HomeMy Public PortalAbout5516-5518-5520-5522 SULTANA AVE_Mechanical__ H'OIrKLR$ COMPI NSATION DLCI AItATION 78A364C APPLICATION FOR PERMIT
eby affirm that 1 hate a Certificate 818 12 80)
ate of consent to s<If U
insure or a ce Tient<Of Workers Cum ensition Insurance or
�+ p HEATING-IIISNTILATI�ING-A19 CONDITIONING
e c ijcUVN- copy ther<Of(Ste 3800-�y1 all C)
Pulic�No C-O/�333-ompans-G9
Crrn(ieJ «Ipt is herc6y furmsh<d
COUNTY OF LOS ANGELEe BUILDING AND SAFETY
CLTtlfled cop) 6 fJ<d with the counts budding inspection FOR APPLICANT TO FILL IN - BU
Jepnrtm<nl ILDING
ESS's Q
Uata�1_1�—�C) 4pphcant_C1�I_\�YLC�/L�- (PAINT OR TYPE ONLY) -ADORE SS
LOCALITY
C.LRTII ICA'IE OI Lll MPTION PROM WORKLRS NO TYPE OF APPLIANCE OR EQUIPMENT FEE
COAIPLNSATION INSURANCL NEAREST y
(This Section need not be Completed if the work Involved ABSORPTION UNIT BTU CROSS ST dQ
by the permit is COI One hundred dollars (SI00) Or less) DISTRICTNO / PROCESSF BY (�
I curt Ry that in the performageO Of the work for which Ihis AIR HANDLING UNIT CFM_ �'O y
Permit Is Issu<d I shall not employ anv parson In ant manner a • O
so as to become subject to the porkers Compcnsatlon Laws BOILER BTU UUUF
APPROVALS �DATE INSPECTOR SSIGNATURE I)J
Dn[e Applicant COMPRESSOR BTU_-000 C) O Q� / "(�� ���� S
ROUGH H
NOTICE TO APPI ]CANT If after making this Certificate of VENTILATION SYSTEM FINAL
Lxcmptron )ou should b<cnmc subject to the Workers
Compeinetmn prrrsmons Of the Labor Code you must forth
with eompl) with such provisions or this p<rmil shall be EVAPORATIVE COOLER �7 VALIDATION
deemed resoked - i
FURNACE FAU—BTU-&,a,
GRAVITY_
LICENSED CONTRAC TO RS DPCLAR ATION FLOOR BTU_ O(]_L O DO
1 hereby affirm that 1 am licensed under provisions of Chapter HEATER SUSPENDED UNIT
19 (commennng with Section 7000)of Division 3 of the Susi WALL J v�
ness and Professions COdc and my hcens0 is In full force and
� <f(ect
f act c Number p�77/a 0`0 Lic Glass /C-,9 v
Coni IIcr _ _��G(_ Date
14
t a n a emyt from th< licensing requirements as I am a
licensed architect Or a rcgister,d professional engme<r Plan Check fee 25%of above
acting it my professional capacity (Section 7051 Bus
mess and Professions Code) PERMIT ISSUING FEES QQ
Lie or Reg No Data TOTAL FEE
HOME OprNLR-BUILDPR DPCLARATION PLAN CHECK APPLICANT
I hereby affirm that I am escmpt from th< Contractors NAME a
License Law for CIO, folinwmg reason (Section 7031 s Busi
ness and Profesuorts Cod-) ADDRESS �y3-7El ,
I as owner of the property will re the work and the CITY —'f�nA_^f/a �I,'fr TEL NO qp -'j ��/ 2 3 0 2 6 A
structur< u not iota nded or offered for sale (Section pfOs��O`/O
7044 Business and Profcssrnns Code)
OOWNER t1 . 1. l'Yl # � • • 41
1 as owner Of the property em exclusively contracting rU O-V V r r
with licensed contractors t0 construct tht,< project
rjo eat MAIL
(Section 7044 Busman and ProRssions Code) p ADDRESS -0�3 �_ _ 12 - e8,700
CONSTRUCTION LLNDING AGENCY CITY TEL NO rJ�Q .,. - 87006
1 hereby affirm thti there w a construction lending agency `,
for (Inc. performance
of the work for which this permit is CONTRACTOR / /rr t/7 I 1 2�8 0
Issued (Sec 3097 CU, C) Q _
Lenders Name ADDRESS 5_ 16-
1
I ender s Addrus CITq-4��A'M Q,, ���-}'� TEL NO AFY/a I6 p
I cert d) That 1 hau n id this application and Siete that the STATE 1 Opo, LIC /r
abos< Information is correct 1 agree to comply with all Count)LICENSE NO E b (J CLASS l.. Os
ordinances Tnd State laws regulating Hearing Ventilating and
Air Conditioning and h<r<bv authon[e reprasentauves Ot this SEE REVERSE I OR EXPLANATORY LANUUAGE
County to enter upon the abose mentioned property for
Ills ctwn purp ses
Vl—o I t`N,'_Fry
Signature of PermNtee Dal,