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Home My Public Portal About6166 AVON AVE_Mechanical__ A3C41^CE 818 5-73 APPLIC ION FOR PERMIT HEATING - VENTILATING - AIR CONDITIO ING COUNTY OF LOS ANGELES 7NEAREST I ,1 DEPARTMENT OF COUNTY ENGINEER V BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TYPE ONLY) MAIL I NO TYPEOFAPPLIANCE OR EQUIPMENT FEE ADDRESS Q V CITY V , TEL NO ABSORPTION UNIT BTU `` v CONTRACTOR - LAuko AIR HANDLING UNIT CFM ADDRESS5 (0 M�to Ij 'Aje. BOILER BTU CITY /A TEL NO - COMPRESSOR BTU STATE LIC 7 ✓ LASSVLICENSE NO 1* 90 CLASS(- VENTILATION ENTILATION SYSTEM DISTRICT NO GROUP ZONE PESSED BY &4—.; � EVAPORATIVE COOLERTj d f FURNACE FAUGRAVITY `/ V INSPECTION AECORD FLOOR BTU HEATER SU ND D UNIT_ LL � a. 0 U O H W al t Cn Plan check fee 25% of above See reverse z PERMIT ISSUING FEE, S 3 00 TOTAL FEE PLAN CHECK APPLICANT aj r NAME ADDRESS CITY TEL NO �/' �iI! � T \ s I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION A I r AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING VENTI APPROVALS DAT INS ECTOR�S SIG ArTURE ' LATING AIR CONDITIONING ROUGH I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF CHAPTER 9 DIVISION 3 OF THE BU NES AND ROF I NAL FINAL CODE OF THE�ST'�+'�/�'�' CALI R E SIGNATUR / - ' � ' _ PERMIT VALIDATION CK M oV CASH ` OF PERMITTEE sq PLAN CHECK VALIDATION 'CK M O CAS 3FEB 194 1 _ _ n8 0-0 ,&--lo s SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ti, r , r WORKER I have COMPENSATION ate of consent to 20 76A3 DPW 9189 APPLICATION FOR PERMIT 11 E GREEN 76A364C I hereby affirm that 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 thereof(Sec 3800 Lab C) F Policy No Company I COUNTY OF LOS ANGELES 'DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV ❑ Certified copy is hereby furnished - + ❑ FOR APPLICANT TO FILL IN BUILDING ++ __ /I e -54- department , Certified copy Is filed with the county building Inspection PRINT OR TYPE ONLY) ADDRESS �p �O/V J�' department ., � f _ // ��tt Date Applicant LOCALITY SAN O-r1(0 r,'e c cA NO TYPE OF APPLIANCE OR EQUIPMENT FEE ` NEAREST "' ro CERTIFICATE OF EXEMPTION FROM WORKERS , A + CROSS ST�0 C►$Ae-40/ 4 LEIS 4,&1 a> COMPENSATION INSURANCE ABSORPTION UNIT BTU This section need not be completed If the work involved by the ASSESSOR / ( P , MAP BOOK 3 so PAGE aylPARCEL OOO permit Is for one hundred dollars($100),? less) AIR HANDLING UNIT CFM ,i„ t DISTRICT NO PROCESSED BY I certify that In the performance of the work for which this permit r c Is Issued I shall not employ any person in any manner so as to BOILER BTU y r become subject to the Workers Compensation Laws eO t y COMPRESSOR BTU APPROVALS DATE INSPEC RS SIGNATURE * 4 Date Applicant VENTILATION SYSTEM 'F ' NOTICE TO APPLICANT If after making this Certificate of ROUGHT Exemption you should become subject to the Workers Compensation EVAPORATIVE COOLER Aprovisions of the Labor Code you must forthwith comply with such FINAL V-2243 provisions or this permit shall be deemed revoked FURNACE GRAVITY VALIDATION tr LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and WALL Professions Code and my license Is in full force and effect s ` t License Number LIc Class � r Y Contractor Date t 0 r ❑ I am exempt under Sec Plan Check fee �� y _ , r a:B&P C for this reason PERMIT ISSUING FEE$ T! °" 00 Date TOTAL FEES' - W o Signature PLAN CHECK APPLICANT Y AL C o Y U) OWNER BUILDER DECLARATION `J�7 IOt■� Z I hereby affirm that I am exempt from the Contractors License'Law NAME lA� D �!