3usiness nnd Prcir.ssions Codr,). A9C=ESS a2v ,�-G LC i-� CONSTRUCTION IENDiNG AGENCV pTy ��� rn.Np _ 1 herc6y nffi�m ih�l�hr.re,is a construction lending agency fer thr,performnnce of�h=work for which this permit is issurd CCNT� �y � , (Scc.3097.Civ.C.). — aoc�ess,S �G-� CLJ l^ndcr's Nnmc � . CIiV �L� /��` �TEL.NO�� F� lender's Address ���� Sil11E +t LIC. I cerlify Ihol I have read�his r.pplication�nd s�a!rt rfiat ihe LiCENSE NO.p,�7�Yl CLASS U above intcrmo�ion is ccrrrct.I ar,rec to cemply wirh a�l Coun�y ord�nancr.s ond Sia�c laws rctar�nq io building constr�ction, and hereby authorizc re�rrsr.nto'ives ef this Co�nly lo�n!rr upon ihn. bove�meniioned property for I�spect�on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �'p/7 ���-k.f s�; vre cr nppGcaN , �i oo�e / / � . _ I.... � . / . � f / • . . i/ .. , ' � 1 . • , . �'.i' . Z • _ • . N . " '� . . m ' � _ ' � � O ' , . 70 ' . . - Vi . _ . . . . Z . � � , . ..� ' m - N ` . , i ul TI I _ � • . • �I ' S� ` , ' � 0 � '' � m ' � N � II` ' I I I /1 V �^ N , p p � - s� F �.�f:" ' ��. :� ; a F o n� O� w° ii '= n c�5. � � N ,��, " _ � ii , � v �, ; ° �u N'n _: . �t' '? x.� � ` �,. ri^ -- ' �� 3 � c S. � ' o ��„ ' � � n C r V �� C ti O [:.�G'= V� L,u �j cn �ry� n'_ i^T; M � i: C: ' (l N �a � n � 4 � L��� c. � `-". �-'' a�_ -i.�o �� c�ci °'�.i � n r. n n O p � ; N tn -�cn H-tl n 3 . O � ^ „ u r o �C � �� � " r' !a�� �^. � r, O ` � V � rr �-? - � / . TJ O N � _N . � +". O +�.p '- C _' n �C.`G ; _ �:) �G � ,.,� w ^ N 7 O -) Z . . . ; u n ._.O � S N n L _ ` � _ ? :. �� c__�� _ _ _ c _ r.i � � i ? � � � ' o U� i,i ,� � � _ - :� � � N - � � o,' ^ry-� c_M � a o _� c � ;i ❑ u t� , o n � c _ ' C; - � � � � ;,�c�.', V ^ = u ' k - q ,�7 i G'' q - G7 n �.� q w �) - . . N - - G � � � � ��n q L� ^ c S �% r G vr'� 7 ^J � �q n � t] O C V � (/� N 7 _ '� .. :� _ `� G�.� u� C ��� != -I �= � r ' U �= C �j � U ["]"-� �' � �.�� � � C� , �-ii O '. �] " � i C � y- fl(; = . � n n , �_ � _.: -�i. � -�� _.� o c T� � � �� ' �-'"` :.-� c r. ? �r,� � -' � .' _ � r N - - �, ± r _ f1 4 '" `• �� ... n ` a t� Z o f1,� � c� .� �2 « � o p c � j� �',- � t, '� ,;� � � Z: •ii n r. � a. r�� � < N ''? „i n.� '^cr� � �?�� � �: � _ p �-1�� v n ' ��, O � U.. ll 7 �.^. �� � � � N �•� O � � ��•`" �I (: " _ � ,� ❑ _ r _ c ;,', . - c �.c,' r. n �i s n � < � �o z^'� _ � o o� D ' �i S$ �° ° o,� 1� � ii o u L U. ���ii'c -• o i �c?, � i„•'- -l+i 4 0 � . c ° °� o z `--n , �_� y ri o n N :i < � j �� � `= � ' c.- �� :: t� ° - � � � n � �' H n �• �.u r.' ° co n • ' � ° °, . `? _ - z� a� �, n_°,c • n _ �,_�; , o n • c� � <� Z n'� ry�' r. ° ' '� N T rl o � r v+_ � � '" ��P � �+[; � , o ° _' � c> >-� _� � " a n � �.^�' o N o ci F�i`�„r� u`n � O n r� _V � r: i ., �l v = �• �,� � (1 -_ -.� o ° � � `; o r � ; � J� � r. � o -� � . � '':' `' =�•`"�, L� . �+ -`l L= L ' +f'