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HomeMy Public PortalAbout9834 BROADWAY_Mechanical__ APPLICATION t�l� pY p� C PERMIT �I��p p[l 4 CE SIC PY Ir Ir LCA 1 �O1tl IrOR IrERIVY � 1 t-WO _VOR COMPENSATION DECLARATION 76 - 64 (2-80) I t@reby ai m that :f have a certificate of consent to self insmre,gir:cer,ificacof Workers'Compensation insurance,or HEATING-VENTILATING-AIR CONDITIONING I ;ertified cop:.thereof(Sec. 3800. Lab.CJ Policy Compan Certified copy is hereby furnished.y COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING department. ADDRESS f 0�,,t p^ 3 y 174 Q.0.Qu/'�t Date-S-111--14— Applicant 3���rr tNQ�_LKSfA1�1,QS, (PRINT OR TYPE ONLYI LOCALITY CERTIFICATE 01-EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE - COMPENSATION INSURANCE NEARE CROSS ST. a (This section need not be completed if the work involved ABSORPTION UNIT, BTU O by the permit is for one hundred dollars (5100) or less.) - DISTRICT NO. r/ PROCESS' 9' 0 1 certify that in the performance of the work for which this AIR HANDLING UNIT,CFM o V cc permit is issued, I shall not employ any person in any manner c UUU O so as to become subject to the Workers' Compensation Laws. BOILER, BTU f p / APPROVALS DATE INSPECTOR'S - NATURE W Date Applicant / COMPRESSOR,BTU_ ROUGH - y NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM Z Exemption, you should become subject to the Workers' FINAL Compensation provisions of the Labor Code, you most forth- with comply with such provisions or this permit shall be EVAPORATIVE COOLER VALIDATION deemed revoked. FURNACE: FAU_� �j9-AVITY_ LICENSED CONTRACTORS DECLARATION ! FLOOR:— BTU_Jv� �Q I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Section 7000) of Division 3 of the Busi. WALL mess and Professions Code. and my license is in full force and effect. �f �f ' �r O � O-u�rs•e�S License Number-9231;j— Lic.Class_C�/. ]7SContractor Sgy,i✓res, NY Date_S 3 . I am exempt from the licensing requirements as i am a licensed architect or a registered professional engineer Pian cheek fee 25%Of above. acting in my professional capacity (Section 7051, Bus- mess and Professions Code). PERMIT ISSUING FEE 4 5 9,3 A Lic.or Reg.No. Date TOTAL FEE # e,e•.eee HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I,e,e3625 I hereby affirm that I am exempt from- the Contractor's NAME ©�� 41 ��N_y_D e o'e 3 a,2 5 m License Law for the following reason (Section 7031.5, Busi- nessandProfessionsCode): ADDRESS 76' ❑ �' 4 �20�•Qy/�� 05, b 86 I, as owner of the property, will do the work and the C structure is not intended or offered for sale (Section CITY %eM ^ _�f TEL. NO. , 7044,Business and Professions Code). /l T El I,'as owner of the property, am exclusively contracting OWNERrp.41 ML• KI^//1( Aer with licensed contractors to construct the project MAIL /^� (Section 7044, Business and Professions Code). ADDRESS q.�1; Y /�2oq' N7..J A. CONSTRUCTION LENDING AGENCY CITY TerVLO_�e Cj TEL. I hereby affirm that there is a construction lending agency, - for the performance of the work for which this permit is CONTRACTOR V.!QOr �{ '7-A e f issued (Sec. 3097.Civ.C.). f Lender's Name ADDRESS ?yF� I AI e& , x/y Lender's Address tam ' CITY s"+u Ozµ��. TEL..NO. 394�l_L16 1 certify that i have read this application and state [ha[ the STATE 3.I ( LI SS above information is correct.1 agree to compiv with all County LICENSE NO. L.