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Home My Public Portal About5338 CAMELLIA AVE_Mechanical__ "'""l x`111' //71 �LlPERMMl ' HEATING - VENTILATING - AIR CONDITIONING BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN BUILDING (PRINT OR TYPE ONLY) ADDRESS LOCALITY C No. TYPEOFAPPLIANCE OR EQUIPMENT FEE NEAREST CROSS ST. ABSORPTION-UN IT, BTU OWNER AIR HANDLING UNIT, CFM MAIL ADDRESS 5335 BOILER, BTU CIT G` TEL. NO. ,2&,6 COMPRESSOR, BTU �� CONTRACTOR VENTILATION SYSTEM ADDRESS EVAPORATIVE COO ER CITY TEL. NO. 1 FURNACE: FAUGRAVITY STATE Ci LIC. l FLOOR BTU LICENSENO. 7 CLASS �f HEATER: SUSPENDED UNIT_ DISTRICT N0. GROUP ONE z ED er WALL 8 INSPECTION RECORD Plan check fee 25% of above. PERMIT ISSUING FEE S TOTAL FEE LgO PLAN CHECK APPLICANT NAME ADDRESS CITY TEL.NO. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE Il CORRECT'AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATLNG HEATING, VENTI- LATING, AIR CONDIJFCALIFORNIA. I HEREBY CERT I AM NOT ACTI 1 IN VIOLATION APPROVALS DATE INSPECTOR'S SIGKATUFM OF CHAPTER G, DIOF 7ryE B I a 4 PROFEIIIONAL ROUGH CODE OF THE STAT SIGNATURE FINAL OF PERMITTEE PLAN CHE ALIDATION, CK. M. CASH PERMIT VALIDATION CK. M.D. CASH ae5_79jW 29 41 1 9--5.0 Q� ELWWRUJ;S'QoMPENSATION DECLARATION APPLICATION F R PERMIT —'d-� thSt f have a certificalp of consent tp'self I;certificate of Workers' Compensation Insurance, 1 HEATING - VENTILATING - AIR CONDITIONING os a 10d copy thereof (Sec. 3800, Lab. C.) CE 81 (REV. 10/81) Policy Company ❑ CedIfied copy Is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ CertFfied copy Is filed with the county build Ing Inspec- FOR APPLICANT.TO FILL IN BUILDINGCA m e I tion department. (PRINT OR TYPE ONILY) ADDRESS 1 // l.i� Date AppHcant LOCALITY 41 L[_ GL NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' QST COMPENSATION INSURANCE CROSS ST' (This sectkm rwmd not be completed If the work Imrolvwd by ABSORPTK)N UNIT, BTU D STRICT Mo. PROCESSED B the permit is for one hundred dollars ($100)or less.) 08 111— 7, i- I certify that In the performance of the work for which this A1R IIA1iDl1NG UNfF,.CFM permit Is Issued, I shall not employ any Person In any manner BOILER BTU so as to become sub ect to the Workers Compensation Laws. �� DATE '�,�� Dote " ' plica nt1*A1 C0&%PRESS0R, BTU ROUGH J NOTICE TO APPLICANT: If, after Makin to of VENTILATION SYSTEM FINAL Exemption, you should become sU o the ars Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be 1 deemed revoked. FURNACE: FAL VTTY O LICENSED CONTRACTORS DECLARATION BOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business WALL and ProfeWons Code,and my license Is In full force and effect. ��) J� �] ✓�I( License Number _ ` -/ Llc. Class C � r2 (� o Contra ,ZAyr t7"rr" 1 Date ❑ I am exempt under Sec. Plan check f@@ -29962A y B.BP.C. fns this reason PERMIT ISSUING FEE Q # o o o,o',6 8 Date: Signature TOTAL FEE � i - a4aoo OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby afflrm that I am exempt from the Contractor's License o 0 - 4 &005, Law for the following reason (Section 7031.5, Business a6d NAME Professions Code): ADDRESS I, as owner of the property, or my employees with wages as their sole compensation,will do the work and c:" TEL_ NO the structure Is not Intended or offered for sale(Section 7041, Business and Professions Code). OW1,1ER ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- M° RFSS tion 7041, Business and Professlons Code). CONSTRUCTION LENDING AGENCYcrrY a /'. TEL No: I hereby affirm that there Is a construction lending agency for l/L the performance of the work for which this permit Is Issued CONTRACTOR r& ' (Sec. 