HomeMy Public PortalAbout5336 BUTTONS AVE_Mechanical__ 769360E ICE-'BISM-9/TT ` APPLICATION FOR PERMIT
HEATING - `VENTILATING - AIR CONDITIONING
COUNTY�FlLOS ANGELEs4l6//
DEPARTMEN IN
COUTYEN EER
BUILDING AND SAFETY DIVI�ION
FOR APPLICANT TO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS
LOCALITY /
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CRO55 ST. .�
ABSORPTION UNIT,BTU
OWNE /jjJ7�J `
AIR HANDLING U T FM MAIL
ADDRESS
BOILER,BTOL��
CITY TEL.N
COMPRESSOR.BTU CONTR T
VENTILATION SYSTEM ADDRES w��n
EVAPORATIVE COOLER CITY
TEL NO. !��'��•--'
FURNACE: FAU—GRAVITY STATE LIG.
FLOOR BTU LICENSE NO. O�42
CLAS
HEATER: SUSPENDED—UNIT— DISTRICT NO. y/�-� zONE vRev
WALL H�J' U(/ D I t
O
INSPECTION RECORD 0
O
u
a .
O
Plan check fee 25% of above.
PERMIT ISSUING FEE$ WI
WI
TOTAL FEE Z
PLAN CHECK APPLICANT -
NAME,.
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE VE READ 15 APPLICATION AND
STATE THAT THE ABOVE IS ERECT ND AG E T COMPLY WITH ALL
ORDINANCES AND LAW REGULAT G HE TING VENTILATING. AIR
CONDITIONING.
I HEREBY CE Y I AM NOT I IN VIOLATION OF. APPROVALS DATE INSPECTOR'S SIGNATURE
CHAPTER 9. DIVI , OF t ° USINES. D ROPE' ONAL CODE
OF THE STATE LIFORN ROUGH — .
SIGNATURE FINAL
OF PERMIT '
PLAN CHECK VALIDATIONcA.. M.O. CASH PERMIT VALIDATION M.D., CASH
ki C0i'1PENSATION
5 .07�hMAY 184,1 0 27.00 A`6
.POLICY HOLDER:�� . _ .
POLICY NUMBER: z 36 ys�
<�'U—
WOFUZER'S*CO
have a ce SATION DECLARATION 76A3" DPW 9/69 APPLICATION FOR PERMIT UAAE GREEK
0-0046
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.) - -
Polley No. Company COUNTY OF LOS ANGELES DEPT'OF,PUBLIC WORKS BUILDING AND SAFETY DIV.
❑ Certified copy is hereby furnished.'. -
❑ Certified copy is filed with the count building inspection FOR APPLICANT TO FILL IN - BUILDING - -
r department. y 9 (PRINT OR TYPE ONLY) ADDRESS 3 3
Date ApplicantNO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
ell
CROSS ST.
COMPENSATION INSURANCE
ABSORPTION UNIT,BTU ASSESSOR
(This section need not be completed the work Involved by the MAP BOOK PAGE PARCEL -
permit is for one huntlretl dollars($1000)or less.) - AIR HANDLING UNIT,CFM
Dlsmx;T 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 ' ��� �O G ,-
become subject to the Workers'Compensation Laws.
COMPRESSOR,BTU �•�J
AFFRWALS DATE INSPECTOR'S SIGNATURE
Date Applicant VENTILATION SYSTEM -
NOTICE TO APPLICANT: If, attar making this Certificate of .ROUGH -
Exemption,.you should become subject to the Workers'Compensation EVAPORATIVE COOLER
you must forthwith comply with such FINAL
provisions of the Labor Code, y p y -
provisions or this permit shall be deemed revoked. FURNACE: FAU- GRAVITY -
LICENSED CONTRACTORS DECLARATION FLOOR BTU " VALIDATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 - - HEATER: SUSPENDED—UNIT—
commencing
USPENDED UNR_, -
•(commencing with Section 7000) of Division 3 of the Business and WALL
Professions Code,and my license is in full force and effect.
'License Number Lic.Class — -
D EL
Contractor-- Date - '- V
❑ I am exempt under Sac. Plan check fee n"(
B.BP.C.for this reason PERMIT ISSUING FEE. -7 0
, i
Date: TOTAL FEE O _ 1 ITEM_ a
Signature - PLAN CHECK APPLICANTTOTAL 77 - 70 W
OWNER-BUILDER DECLARATION - -. '1 Z
I hereby affirm that I am exempt from the Contractor's License Law NAME. - D ' CASH 7?"(-f 1l
for the following reason,(Section 7031.5, Business and ProfessionsA
C ADDRESS - .. CHANGE - sIJII
'rrY'll I, as owner of the property, or my employees with wages
as their sole compensation, will do the work and the CITU TEL.NO. n i
structure isnot intended or offered for sale (Section 7044, - - - !][1[I[I—Q[(IJ1 3� 0/}'.S
.Business and Professions Code). OWNER
❑ . i ;.5c
I, as owner of the property, am exclusively contracting 1145I i AN
MAIL
' with licensedcontractors to construct the project (Sec ADDRESS -
tion 7044, Business and Professions Code). -
CONSTRUCTION LENDING AGENCY CIJ�b TEL.NO
hereby affirm that there is.a construction lending agency for CONTRACTOR
the performance of the work for which this permit Is issuad
(Sec.3097.Civ.C.).
ADDRESS
Lender's Name
CITY" - TEL.,NO:
Lender's Address STATE .. LIC. .. _. ..._ . . _.
I certify that I have read this application and slate 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
property forinspecNA
tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
C)..lvleti.J'LR44"
-
SIGNATURE OF APPLICANT OWAGEW DATE