HomeMy Public PortalAbout9737 VAL ST_Mechanical__ ION
I WORKER I have a certificate
of cLARATI to 76A364 DPW 9/89 APPLICATION FOR PERMIT LIME GREEN
78Asa�C
I hereby affirm that I have a certlllcete of consent to Bell Insure
or a certificate of Worker a Compensation Insurance or a certified HEATING-VENTILATING-AIR CONDITIONING
copy thereof(Sec 3900 Lab C I '
Pommy No, Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
Cerduxl copy is hereby furnrshad
❑ Cemfbd copy u filed with Ste county building Inspection FOR APPLICANT TO FILL IN ADDRESS
573 V �''
depamMm (PRINT OR TYPE ONLY) BUILDI� SS
Date AppllcMtLOCALITY Ply , G rY
NO TYPE OF APPLIANCE OR EQUIPMENT FEE -
ST
CERTIFICATE OF EXEMPTION FROM WORKERS' SSS Esr
COMPENSATION INSURANCE ABSORPTION UNIT BTU �-/
(This section need not be completed N the work Involved by the p-� O ASSESSOR
S PAGEOI / PARCEL�a�3
permit Is for one hundred dollars(fil or top) AIR HANDLING UNIT CFM A pgmcrrq prAGEaem ev ,
1 certify that In the performance of the work for which this permit ,
is Issued I shall not employ any person In any manner so as to BOILER BTU
become
`subject to the Workers Cc enitation we
J_ 11 q I f COMPRESSOR BTU
APRIQJ.ea DAM NBPFCTPa BtlINIUVE
Date Applicant VENTILATION SYSTEM
r NOTICE 70 APPLICANT It alter making this Cerllhcate of ROlX3H
Exemption you should become subject to the Worker° Compensation EVAPORATIVE COOLER
-prowslons of the Labor Code you must forthwith comply with such FINAL zLzJ
provisions or this permit shell be deemed revoked FURNACE FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU V LIDATION
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER SU9PENDED UNIT_ -
(commencing with Section 7000)of Division 3 of the Business end WALL
Professions Code and my license is in lull force and effect
N!✓fi� 0 UrL�TS
License Number Lic Class
Poo-
r
,infractor Date (�
❑ I am exempt under Sec Plan Check fee 2
B aP C for Ws reason PERMIT ISSUING FEE$ 0
�° TOTAL FEE W
• Oa a
` Signature OWNER BUILDER DECLARATION FLAN CHECK APPLICANT co
I hereby,affirm that I am exempt from the Contractor a License Law NAME M O 1! I 1 J
.0 01" C
for the following reason(Section 7031 5 Business and Professions K��� V ;J
Coital
I as owner of the pADDRESS r2roperty or my employees with wages 3 VA-L- `f� Ai CT,'.i
as their sole compensation will do the work and the CITY —r-;p
-yN _�G7
structure Is not intended or offered for sale (Section 7044 GI� TEL NOS �'�3� i 45.00
Business and Professions Cod°) OWNER �'7r 1,4 , S 1 ITEMS
QI as owner of the properly am exclusively contracting
with licensed contractors to construct the project (Sec ADDRESS TOTAL
OTAL. ` 41_ 00
tion 7044 Business and Professions Code) CITY `E 01 TEL NO ���} s.t UEC{ 't5.01,
CONSTRUCTION LENDING AGENCY �V t�/�'1�T
I hereby affirm that there is ° construction lending agency for CONTRACTOR , 1.f11'lIlGE ,CO3
the performance of the work for which this permit a Issued '^
(Sec 3097 Civ C) r •! - _ .,
ADDRESS
Lender a Name CT' TEL NO 0000-0001 3/12/91
LBrdera AddresssrATE LIC , , 6030 1 AM 8:42
1 certify that I have read this application and stalls that the above LICENSE NO CLASS ,
Iri(prrrlatlon Is cored I agree to comply with all County oidmencee ,
and State law°relating to building construction and hereby authorae _
r resentabve of this County to enter upon the above mentioned
for c poo ea ` I SEE REVERSE FOR EXPLANATORY LANGUAGE