3097, Ov. C..). I ADDRESS ' Lenders Name CITY TEL NO. -2,116 *c,rdlwnnd dAddss ' STATE UC. cart have read this application and state that the LICENSE NO. - CLASS Ion b correct. I agree to comply with all County d State laws relating to bullding constructlon, a representatives of this County to enter io property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE licant or Agent Date WORKER'S have a cartATION Df.consAT10N �W°'� APPLICATION FOR PERMIT LIME GREEN I hereby affirm that I have a cerUnoete of consent to self Insure, or a certlfloate of Worker's Comprnsatton Insurance, or a certified HEATING-VENl1LATING-AIR CONDITIONING copy.thereof(8,&o.3800 Lab.C.) u Poky Na Corn?arry COUNTY OF LOS ANGELES DEPT,OF PUBLIC WORKS BUILDING AND SAFETY DIV. nCertfffed copy Is hereby tumbled. Certified oopyJ#pled with the coutrty bulkilnp lospegtton FOR APPLICANT TO FILL IN �I� er depertrr»nt (PRINT OR TYPE ONLY) ADORFss DoteLOCALITY APPS. Not TYPE OF APPLIANCE OR EOUIPI FENT FEF NEAFEBT CERTlFk;ATE OF DCEIIAPTtON FROM WORKBW ` fC COMPENSAT10N INSURANCE CR068 ST. �} (T-his seotlon nhd not be completed k the work Imotved by theABSORPTION UNIT BTU ASSESSOR. IUP BOO!( PAGE, PARCEL rt - � penk la for one hundred dolLSFs(><1 Le Q0)or as.j NR HAJYDLING UNIT,CFM MAP PFOCENOWBy L oeFUfy that In the performanQo of 1hq.work for.whloh this permit Is Issued, 1 shall.not employ any person In any manner so as to 13041_01,BTU �,� � � F�`��►�'6� ' bdcome qubjact to the Workers'Compensation /' l COMP RES90R,BTL A"'RbvALs DATE s�:rorrseinumrs, ppplk7arrt VE�NT1LATIQN SYSTEM .t4OTJCI` TO APPLICANT: If, atter making this Certificate ofROUGH Exemption,you alo(Jld,become sub}ept Workers' to the Compensation provlMons of the Labor Code;you mu*4 forthw th'compty wtth such FINAL COOLERAPORATrVE FINAL provlalons-or thtapemlkshall be deemed revoked. FURNACE: FAU GRAVITY LICA QONTRACTORS DECLARAT)ON FLOOR -BTU VALIDA ION I herepy affirm that]'am licensed under provisions of Chapter 0 - 61-181--81DED UNIT . (oommenging,wkh Seellort 7000) of Dlvlston 3 of the Business and WALL ProfesslonQ Q-oda,:and. my Incense b In full foroe and effect a'.( u ly OS License Number LJc.Ciass Contractor Data S 0 l am exempt under Sec. Plan check fee. Q B.J6P.C.for this reason PERMIT ISSUING FEE; y0 De3e TOTAL FEE a SlgnsiuraPLAAPPLICANTCJ(APPLICANT 1• �/� Z OWNEF -BUILDER DEC-ARATK>9 V r 7�7 I hereby afflnh that I airs exempt from the Contractor's I_toense Law NAME for the following reason (8eotlon 7091.6, BudInees and Profe"ons ADDRESS CodDKI, es owner of the propQrty, or my employees with wages Mr I as their sole compensation, will do the work and the CITY TEJ_.NO. I ft•41 .i ' atruotdre Is not Intended or offered for sale (Seotlon 7144, ��.' �uslnoes and Profeetiona Code). OWNER 37.45. ❑'. I, as owner of the property, ■m exclusively gontraoting HAIL Ttt�r 1 I IG[1' -with licensed contractors to construct the project (8ec- ADDRESS _ tion 7044,.Business and ProfealdnTOTAL . 30 45".s Code). , CONSUQTION LENDING AGENCY CITY. TEL NO. TR �ASH 30 L 1hereby atflrm that there Is a oonstructl611 lending agency for CONTRACTOR oil ;the performance of the work for which this permit le Issued . (Seo.3097,Clv. C.). .00 ADDRESS 9/r./94 Lenders Nemo CITY Tl_NO. - i�JI;J1Lc9 r Vl1Jl I1 LarxWo.Address ' STATE Uc. 706 1. . 1 AN -3:14 1 cerMy that I have read'thle application and state that the above LK 318E NO, CLASS lnfopnetim to correct. I agree to comply with all County ordinances and State laws reLatN to buBcVQ construction,end hereby authorb* repreesntattvee of this County to enter upon the above-mentioned p f for epeatlon pu SEE REVERSE FOR EXPLANATORY LANIMAGE ti AoarrDATE