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HomeMy Public PortalAbout4862 ARDSLEY DR_Mechanical__ CE-'B 18 IRF-V.67781• ,` .. ©s APPL`I TION, F'®R PJVT. HEATING NENTILAT.IMG. All CORDITIONING COUNTY. OF.LOS,ANGELES BUILDING AND SAFETY,. FOR,APPLICANTT,O FILLLII�Ii 'BUILDING /. _ ,IMPRINT OR TYPE_ONLY) ,,. - ADDRESS - .' LOCALITY - ;NO.- 'TYPE OF APPLIANCE OR EQUIPMENT NEAREST` CROSS ST. �w • ABSORPTION UNIT,-`BTU - - -' - // - -OWNE - . " AIR HANDLING',UNIT,CFM MAIL,// - . ADb SS BOILER BTU ...:.. , c - .- • - - - _ CITY L.NO COMPRESSOR,BTU-3 CONTRA TOR Zl VENTILATION•SYSTEM, ADDFE = - - EVAPORATIVECOOLER - ? - ... CITY FURNACE "�FAU" ", GR TY ' STATE • ' LIC' �Q FLOOR BTU'; LICENSE,NO. _ �— �. - CLASS(! HEATER 'SUSPENDED UNIT Ap pROVALS "DATE INSPECTOR'S SIGNATURE •.'.WAGE 'r.. .. - - R06GH ,t` P:. �3teie!{'�L/fra'r/--[� � +x. FINAL- Fi INSPECTION RECORD 09 Plan check fee 25% of above. PERMIT ISSUING FEE t TOTAL FEE VZ� PLAN APPL ANT t - PLAN CHECK VALIDATION - NAME.. , .. ADDRESS ' - •, :. ,.. , - ' CITY TEL'.NO. - -1.HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND. STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY'WITH ALL 1•;8�21 A ORDINANCES' AND LAWS 'REGULATING� HEATING,.VENTILATING,' AIR E- ,. - . CONDITIONING. PERMIT VALIDATION . 1 HEREBY CERTIFY. A I:AM N T ACTING IN VIOLATION OF4. - # o o'o';0 4 1 CHAPTER 9, DIVISI 3 0 HE,BUS SS AND PROFE 071AL CODE OF THE STATE OF ALI IA. P - 2 O o,,2 7..0 O r, SIGNATURE -OFPERMITTEE �� 2Z.•�:��6' ' - O.O O DISTRICT NO. i PROC BY 12'1-4'—7 8 c "for" that I'have.a TION DECLARATION nn n C n IM N FOR P E RM7 hereby'affSrm"that h have.a certificate of consent to self h111�IT L� /� ��f jl�uvu insure, or a=cQrtificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING or a certified copy thereof (Sec. 3800, Lab. C.) 76A364C CE-818(REV. 10/81)- Policy 10/81)'Pol cy 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 tion department. '(PRINT OR TYPE ONLY) ADDRESS Date ApplicantLOCALITY t NO. TYPE OF APPLIANCE OR EQUIPMENT. FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION'INSU RANCE CROSS ST. (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. PR ESSED e /. the permit is for one hundredlAollars ($100)or less.) I certify that in the performance of the'work for which this AIR HANDLING UNIT, CFM (1 Q permit is issued, I shall-not employ any person in any.manner BOILER, BTU � OV so as to become subject-to_the,,Werk Comp satlon-Laws. APPROVALS DATE INSPFP OR'S S ATURE Date _ZS �O Applican COMPRESSOR, BTU ROUGH NOTICE TO APPLICANT: If, after making this'Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deemed revoked. FURNACE: FAU'` GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm-that I am licensed under provisions of Chapter.9 SUSPENDED UNIT Division'(commencing with Section 7000) of 3 of the Business HEATER: WALL and Professions Code,•and my license is in full force and effect' License Number Lic. Class D V Contractor Date' 0 ❑ LU I am exempt under Sec. W Pian check fee H B.&P.C. for this reason PERMIT ISSUING FEE'$ 7 ]IL(�p z Date: Sign ture TOTAL FEE J #,0 0 0 0 08 OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT _ I hereby affirm that I am exempt from the Contractor's License D N -;a 2.0 5.0 Law for the following reason (Section 7031.5, Business and NAME Professions Code) ❑ .I, as owner of the property, or my employees with ADDRESS 'a."'0 2 0.5 0 V wages as their sole compensation,will do the work and2 rj 8 7 the structure is not intended or offered for sale(Section CITY' TEL. NO.. Q 8 -. 7044, Business and Professions Code). OWNER E] 1, as owner of the property, am exclusively contracting with licensed contractors*to construct the project (Sec- MAIL tion 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY CITY TEL. NO. ' I hereby affirm that there is a construction lending agency for _ D the performance of the work.for which this permit is issued CONTRACTOR (Sec. 3097, Civ. C.). ADDRESS Lender's.Name CITY G 76-76 . Lender's Address TEL. NO. STATELIC. G I certify that I have read this application and state that the LICENSE NO. l 7 2— CLASS e _2�C,. ,- above information is correct. I agree to comply with all County ordinances and State laws relating to building construction, tnd hereby Vuthorize representatives of this County to,enter the a ove- n oned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE _ . Signature of Applicant or Agent " Date -