The URL can be used to link to this page

Home My Public Portal About4846 CAMELLIA AVE_Mechanical__ 76 A366 =CE 818 - 9-71 APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING p A �� L�r A 14.vF DEPARTMENT OF COUNTY ENGINEER ADDRESS D `t BUILDING AND SAFETY DIVISION LOCALITY TF_p') 19(,L. _ C� NEAREST CROSS ST: A7;1-U FOR APPLICANT TO FILL III lYlN �� r2 OWNER 1." . (PRINT OR TYPE ONLY) u� r MAIL 1,NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS ® C✓kM SLC// n(k' '/ VIS' CITY Tr Al PLL 4', EL. NO. 2' d/b ALL ABSORPTION UNIT, BTU /' CONTRACTOR E C oer AIR HANDLING UNIT, CFM Crn ADDRESS +,wlyi' k L BOILER, BTU //ry� `Ifs O00 CITY D L //M "�/�TEL. NO.S -259?- COMPRESSOR, BTU QU LICENSE NO. Z-p SU "y- CLASS STATE VENTILATION SYSTEM DISTRICT NO. GROUP zpNE PR�Jp)c ESSEDDBBY EVAPORATIVE COOLER ;r: EVAPORATIVE /' �7�� Y / FURNACE: FAU_GRAVITV ✓✓✓ 4•• FLOOR BTU 000 INSPECTION RECORD HEATER: SUSPENDED_UNIT � WALL U w y N Z Plan check fee 25% of above. See reverse. 17 O PGH\IIT ISSUING FL'E S 3 00 TOTAL. FF:E %S —U PLAN CHECK APPLICANT NAME ADDRESS CITY TEL.NO. HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ANp STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL OR 0 ZNANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPE VRZ SIGNATU LATING, AIR CONDITIONING. ROUGH I HEREBY CERTIFY THAT I AM 4C G IN VIOLATION OF CHAPTER 9, DIVISION 3, OF THE S SINE A PROFESS ONAL FINAL CODE OF THE STATE OF CALIFOR IA. SIPERMITTEE GNATURE PERMI VALIDATION OF Cir. ..OW cnsH PLAN CHECK VALIDATION C .D. CASH ,Ir, 39344tC 4 41 0 15:50p SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE = WORKER'S COMPENSATION DECLARATION 20-0046DPW9/89 APPLICATION FORPERiiAIT. II /R1� GREEN ./p r1l�'' ILII :]6A364C � Jm�E `,t�`�E E I lel I I Nereb►'afftrnTYhat Hhavo a certificate of consent to self jnsure If�].Il l� V IJo _uV ora certificate of Worker's Compensation Insurance, or a certified HEATING-.VENTILATING- AIR CONDITIONING, - ,IlJll copy thereof(Sec.3800 Lab. C.) t " Policy, "° 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 - department. _ (PRINT OR TYPE ONLY) 'ADDRESS /> K i . _ 'Date _ Applicant .. NO. TYPE OF APPLIANCE OR EQUIPMENT - FEELOCALITY ' e •� ' CERTIFICATE OF EXEMPTION.FROM WORKERS' NEAREST COMPENSATION INSURANCE' CROSS ST. Lqw ABSORPTION UNIT,BTU ASSESSOR ' (Thissection need not be completed if the work involved by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM .. oisralcr No. Psocsss 1 certify that in the.:performance of the work for which this permit `` o isrissuetl I shall not employ any person in any manner so as to BOILER,BTU �• V become�sbblect to the.Workers' Compensation Laws. _ `` - ^ _ COMPRESSOR,BTU V'P.IOu.�'NecA '244 &0 Dale " Applicant VENTILATION SYSTEM ' aPPRovALs, oar Pe DR's SGrvaIURE NOTICE'.TO APPLICANT: If, after making this Certificate of _ ROUGH — ' r Exemption,you,should become subject to the Workers Compensation t provisions of the Labor Code, you must.forthwith comply with such EVAPORATIVE COOLER - FINAL- provisions INALprovisions or thispermit.shall be deemed revoked. FURNACE: FAU_GRAITY LICENSED CONTRACTORS DECLARATION I FLOOR BTU Ike'\OL Q - V TION I hereby affirm that I am licensed under'provisions of-Chapter 9 SUSPENDED UNIT_ (commencing with Section 7000) of.Division 3 of the Business and HEATER: WALL - Professions Code;`and'my license is in Lull force and effect. . 