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HomeMy Public PortalAbout6019 AGNES AVE_Mechanical__ f. 76A964C CE-8181REV.6/78) ©s APPLICATION FOR PERMIT HEATING' - VENTILATING .- AIR CONDITIONING COUNTY OF LOS ANGELES BUILDINGAND SAFETY FNEAREST FOR APPLICANT TO FILL IN (�1 /� . &e-s !t��. (PRINT OR TYPE ONLY) �� tNO. TYPE OF'APPLIANCE OR EQUIPMENTFEE / H:- C'(�1lyQ� ABSORPTION UNIT,BTU f OWNER ' ell N'111C- r MAIL / ADDRESS &01 It lIE'''S B ITY'� �; �,1 TEL.NO. L/5 COMPRESSOR,BTU Q Q W CJd CONTRACTOR VENTILATION SYSTEM ADDRESS EVAPORATIVE COOLER CITY TEL.NO. FURNACE: FAA GRAVITY STATE 'LIC. FLOOR B U DO 10 LICENSE NO. CLASS HEATER: SUSPENDED-UNIT- WALL USPENDEDUNIT_WALL APPROVALS DATE INSPECTOR'S SIGNATURE 406 ROUGH FINAL INSPECTION RECORD Plan check fee 25% of above. PERMIT ISSUING FEE$ ea TOTAL FEE d a PLAN CHECK APPLICANT PLAN CHECK VALIDATION NAME - ADDRESS 27835A CITY TEL.NO. 1# O OO O 4.1 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL- ORDINANCES LL Z 31.�,� ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR • CONDITIONING. 1. PERMIT VALIDATION `O O o 3 1.,0 0 6 I -HEREBY CERTIFY THAT I ,MNO-R,AC IN IN VIOLATION OF CHAPTER 9, DIVISION 3, OFT E' USIN Si4Njp PROFESSIONAL CODE 1. 19-79 OF THE STATE OF CA ORNIA. T,F . SIGNATURE * _ OF PE RM ITTE N! "_'"•' DISTRICT NO. PROCESS BY ION am that I'have a certificate of consent to 76A346DPW9l89 APPLICATION FOR PERMIT LIME GREEN 76A364C I hereby affirm flat I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy ther (Sec.3800 Lab. C.) i/ Policy No. Company _r �✓ /� El Certified OFLOSANGELES DEPT OF PUBLIC WORKS. BUILDING AND SAFETY DIV. ElCertified copy is hereby furnished. —0 Certified co Is filed with the coup uil `X ection FOR APPLICANT TO FILL IN BUILDING / G p PY P ADDRESS (y 0/7 . /L✓ All de ment. (PRINT OR TYPE ONLY)' �r.,��/ Date Applicant LOCALITY /�-=�Y��ke (54- y NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS ST. COMPENSATION INSURANCE ABSORPTION UNIT,BTU (This section need not be completed if the wo involved by the ASSESSOR permit is for one hundred dollars($100)or s.) AIR HANDLING UNIT,CFM DISTRMAP ICT NO. FROG ESEDev PARCEL I certify that in the performance of th ork for which this permit is issued, I shall not employ any son in any manner so as to BOILER,BTU Q become subject to the Workers' mpensatiori Laws. r-�/ cC COMPRESSOR,BTU----L-- 11 TU — a Date Applicant APPROVALS DATE INSPECTOR'S SIGNATURE VENTILATION SYSTEM NOTICE TO APPL ANT: If, after making this Certificate of ROUGH S Exemption,you sh Id`become subject to the Workers'Compensation EVAPORATIVE COOLER .provisions of the Labor Code, you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. F CE' FA RAVITY LICLNSED CONTRACTORS DECLARATION, FLOOR BTU © VALID:T;ON I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and HEATER: WALL Professions Code,yand myyy license its in full force and effect. License Number ( V✓r /0 Lic.CIasS r Contractor�-`�" � ��ff t3 a 'er G iy , 0 ❑ U I am exempt under Sec. Plan check fee' cc .76 B.&P.C.for this reason PERMIT ISSUJNG FEE O Date: TOTALZ EE / W Signature PLAN CHECK APPLICANT ) (n OWNER-BUILDER DECLARATION +-° Z I hereby affirm that I am exempt from the Contractor's License Law NAME a• , ' for the following reason (Section 7031.5, B 'ness and Professions ACC�°s Code): ADDRESS n "1 3 j 1159. c 9. 'Sf I, as owner.of the property, o my employees with wages �a_ as their sole compensati will do the work and the CITY TEL.'NO. =i:tt_ structure is not intended offered for sale (Section 7044, Business and Professio Code). OWNER ,,, TOTAL I,.as owner of the o ert am exclusive) contractingMAIL with licensed contra tors to construct the project (Sec- ADDRESS CHECK&�/19 CHANGE °ESL tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY.. CITY P4� /1 TEL.:NO.���j� � I hereby affirm that there is a const ction lending agency for CONTRACTOR (� the.performance of the work for ich this permit Is issued / j• f .,i- ;j. :, (Sec. 3097,Civ. C.). -L `ylc/r�l® C6� C/p/�� , �I0U11i-00"Ll1 9112 /92 ADDRESS r-s J j9A. GG� 559 M ° Lender's Name �/ 1 �t i 'T° ? CITY �� TEL.NO, 4%VVW Lender's Address STATE / LIC. LLL I certify that I have rea(agree this application and state that the above LICENSE NO. y �� CLASS information is correct. I to comply with all County ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon the above-mentioned prop fo in�Cfiurp . SEE REVERSE FOR EXPLANATORY LANGUAGE SI NATURE OF APPLICANT OR AGENT DATE -