� I j , ` { t ITEMS ' for the following reason (Section 7031`5 Business andProfessionsv ' 1 ITEMS Code) ; ADDRESS i�O d s� _ 11 TI�TAL 101 ',C-;,9 1 as owner of the property or my employees with wages 1� im�^��F as their{sole compensation will do�the work and the CITY /i d f19r,Ile-Il TEL NO Z� 1 �33� n0. j _ t HUK , liti,�� structure Is not intended or offered for sale (Section 7044 19�1 ti Business and Professions Code) OWNER CH44GE J Y ■0 l F-1 I as owner of the property' am exclusively contracting MAIL with licensed contractors to construct the project (Sec ADDRESS r tion 7044 Business and Professions Code) CITY TEL NO III —�V�1 4� / CONSTRUCTION LENDING AGENCY f t i I hereby affirm that there s a construction lending agency for �y.�i0 i ■'}� the performance of the work for which this permit is Issued CONTRACTOR ttft L¢�'L'?/'7te2� , 1 ) tr " t (SBC 3097 Civ C) ADDRESS Lender s Name + CITY r + TEL NO r , 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 repr tatrves of this County to enter upon the above mentioned 1 oyer for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANT ORA DATE 7 WORKER'S COMPENSATION DECLARATION 46DPW 9,69 APPLICATION FOR PERMIT LIME GREEN, 76A3 I heieby,�.ffirm that I have a certificate of consent to self insure, 76A364C 0 or•a certifica te of, Compensation Insurance, or a certified HEATING -VENTILATING-AIR CONDITIONING copy thereof(Sec. 3800 Lab. C. 9�0� Policy No_/y�Z Compan G COUNTY OF LOS ANGELES' DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the county buildin spection. FOR APPLICANT TO FILL IN BUILDING department. (PRINT OR TYPE ONLY) A Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST 1�/ CROSS ST. COMt be INSURANCE ( hisid ABSORPTION UNIT,BTU ASSESSOR Ts ecton neeno com leted if the work involved b o h P Y the MAP BOOK 0 PAGE vo� PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM • DISTRICT NO. PROCESSED BY certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU become subject to the Workers'Compensation Laws. COMPRESSOR,BTU APPROVALS 'DATE INSP TOR'S SIGNATURE' Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL u�,7 provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and WALL / v JI✓ Professions Code,and my license is in full force and effect210 . License Number �w Lia Classr ICL Contractor '�y "�7� Date 40 O F-1I am exempt under Sec. Plan Check fee B.&P.C.for this reason PERMIT ISSUING FEE$ 0 Date: TOTAL FEE LU Signature „•. . a N OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT ,l •'. Z I hereby affirm that I am exempt from the Contractor's License Law NAME �_7 , G a '% '-•I"k: for the following reason (Section 7031.5, Business and Professions Code): ADDRESS ❑ I, as owner of the property, or my employees with wages rc if ,d- / as their sole compensation, will do the work and the CITY TEL.NO.2f . ' " ,•,. structure is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting MAIL f.., ,t,at,z_ >>.•.I with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY TEL.NO. ..I I hereby affirm that there is a construction lending agency for CONTRACTOR I he erformance of the work for which this ermit Is issued �� , `S•- p;;,.,,x,;;t (Sec. 3097, Civ._C.). ADDRESS Lender's Name CITY G /{/ i G— TEL.NO. �"7 D Lender's Address STATE I LIC. A✓ +,., ,� - I certify that I have read this application and state that the above LICENSE NO. CLASS( _�(p L� information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize representatives 210rs County to enter upon the above-mentioned propert pection pfposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNAT RE OF AP CANT OR AGE91IT DATE