4 �►��s ori leis o License Number - Lia Class bU.i,� ' S (➢0 . ' D r a Contractor Date - - V ❑ • 4 Plan check fee - .. I am exempt under Sea •- � • ' B&P.O.for this reason .PERMIT ISSUING FEE$ 2, O - Date: TOTAL FEET '1 - q0 - d Signature - FA • OWNER-BUILDER DECLARATION' PLANCHECK APPLICANT I Z I hereby affirm that I am exempt from the Contractor's License Law NAME for the following reason (Section 7031.5, Business and Professions D /u�'- 1g ITEMS* 90 Code): - - ADDRESS' b. FIy.0 rKT a ❑ I, as owner of the property, or my employees with wages V f }�]3Tn1' r. C �f as their'sole compensation, will do the work and the CITY, TEL.N . - Mppla 154.90 structure is not intended or offered for.sale (Section 7044, c Business and'Professions Code). •.^ OWNER e - CHANGE 00 ❑' I, as owner of the property, aML exclusively-contracting MAIL - M1.. with AiclI contractors to construct the project (Sec- ADDRESS o, ' tion 7044,Business and Professions Code). r':• 010[00[ 0001 5/15/96 CONSTRUCTION LENDING AGENCY - - CITY - :N 6416 1 AM y-Ce hereby affirm that there is a construction lending agency for- CONTACTOR 8 the performance of the work for which thispermitis issued (Sec. 3097. Civ.C.). " ADDRESS - •, Lender's Name" CITY TEL:NO. - Lender's Address STATE LIC .. I Certify that) have read this application and state that the above LICENSE NO.. - .CLASS - information is correct. 1 agree to comply with all bounty ordinances , and State laws relating to buildirl%construction,and hereby authorize repress tgtives of th' al t)�t enter upon the above-mentioned. prq y fb pe ion pL r s. SEE REVERSE FOR EXPLANATORY LANGUAGE - J - �� µ . GNATUR O APPLIC 1 'GATE - ,. WORKER'S have a certificate DECLARATION ZOOOOSDPW 9/89 APPLICATION FOR PERMIT LI M E GREEN I hereby affirm that I have a certificate of consent to self insure, 76A'181C or a certificate of Worker's Compensation Insurance. or a certified HEATING-VENTILATING-AIR CONDITIONING !� copy thereof(Sec.3800 Lab. C.) v Policy 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 county building inspection FOR APPLICANT TO FILL IN BUILDING department. (PRINT OR TYPE ONLY) ADDRESS Dale ApplicantLOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. ABSORPTION UNIT,BTU ASSESSOR (This oneed not Completed the work involved by the MAP BOOK PAGE PARCEL permitt Is ie for one hundreded dollars($7000)or lose.) 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 i r become subject to the Workers'Compensation Laws. 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 provisions of the Labor Code, you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU_GRAVITV LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED—UNIT— WALL 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. 14 License Number Lic.Class } CL Contractor Date V ❑ I am exempt under Sec. Plan Check fee W J s.aP.D.for this reason PERMIT ISSUING FEES Ly Date: TOTAL FEE } Signature PIAN CHECK APPLICANT < OWNER-BUILDER DECLARATION Q 1 hereby affirm that I am exempt from the Contractor's License Law NAMEPoo. t- 1 �y�yC d for the following reason (Section 7031.5, Business and Professions - �O8ayy��A 1 Jif] 2 Code): ADDRESSLLJ Eli' sSOFSKT .l.e i,R(; F I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the CITY _TEL.NO. iSx structure is not intended or offered for sale (Section 7044, - Business and Professions Cade). OWNER ❑ I, as owner of the property, am exclusively contracting MAIL �f�r�_xyM11 with licensed contractors to construct the project (Sec- ADDRESS Ilxtllt)-IIwJC}S -r5y�cl tion 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY TEL.NO. EYP 16 L AMhereby affirm that there is a construction lending aggency 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 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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANT on AGENT DATE