(',� - ordinances and State laws regulating Heating• Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter uponyyy abov -mentioned property for inspeC n purpos67-3 Signature of Permittee Date O/'L -V 116177 WORKERS'COMPENSATION DECLARATION 76A364C APPLICATION _'!^ p '�'�pI ICO1� PERMIT I�p4 �1T I hereby affirm that I have a certificate of consent to self CE-818 (280) A Ir P L C A 1 tl 1'— R Ir E R M Y ^ insure, or a certificate of Workers'Compensation Insurance,or HEATING-d EIVTIL TIWG-AIR CONDITIONING SUI 'c I`.. cow the'eor'�:c. 3800,f'' .C Company– El Certified copy is hereby furnished. COUNTY OF LOS ANGELES -BUILDING AND SAFETY Certified copy is filed with thl counr;building inspection FOR APPLICANT TO FILL IN U BUILDING d rt m �' /(�''����{p�/�%�'/'�'' (PRINT OR TYPE.ONLY) ADDRESS �^f7 Date_r_y_� � Applicant ,��LJ.[—r41 !/ ' / 111111 ! LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE 4.LL( C.� ✓ 7 COMPENSATION INSURANCE NEAREST IL } (This section need not be Completed If the work involved ABSORPTION UNIT, BTU CROSS ST. / O by the permit is for one hundred dollars ($100) or less.) olsTRlcr No. d _-_ver U R 1 certify that in the performance of the work for which this AIR HANDLING UNIT,CFM — permit I permit is issued. I shall not employ any person in any manner V C/ so as to become subject to the Workers' Compensation Laws. BOILER, BTU ` F / APPROVALS DATE NSPECTOR'SSnf.1TURE V Date Applicant �S� ___� O W COMPRESSOR, BTU ROUGH y NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM Z Exemption, you should become subject to the Workers' FINAL Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be EVAPORATIVE COOL VV.ALIDATION deemed revoked. FURNACE: FAU—� RAVI LICENSED CONTRACTORS DECLARATION FLOOR: BTU— _— I hereby affirm that I am licensed under provisions of Chapter ) HEATER: SUSPENDED UNIT 9 (commencing with Section 7000) of Division 3 of the Busi- WALL ness and Professions Code, and my license is in full force and effect. License Number Lic.Class Contractor Date ❑ 1 am exempt from the licensing requirements as I am a licensed architect or, a registered professional engineer Plan Check fee 25%Of above. acting in professional capacity (Section 7051, Bus- iness and Professions Code). PERMIT ISSUING FEES Lia.or Reg.No. Date TOTAL FEE HOME OWNER-BUILDER DECLARATION -PLAN CHECK APPLICANT I hereby affirm that 1 am exempt from- the 'Contractor's NAME License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): ADDRESS ❑ I, as owner of the property, will do the work and the CITY TEL. NO. structure is not intended or offered for-sale (Section �q Or7 9 2 A 7044, Business and Professions Code). /7 , ❑ OWNER !/O �Y/` f, p :e a e e o 1, as owner of the property, am exclusively contracting / 8 with licensed contractors to construct- the project MAIL (Section 7044, Business and Professions Code). ADDRESS g��{' 6: AQI 2 0027.00 . CONSTRUCTION.LENDING AGENCY CITY / J/ TEL NO. I hereby affirm that there is a construction lending agency /� L� I io e e 2'7,,Q Q 2 6 for theis erformance of the work for which this permit CONTRAC 11O issued(Sec. 3097.Civ,C.). I —__ -r"/-„' �"�^.-`r_'-'-'_'-�"_.LL.d�” 0 a 1 17,4-8-) Lender's Name ADDRESS Lender's Address CITY y/,yy TEL. NO [%��2i � I certify that I have read this application and state that the STATE S LIC. above information is correct. 1 agree to comply with all County LICENSE NO. CLASS l'S ordinances and State laws regulating Heating, Ventilating and Air Condi oning%ru and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County o he above-mentioned property' for _areofS na ure of Date Lj