HomeMy Public PortalAbout10640 BOGUE ST_Mechanical__ 7 6 A 364- E 8 1 B-B 6B APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
- COLEMAN W. JENKINS, SUPERINTENDENT QF BUILDING LOCALITY
NEAREST .00,
FOR APPLICANT TO FILL IN CROSS ST.
(Print or type only) OWNER Ip
NO. TYPEJOF APPLIANCE OR EQUIPMENT FEE
MAIL �'A
ADDRESS
ABSORPTION SYSTEM, BTU CITY TEL. NO.
AIR HANDLING UNIT, CFM CONTRACTOR
BOILER, HORSEP OWE 1:2� ADDRESS
o //��Dv���j
COMPRESSOR, HORSEPOWER CITY TEL. NO.
C.
STATELIC.
VENTILATION SYSTEM LICENSE NO. CLASS
DISTRICT NO. GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER q `
FURNACE: FAU ,GRAVITY LJ QIP p
FLOOR—BTU INSPECTION RECORD
HEATER: SUSPENDED UNIT
WALL
L
0
v
0
U
' W
a
N
Z
NEW- ADDITION PERMIT $ 3 00
ALTER—REPAIR— TOTAL FEE $
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 - DATE -I CTOR'S SIG TURE
LATING, AIR CONDITIONING.
ROUGH
1 HEREBY CERTIFY THAT 1 .AM NOT ACTING IN VIOLATION FINAL
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL
CODE OF THE STATE OF CALIFORNIA.
JACK R. ALLEN,SUPERVIS CHANICAL ENG'R.
SIGNATURE PERMIT VALIDATIO CK. M.O. CASH
OF PERMITTEE
PLAN CHECK VALIDATION
uAGo7 2-4`0, : JUL28 4 .1. D .1:* 0'54N.
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT
I her, nfflrm that I have a certificate of consent to self
Insure, r a certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
or a cc ified copy thereof (Sec. 3800,-Lab C.) 76A364C
;��/�/
CE-818(REV 10/81)
Policy No%3&2' Company
❑ Certified copy is•hereby furnishedCOUNTY OF LOS ANGELES BUILDINGAND SAFETY
❑ Certified copy is filled with the county building inspec- FOR APPLICANT TO FILL IN BUILDING //,
tion department ADDRESS 77
(PRINT OR TYPE ONLY.),
Date Applicant �� ' �" — LOCALITY
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST tX�L�'�
(This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO PROCESSED BY i
the,permit is for one hundred dollars ($100)or less.) C
AIR HANDLING UNIT, CFM r
I certify that in-the performance,of the work for which this ....
permit Is Issued, I'shall not employ ahy person in any manner
so as to become subject to th'e'Workers'Compensation Laws. BOILER„BTU j� APPROVALS DATE IN CTOR'S SIG ATURE
Date Applicant COMPRESSOR, BTU �D 6V ROUGH
NOTICE TO APPLICANT:'If, after making this Certificate of VENTILATION SYSTEM FINAL
Exemption, you should become','subject to the 'Workers'
Compensation provisions-a f the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATIFN
with comply with such provisions or this permit shall be
deemed revoked FURNACE FAU GV T
:LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9HEATER SUSPENDED UNIT"'
(commencing with'Sectlon.7000)•of Division 3 of the Business WALL
and Professions Code,-and my license Is in full force and effect
2 3 i C. /oq Ly za
License Number Lic. Class4r, TA I ,4 00
�
Contractor Date
❑ V
I am'exempt under Sec. w
Plan check fee a.
B&P C. for this reason ` PERMIT ISSUING FEE $ V (� -91 0 7.8 A Z
` Date: - •
Signature TOTAL FEE' # o 0�0"0 0 8
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT :( 0 0 3750
.
I hereby affirm that I am exempt from the Contractor's Llce'nse
Law for the following reason (Section 7031 5, Business and NAME , 0 0'`0 3 7,5'Q
Professions Code)-
EI, as'ow ner of the property, or my 'employees with ADDRESS' )l 0 T-r 8 8,
wages as their'sole compensation,will do the work and
the structure Is not intended or offered for sale(Section CITY TEL NO
7044, Business and Professlons.Code).
OWNER. /►� /.�
❑ I, as'owner of the property;am exclusively contracting V v
Ar
with'licensed contractors to construct the project (Sec- MAIL
ADDRESS 0 0 a t
tion 7044, Business and-Professions Code)
CONSTRUCTION LENDING AGENCY CITY TEL'NO s'.0
-.1 hereby affirm that there is a construction lending agency for ,
the,performance.of the work'for which this permit is Issued 'CONTRACTOR'
(Sec. 3097, Civ C )
ADDRESS �[ .
Lender's Name
CITY 1� r0 v I TEL NO 3/
STATE LC
Lender's Address
I certify•that I have read this application.and state that the LICENSE NO � g -Z CLASS
above Information Is correct I agree to comply with all County
ordinances and State laws relating to building construction,
and ereby authorize repres ntatives of-this County to enter
urA the above- entioned roperty for In e:tion purpos s. SEE REVERSE FOR EXPLANATORY LANGUAGE
Slgnatur of Ap hcant or Agent Date -- "