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HomeMy Public PortalAbout9206 BLACKLEY ST_Mechanical__ pp— Ia CE-ti'!8(EV.6/78) ©s• APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN FBUILDING 9206-E. BLACK= (PRINT OR TYPE ONLY) ESS _ LITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE STS ST. QLD ABSORPTION UNIT,BTU OWNER SAtV'�ITTA'!T 'DA1�AL+'T AIR HANDLING UNIT,CFM - MAIL SAM i�t'iL'��•.� ADDRESS`��• ' BOILER,BTU CITY TEL.NL ' '1 COMPRESSOR,BTU Jlo nnCONTRACTOR 111L71VE HCC VENTILATION SYSTEM ADDRESS iq3e ,2034 n. PECK EVAPORATIVE COOLER, CITY TEL.NO. FLOORFURNACE: . FAUGRAVITY LICENSE NSTATE LIC. O. 265094 CLASS c-20 .HEATER: SUSPENDED. UNIT_ APPROVALS DATE INSPECTOR'S SIGNATURE WALL ATE ROUGH / FINAL Q./ <C INSPECTION RECORD / cc cc Plan check fee 25% of above. I _ PERMIT ISSUING FEE$ Z TOTAL FEE. 27, .0 PLAN CHECK APPLICANT_ PLAN CHECK VALIDA,TBION ' NAME u--w�' ADDRESS D Y 0 O U CITYTEL.NO. IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL / Z 7 A ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR PG 4'7 CONDITIONING. PERMIT VALIDATION #,q 0 0,0 4 1 IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND ROF ESSIONAL CODE - OF THE STATE OF CALIFORNI . ` . 2 O - 27.00 SIGNATURE L OF PERMITTEE -" V— 0 0 o27,006 DISTRICT NO. ROCESSED& 0.6.04-'79 11NORKEFi'SCOMPENSATION DECLARATION 20-0046 DPW 9/89 I Fi' APPLICATION .FO.R PERMIT LIME GREEN 76A364C e��by a'rfirm that I have a.certificate of consent to self insure, or a cert),ficate of.bNorker'sCompensation Insurance, or a certified HEATING -VENTILATING-AIR CONDITIONING copy th*reof(Sec.3800 Lab. C.) •^t Policy N8. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING p, �t�, department. (PRINT OR TYPE ONLY) ADDRESS V 62 P 10-& (44 Date Applicant LOCALITY I a ! q NO. TYPE OF APPLIANCE OR.EQUIPMENT FEE liL `-`�l� CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST �` ,lit n I CROSS ST. COMPENSATION INSURANCE (This section need not be completed if the work involved by the ABSORPTION UNIT,BTU NASSESSOR MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU become subject to the Workers'Compensation laws. r()� 0,000 0v® COMPRESSOR,BTU .APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after,making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER t provisions of the Labor Code, you must forthwith comply with such FINAL L provisions or this permit shall be deemed revoked. FURNACE: FAU GRA TY LICENSED CONTRACTORS DECLARATION FLOOR BTU /U� /iT �3 V LIDATION ,�/���/ I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT /, (commencing with Section 7000) of Division 3 of the Business and HEATER: WALL Professions Code,and my license is in full force and effect. License Number Lic.Class d Contractor Date O ❑ I am exempt under Sec. Plan Check fee BAP.C.for this reason PERMIT ISSUING FEE$ 0 Date: 1 &7TOTAL FEE 00 W Signature 0- OWNER-BUILDER OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT (n I hereby affirm that I am exempt from the Contractor's License Law NAME W , for the following reason (Section 7031.5, Business and Professions ire)' ;:ti.r I, as owner of the property, or my employees with wages ADDRESS gaoco 6 1aL� H _'f�ii•� � f tt k as their sole compensation, will do the work and the CITY ( TEL. i %oti:t structure is not intended or offered for sale (Section 7044, `� s _TES_ Business and Professions Code). OWNER -I' ❑ I, as owner of the property, am exclusively contracting MAIL 1 TOTAL I riL t -� with licensed contractors to construct the project (Sec- ADDRESS l ._ 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 F I €moi' Lender's Name f'("UU-1i•�(•'d CITY TEL.NO. ' lt4•� f _ if i 'ili1 in10:'. 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 representatives of this County to enter upon the above-mentioned pro erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURT OF Ir PUCANT OR AGE DATE