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HomeMy Public PortalAbout6046 AGNES AVE_Mechanical__ k b S b •, �.� 1 T 7EA9C,4C CE 818(RE 8/78) °+ ©s APPLICATION FOR PERMIT > HEATING -, VENTIL'ATING - AIR CONDITIONING Vim/ t COUNTY OF LOS ANGELES ? t BUILDING AND SAFETY y FOR APPLICANT,TO FILL IN BUILDING + rs� i ADDRESS r L (PRINT OR TYPE ONLY) '�"' G� G iY NO TYPE OF APPLIANCE OR EQUIPMELOCALITY NT ° FEE �--1 � NEAREST = CROSS ST t ABSORPTION UNIT BTU ° OWNER AIR HANDLING UNIT CFM MAIL ' ADDRESS J/vl Y BOILER BTUI, ! CITY N�Gz i Y TEL NO ����,y� COMPRESSOR BTU Y D Ov1 CONTRACTOR VENTILATION SYSTEM d ADDRESS 7o e EVAPORATIVE COOLER CITY TEL�NO Jay ✓ori r FURNACE , FAU X GRAVITY ' , STATE / LIC FLOOR BTU r a O LICENSE NO 3 CLASS HEATER SUSPENDED 'UNIT_ r APPROVALS DATE INSPECTOR S SIGNATURE t WALL Y 4 ROUGH L l dfd AL-I ~ ti' « FINAL 7 f/6 -V�—�y O � INSPECTION RECuORD � A ® Plan check fee 25% of above PERMIT ISSUING FEEL 7Q — Z TOTAL FEE 7 tJp PLAN CHECK APPLICANT s '� r ! PLAN CHECK VALIDATION,,{ NAME I ` yu ADDRESS CITY TEL�NO 2 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND ,. STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES I BAND LAWS REGULATING HEATING VENTILATING AIR i c Q n CONDITIONING r PERMIT VALIDATION V f'� I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF # o o o o 41 CHAPTER 9 DIVISION 3 OF THE AND PROFESSIONALtiCODE, ci OF THE STATE OF CALIFO q SIGNATURE - "1 2 - 2 7 0 0 OF PERMIT i� F DISTRICT NO L PROCESSED BY o C 0 2 7.0 0 6 a '5 D g 0509-79 a a rl WORKERS COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self Insure or a certificate of Workers Compensation 4nsurance HEATING VENTILATING - AIR CONDITIONING or a certified copy thereof (Sec 3800 Lab C ) 76AWC CE 818(REV 10/81) Policy No Company Certified copy is hereby furnished COUNTY OF LOS ANGELES - BUILDING AND SAFETY Certified copy is filed with the county building Inspec FOR APPLICANT TO FILL IN BUILDING f 1 tion department (PRINT OR TYPE ONLY) ADDRESS /l!r Date ' Applicant� LOCALITY NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST C.G COMPENSATION INSURANCE CROSS ST (This section need not be completed if the work involved by ABSORPTION UNIT BTU DISTRICT NO PROCESSED BY the permit is for one hundred dollars (;100)or less ) AIR HANDLING UNIT CFM f I certify that in the performance of the work for which this permit is issued I shall not e�W2Y n any nner so as to become subject to tnsu LAWS BOILER BTU APPROVALS DATE INSPECTOR S SIGNATURE Date ~r " 'App i COMPRESSOR BTU ROUGH NOTICE TO APPLICANT If a Ing this Certificate of VENTILATION SYSTEM FINAL Exemption you should become subject to the Workers Compensation provisions of the Labor Code you must forth EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deemed revoked FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED-UNIT- (commencing USPENDED UNIT WALL (commencing with Section 7000) of Division 3 of the Business } and Professions Code and my license is in full force and effect License Number LIC Class _ ► V OC Contractor Date 0 f V I am exempt under Sec Ay Plan check fee d Vf B 8P C for this reason - PERMIT ISSUING FEE $ Q Z Date Signature TOTAL FEE �2 0 8 9 8 A OWNER BUILDER DECLARATION PLAN CHECK APPLICANT 1 hereby affirm that I am exempt from the Contractor s License # °I o 0 0 0 Law for the following reason (Section 7031 5 Business and NAME FV Code) 7� � 25°�° 2 Q 5 0 LTJ I as owner of the property or my employees with ADDRESS 6 Nr S "0 - 20E05: ,\ wages as their sole compensation will do the work and the structure is not Intended or offered for sale(Section CITY L� C! TEL NO � 0502-84 7044 Business and Professions Code) mac• OWNER ❑ I as owner of the property am exclusively contracting with licensed contractors to construct the project (Sec MAIL tion 7044 Business and Professions Code) ADDRESS r CONSTRUCTION LENDING AGENCY CITY - TEL NO 1 hereby affirm that there is a construction lending agency for 0. the performance of the work for which this permit is issued CONTRACTOR , (Sec 3097 Civ C ) ADDRESS - Lender s Name Lender s Address CITY „TEL NO STATE LIC I certify that I have read this application and state that the LICENSE NO CLASS above information Is correct I agree to comply with all County ordlnan d State laws lating to building construction an ereby auth rize re sentatives of this County to enter on thea of ov rye pro erty for ins ctlo ur oses SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Da i 4 i