HomeMy Public PortalAbout4935 BALDWIN AVE_Mechanical__ (2) V �
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76 A364 - CE 818 - 9-71 pppL ATION FO ERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADDRESS I
DEPARTMENT OF COUNTY ENGINEER ,L�-�
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER L
(PRINT OR TYPE ONLY) / 1 •� `
MAIL 93
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS �s" �� ALS�Loi �ty- !-�
CI, �L TEL. NO.
ABSORPTION UNIT, BTU ' /
CONTRACTOR ✓/ L_^ � C_�
AIR HANDLING UNIT, CFM
ADDRESS ZI-11�7-- `�j'
BOILER, BTUI476S-7
CIT, /� - TlIEL. NO.
141
/ COMPRESSOR, BTU 145O y� fir STATE sLIC. G
LICENSE NO.I .1 CLASS Z
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE P SSED BY
EVAPORATIVE COOLER QlS ^ >-
C! �
J FURNACE: FA _GRAVITY
/ FLOOR BTU� �� %� 7 S INSPECTION RECORD v
HEATER: SUSPENDED UNIT_
WALL U
Lu
d
N
Z
Plan check fee 255 of above. See reverse.
PERMIT ISSUING F'LE S 3 00 1.
TOTAL FEL
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS D E PECTOR'S SI ATURE
LATING, AIR CONDITIONING.
ROUGH
IHEREBY CERTIFY THAT I AM NOT ACTING/I*-V)OLAI ION
OF CHAPTER 9, DIVIS '17-3-OF BUSINESS A�10 RO 1`'� -SSIONAL FINAL
CODE OF THE STAT F C LI�
SIGNATURE WERMIT VALIDATION CK. M.O. CASH
OF PERMITTE ,'
PLAN CHECK VALIDATION CK. M.O. CASH
! F , 2 b 8 1113 rJG 9 4 1 D 1 5 :5Od
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
RKER'S COMPENSATION DECLARATION 20-0046 DPW 9/89 APPLICATION FOR PERMIT
1 her r".:z,,,frhrm e!ro��, that I have a certificate of consent to self insure, 76A364C LIME G
or a certi,lcate of Worker's Compensation Insurance, or a certified HEATING- VENTILATING -AIR CONDITIONING
copy theri�,)f(S c. 800 Lab.C.)
Policy No. G�pany COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
Certified copy is hereby furnished.
Ce ified copy is filed with the count building inspection FOR APPLICANT TO FILL IN
BUILDING
d rtm n (PRINT OR TYPE ONLY)
Date Applicant OPWNO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY
CE TIFICATE OF EXEMPTION FROM WORKERS' NEAREST
CROSS ST.
COMPENSATION INSURANCE ABSORPTION UNIT,BTU
This section need not be completed if the work involved ASSESSOR
( b P y the MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO. PROCESSED BY
I 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,BTUO
become subject to the Workers' Compensation Laws. G
COMPRESSOR,BTU
APPROVALS DATE INSPECTOR'S SIGNAT R
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH 46
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL, Af
provisions or this permit shall be deemed revoked. FURNACE: FAURAVITY VALIDATION
LICENSED CONTRACTORS DECLARATION 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 and WALL
Professions Code,and my license is in full force and effect/..
License Numbe dhq?V2J5_ Lic.Clas ' V
m , r7L{.•i a T O
Contractor ate
ElUPlan check fee
I am exempt under Sec. 330$1 ITEMS .r.3.70 �
B.&P.C.for this reason PERMIT ISSUING FEE$ ITEMS 0
Date:
TOTAL FEE -cow U
r W
Signature a
PLAN CHECK APPLICANT
OWNER-BUILDER DECLARATION �rq�{t�('t1i 'moi. c
I hereby affirm that I am exempt from the Contractor's License Law NAME , ML oil im15A
for*the following reason (Section 7031.5, Business and Professions
Code): ADDRESS
❑ I, as owner of the property, or my employees with wages
as their sole compensation, will do the work and the CITY T L.NO.
structure is not intended or offered for sale (Section 7044,
Business and Professions Code). OWNER c
❑ I, as owner of the property, am exclusively contracting MAIL
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code).
• CITY TEL.NO.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for CONTRACTOR ,
the performance of the work for which this permit Is issued
(Sec.3097,Civ. C.).
ADDRESS
1
Lender's Name
CITY TEL.NO.
Lender's Address STATE LIC.
I certify that I have read this application and state that the above LICENSE NO. CLASS
information is correct. I agree to comply with all County ordinances
and State laws relating to building construction,and hereby authorize
re esentatives of this County to enter upon a bove-menti
p e ty for insp urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
SI AT A CANT A DATE