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HomeMy Public PortalAbout6302 AGNES AVE_Mechanical__ I Y , w CE 818(REV 6/78) s ©S APPLI -►TION FOR�PEMWIT HEATING - VENTILATING - AIR CONDITIONING r COUNTY OF LOS ANGELES BUILDING AND SAFETYBUILDING FOR APPLICANT TO FILL IN ADDRESS 6302 0 AGNS AVE (PRINT OR TYPE ONLY) r�p� T�7 LOCALITY „• LE CIT f NO TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST CROSS ST ABSORPTION UNIT BTU OWNEF 'M 1JUlOS'I11 AIR HANDLING UNIT CFM MAIL Sim ADDRESS i BOILER BTU CITY SAME: 1�['iLTEL Na 2876625 J COMPRESSOR BTU 0, 0V CONTRACTOR 1VE HCC I VENTILATION SYSTEM ADDRESS EVAPORATIVE COOLIE CITY S EL MM TEL NO 5797982 FURNACE FAU ^ G Y s OTATE LIC FLOOR BTU t �/ LICENSE NO 65094 CLASS C-20 HEATER SUSPENDED WALL UNIT_ APPROVALS DATE INSPECTOR S SIGNATURE ROUGH + I �I FINAL 0 INSP CTION RECORD V cc Plan check fee 25% of above 9 IL PERMIT ISSUING FEE$ �7 Z TOTAL FEE - PLAN CHECK APPLICANT PLAN CHECK/VALIDATION i NAME oo /yltti'( /1�.. '\.S✓'wc LJ ` L� ADDRESS �'pO� " v�/yoa6h076-✓ CITY TEL NO` t IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND t STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING VENTILATING AIR 4 6 612 A CONDITIONING PERMIT VALIDATI6N I HEREBY CERTIFY THAT I AM NOT ACTING A VIOLATION OF # o o,o o 4,1 CHAPTER 9 DIVISION 3 OF/HEN D P FESSIONAL CODE OF THE STATE OF CALIFOR 2,o o 217 0 0 SIGNATURE 1 OF PERMITTEE 0002'7006 DISTRICT NO P BY r vo 0531 -79 r WORKERS COMPENSATION DECLARATION APPLICATION FOR, PERMIT I hereby affirm that I have a certificate of consent to self !insure or Q certificate of Workers Compensation Insurance HEATING VENTILATING AIR CONDITIONING or a certified copy thereof (Sec 3800 Lab C ) 76A364C 20 0046 DPW 9/88 Policy No Company _ ❑ Certified copy is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY ElCertified copy is filed with the county building inspec FOR APPLICANT TO FILL IN BUILDING tion department ADDRESS p 3 —NG (PRINT OR TYPE ONLY) ,rDate Applicant LOCALITY NO TYPE OF APPLIANCE OR EQUIPMENT FEE ' CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST s , i i COMPENSATION INSURANCE CROSS ST LDUGpbN (This section need not be{completed if the work involved by ABSORPTION UNIT BTU DISTRICT NO PRoc s ev I the permit is for one hundred dollars ($100) or less) ` I certify that in the performance of the work for which this AIR HANDLING UNIT CFM I permit'is Issued I shall not employ any person in any manner * so as to become subject to the Workers Compensation Laws BOILER BTU APPROVALS DATE INSPECTOR S SIGNATURE Date Applicant ` COMPRESSOR BTU ROUGH NOTICE TO 'APPLICANT If after making 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 ; V/ D TIO -with comply with such provisions or this permit shall be deem ed revoked F 1, FURNACE FAU GRAVITY LICENSED CONTRACTORSDECLARATION FLOOR BTU I hereby affirm that I am,licensed under provisions of Chapter 9 HEATER SUSPENDED UNIT— (commencing with Section 7000)of Division 3 of the Business WALL and Professions Code and my license is in full force and effect U } } t ' License Number ; Lic Class , ti O V Contractor Date OC ❑ O I am exempt under Sec' 1 Plan check fee W t B&P C for this reason I H PERMIT ISSUING FEE $ Z Signature Date t _ TOTAL FEE OWNER BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor s License , Law for the following reason (Section 7031 5 Business and NAME Professions Code) (q ADDRESS _ JI �` I as owner of the property or my employees with ACCT. ' wages as their sole compensation will do the work and CITY TEL NO 2307 111.2`i the structure is not intended or offered for sale(Section - 7044 Business and Professions Code) OWNER 1 ITEMS ❑ I'as owner of the property am exclusively contracting ,-� with licensed contractors to construct the project (Sec MAIL T�Il AL 12 ® 2 - tion 7044 Business and Professions Code) ADDRESSr ill ,zc CONSTRUCTION LENDING AGENCY CITY TEL NO * CHEC6K �•L I hereby affirm that There is a construction lending agency for , __ t HGE •L'I the performance of the work for which this permit is issued CONTRACTOR (Sec 3097 Civ C ) U Lender shame d T >t /V ADDRESS i L1�1"'VSJV 1 Ya./ 7!AS w _ - / x� )) CITY TEL NO F a+ . 17_T1 1~ AM-8-�t� /y Lender s Address / STATE LIC ti v ti' r '4, I certif that I have read this application and state that the LICENSE NO CLASS abov i formation Is correct ee to comply with all County ` ordi an s and State law rel ing to building construction and h r y authorize repfes atives of this County to enter upo the bove mentioned r perty r inspection purposes y r / SEE REVERSE FOR EXPLANATORY LANGUAGE y Signature of Ap I cant or Agent Date &S i f _