daNATURE6APPLCNIT OB EMAO ' ,
1tuRLI IIS (Oki Y LNSAI ION D t CLAR A r-bd 76P464C APPLICATION FOR PERMIT
;_h(rcbv cffirm rh a I h/�:
fa,it, of consent to self CE (818 (2 80)
insure or iLLrufmatL ntpcnsauonlnsurence or HEATING-VENTILATING-AIR CONDITIONING
a ctrl find Lop) th,rulf ItbL )Pohcs Nn (Certified cups Is lyrd COUNTY OF LOS ANGELES BUILDING AND SAFETY
❑ Certlr to Lisps n hind svtth th, count) budding inspection BUILDING -� �/ �f
JLp a•m.m _ FOR APPLICANT TO FILL IN J r /L
UatL Appllt int (PRINT OR TYPE ONLY) ADDRESS A--L- T
CFR"rlf I(ATL OI PXI AIPTION 1 ROII PIORI.LRS' LOCALITY re /f� G T�/
NO TYPE OF APPLIANCE OR EQUIPMENT FEE 'ell
- //-
(O\IPI NSA rJON INSURANCE NEAREST
(This ItL116111 nted not he completed If the stork involved ABSORPTION UNIT BTU CROSS ST - 1
b) tht, pl emu IS lot one hundred dollars (5100) or less) DISTRICT NO PROCESSED e Q
1 csrtlfs shit w thi pcclorm mcL of the work for which this AIR HANDLING UNIT CFM—
permit
FM permit is ns ULd, I Oi dl not Lmplu) ans mrson In any manner 5r
u
so is , 11"Im, hast to th er ( n�L s- I Laws BOILER BTU U
]ye�'f APPROVALS DAT I sr CTORSS NATURE
COMPRESSOR BTU _L�-i00—/O ROUGH
r INOI ICL TO %I PLI( ANI h, attLr making this Ctrtdicate of VENTILATION SYSTEM( - - - - y
stmpbmi lou hnulJ become suhlut to the 1VorkFINAL Z
srs ^
m PLnvunn p iot%Lons of 1hL Libor Code you must forth
loth Lompl) with such proslslons or this permit shall be EVAPORATIVE Co LER - VALIDATION
LILem,SrtsolOVII
I FURNACE FAV G AVITV_
I R FNSI D( O\TRACIORS DI CI ARATION / FLOGR BTU_ p•qpi_ ��
I bLr.hs affirm th,t I am hccnsed under pro Islons of Chapter HEATER SUSPENDED ONIT
9 (c,imnrnoa,I with SLLtton 7000) of Dist on 3 of the Bust WALL eI�
nLSL and Pro IL stuns (ode Ind m) license is in full torcL and a Q a O
LtftLt # • • • • • C
Luuiu Numh,r LiL C ss i • • 3 a 5 0
Contr,clor
— ° B • • 03a506 e
❑ 1 am .scmpt from tht Iter sing reymrtments as I am a �, 3 8 a
o-Lnscd ,rchil cr or a r plstcred professional Lngineer Plan check fee 25`X, of above
aclnl m ns pfore, '0• I La PILtts (SeLUun 7051 Bus
me s i^d Prot."lons C((de) PERMIT ISSUING FEE.$��
I is or R,,1 X11 .-7- Date TOTAL FEE '
I IONIL OV Vl P BLILD1,11 DECLARATION PLAN CHECK APPLICANT 4
1 hdreI l nor [hit 1 am K rCJ%0 barn%cc on 031 5 ctus, NAME /
LsLn L I,LL fur thL Toile. "IK reason (SLctlnn 7031 5 Bust
nes. ind Profunoo,(ode) ADDRESS
XJ I a, ownLI of,the rroptrts will do the work and the CITY TEL NO ,
structure Is not intend Ld ur,offersd for silo (Section
7041 BusrLessund P(nfi.timonc Code) q����
' e J OWNER H—W S
❑ ^I a1,�nwn(r'a y1tB prl)PLrj vl om esFlusiv,lY contracting /_�/�,-A` ��{ _
senL uam4 Business nr, Pr t"smr,5 C t)tn protect DD T73-7
/� n � •��
(hsbun 7044 Business and 1'rohsvons Code) AAt DDRESS
CONSTNUC f10\ ILNUING AOLNCY 'C IT r GfTMrEL NO S�L,{•��
Its
affirm that them u a Lu nstruct,un knifing aguicv
for the pLrGrtnunct or the ssork for which this permit Is CONTRACTOR
Issu,d (SLc 3097 Cn C )
Ltndtr s Nun,. ADDRESS
lLndLrs lddrem CITY TEL NO
1 cLrtIfs thlt 1 hast /rb
pph,dttun and state that the STATE LIC
'h." mfornunon rs Lres to cumpl) with all Counts LICENSE NO CLASS
ordui ince. and StatetmP .scaling Ventilating and
A,r Cc,ndns uu. anti horI c represtnt4 t"es of thlS She RLVLRSE I OR CXPLANATOR} LANGUACL
ASI,n."iurt
Is tou n [I : bast menbuntd proptn) fur
• C (`�of Ptrm`ittrV_,v' Dat,