HomeMy Public PortalAbout9451 BROADWAY_Mechanical__ "'RAE'c =a'a"' ' " APPLICATION FOR PERMIT
HEATING - VENTIIATI _ - AIR'CONDITIONI
COU NT.Y O OS ANGE _
DEPARTMENT OF COUNTY E (NEER '
BUILDING AND SAFETY DIVISION ✓✓✓
.. ..,-. .. ..:. ..�., .. ,... :.. -�.. ... BUIL ,. ,.....s.-,. ., .n.,.,....., ,•
FOR APPLICANT TO FILL IN LDING
.
(PRINT OR TYPE ONLY) ADDRESS '
LOCALITY —7:17
-NO.- 'TYPE OPAPPLIANCE'O R.E OUIPM ENT_ ._. ,F.EE v.. NEAREST /
CROSSIST.
ABSORPTION UNIT.BTU - �/ A
OWNER
- AIR HANDLING UNIT.CFM - MAIL
ADDRESS
BOILER,BTU CITY - TEL.NO.-
COMPRESSOR,BTU ' C (}(, CONTRACTOR /F
VENTILATION SYSTEM ADDRESSC,for,.
EVAPORATIVE COOLER FAU_ - CITY 1 /JY-1 w At�7lt/ TE L.' Iy
NO. 1
STATE
FURNACE: G RAyj'(Y� h`'� C A
LICENSE NO.
FLOOR EITU QQ�� G4 �
HEATER: SUSPENDED_ DI�=T NO.' �ua NEPESSEDBY
WALL• L! 3
INSPECTION RECORD
-CN "
c
Plan check fee 25% of above. W
IL
PERMIT ISSUING FEE$ OO Z
TOTAL FEE 4- op —
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. VENTILATING.•AIR +
CONDITIONING.
I HEREBY CERTIFY THAT,I AM NOT ACTING IN VIOLATION OF APPROVALS - DATE" INSPECTOR SSIGNATUP^
CHAPTER 9. DIVISION 3. OF THE BUSINESS-AND PROFESSIONAL CODE .
OF THE STATE OF CALIF A.
4�
ANATUR ROUGH
OFATU
GIT FINAL
TE
PLAN CHECK VALIDATION CN. MO. CASs PERMIT VALIDATION cR: N. cnsx
4s o 4 7.0.0 Am
WORKER'SthatIhve a ceSATION DECLARATION 200048 DPW 9189 APPLICATION FOR PERMIT �� � �.����
I hereby affirm that have a certificate of consanLlo self insure,
or a certificate of Worker's Compensation Insurance, or a certified HEATING •VENTILATING •AIR CONDITIONING
copy the�p000fJf,(Sea 9800 Lab. C.) _ ,
Pollcy N;/10 ompa '"¢ COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑
Certified copy is hereby furnished.
❑ Certified copy is filed with the county it , g inspect FOR APPLICANT TO FILL IN BUILDING {�
department. (PRINT OR TYPE ONLY) ADDRESS
Date VZ LL3ApplicaN �f /_C� NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY "
CERTIFICATE OF EX T N FROF.A WORKEHS3 it - - CROSS ST
COMPEN NEAREST
i 'INSURANCE' - _- - _ --«-- _/_ ��OODOO_ 0__
(This section need not be completed If the work Involved by the nnemm� c - ASSESSOR- - -:MAP BOON PAGE PARCEL
_
permit is for one hundred dollars($700)or less.) 11t /n-P<_. CJ
•� MR�IANBNNB-BNfF OFM plSiflICTAO. PROCESSED BY
I certify that in the performance of the work for which this permit
is issued,1 shall not employ any person in any manner so as to pA J/o O,000
become subject to the Workers'Compensation Laws.
COMPRESSOR,BTU 7/001 Oo U Q
APPIGI GATE 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 EVAPDROVI E 700L R-
provisions of the Labor Code, you must forthwith comply with such /�1� y FINAL - _9
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 SUSPENDED—UNIT—
(commencing
USPENDED UNIT -
(commencing with Section 7000) of Division 3 of the Business and HEATER: WALL _
- 3
Professions Code,and my license is in full force and effect. a _
a �C�� 1��.'L.r-��:�- �o � �8`77G•�3 ACCs.
License Number 3 W'"1 �¢ Lic.Class G—Za �� y _. 'p O
''I'' L/� �?I i' , 1111.42 a
Contactor G!/G5�6�JD - �1 Date S —A' —43 �«.z' /�" _ 1 ITEMS t 0
❑ I am exempt under Seca Plan check fee �L 'r 'j / TOTAL 1111.42 I=
B.BP.C.for this reason PERMIT ISSUING FEE $ i_.J-IEC:�� 1111.4:: 0
to! 3-I& r 4 3 . .TOTAL FEE - - _. - _ -. UJI
Signature a HANG .1711 a
O R-8 L TION PLAN CHECK APPLICANT n i - _ i t a Z
I hereby of th I am exempt from the Contractor's License Law NAME D - 0000-0001 s/1h/9.*7
for the following reason (Section 7031.5. Business and Professions , [(pp 1 M i
Code): ADDRESS - 3693 �1 PM11e13
.❑ 1, as owner of the property, or my employees with wages
as their sole compensation, will do the work and the CITY TEL.NO.
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 -
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING'AGENCY CITY - TEL.NO.
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
Lender's Name
CITY TEL.NO.
Lender's Address _ / /(� � b'./✓
I certify that I have read this application and state that the above STATE LIC.
NO .LICENSE Bj•Yi�oC yf�K G 373 �Y -
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
property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r
SIGNATURE OF APPLICANT OR AGENT DATE