HomeMy Public PortalAbout4935 CLOVERLY AVE_Mechanical__ 76A364C '
CE 818(REV 6/78)
�S APPLICATION FOR" PERMIT -
HEATING - VENTILATING " }AIR CONDITIONING
,
COUNTY OF LOS ANGELES BUILDING AND SdFETY' y
FOR,APPL•ICANT TO FILL IN r BUILDING j�
y' (PRINT,OR TYPE ONLY) + ADDRESS Alf J49
LOCALIT
NO TYPE OF APPLPANCE OR EQUIPMENT FEE'
NEAREST, `a
CROSS ST (,�,
>' e ABSORPTION UNIT"BTU
OWNE r}
'AIR HANDLING UNIT CFM µ MAIL
ADDRESS 0 '
BOILER BTU
u 1 y CITY — TEL NO (I`�O
4 O (7 J v
COMPRESSOR BTU � 'CONTRAC OR @ �'
1
VENTILATION SYSTEM e .' I
ADDRESS d
EVAPORATIVE COOLER CITY TEL NO 6 �+
FURNACE FAUN G IT
STATE LIC /p _ '
FLOOR BTU /O LICENSE NO,z '�Z Qs aCLASS (i ,
HEATER' SUSPENDED UNIT= 1 APPROVALS DATE , INSPECTORS SI NATURE
WALL x
' ROUGH + //J�r ;
FINAL 5 7� h KC9G/LlEC✓C'L O
..
y INSPECTION RECORD V
G
Plan check fee 25% of above �C16
tA
'PERMIT ISSUING FEE$ _ Z
TOTAL FEE '
4 �f
PLAN CHECK APPLICANT'
PLAN C C ALIPATION
NAME E , �' t SCC � K-d �/'�''v\ 'C
ADDRSS S&, 4 6 ! '
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 , }411 2 A
CONDITIONING 1' '"
PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM NOT+ACTING,IN VIOLATION OF i +` +-r+ '#t0'O O O 4 1 !
CHAPTER 9 DIVISION 3 OF THEIBUSINESS AND PROFESSIONAL.CODE r"
OF THE STATE OF CALIF IA �'O„CI 2 7.O 0
SIGNATURE , '
OF PERMI7T , M
O 2 ,700
DISTRICT NO PR �SSED Y „ , , , F`Q"O' '
b�� D f> 0602—. 7,9,00 -
WORKER'S COMPENSATION DECLARATION 46DPW 9/69
76A364C APPLICATION FOR PERMIT LIME GREEN
hereby sffi�m that.1,have a CertificIte'pf.coi!t5ent to self insure, 76A3
or a cert;fieate`of Worker's Compensation Insurance, or a certified HEATING -VENTILATING -AIR CONDITIONING
copy thereof('Sec. 3800*Lab. C.)
Policy No. ` Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
Certified copy is hereby furnished.
❑ Certified co Is filed with the count building inspection FOR APPLICANT TO FILL IN BUILDING copy is Y 9 P ADDRESS
department. (PRINT OR TYPE ONLY)
Date Applicant LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
CROSS ST.
COMPENSATION INSURANCE ABSORPTION UNIT,BTU
This section need not be completed if the work involved ASSESSOR
( b P Y the MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any perso in anyA
BOILER,BTU
become�Subjtto Workers' ati n elf
r
/ COMPRESSOR,BTU QI�
oft
APPROVALS DATE. INSPEC 'S SIGNATURE
Data. Applica VENTILATION SYSTEM
NOTI TO APPLI ANT: If, er m ing thROUGH _
Exe ption, ou should become ject to the WorkEVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith FINAL
provisions or this permit shall be deemed revoked.. FURNACE: FAU GRAVIZY / VALIDATION
LICENSED CONTRACTORS DECLARATION FLOOR BTU Q (OJ
I hereby affirm that I am licensed under provisions of Chapter 9 HEATERSUSPENDED UNIT
:
(commencing with Section 7000) of Division 3 of the Business and WALL
Professions Code,and my license is in full force and effect.
License Number V,V� Lic.Class
�L � �.� a _
Contractor Date I'' !°_z _ 0
�___
❑ Plan check fee 0
I am exempt under Sec.
B.&P.C.for this reason PERMIT ISSUING FEE$ 0
Date: TOTAL FEE �� U
Signature
LAN CHECK APPLICANT CD
OWNER-BUILDER DECLARATION of 6 c° 1U 7
I hereby affirm that I am exempt from the Contractor's License Law NAME
for the following reason (Section 7031.5, Business and Professions /T Af
-
Code): ADDRESS
❑ -
I, as owner of the property, or my employees with wages .�—•
as their sole compensation, will do the work and the CITY7EL.N .�
0
structure is not intended or offered for sale (Section 7044,
Business and Professions Code). OWNER l�4.1!{_—'•. i __. .
❑ I, as owner of the property, am exclusively contracting MAIL `/ / :t324 1 AM11 1°=)
with licensed contractors to construct the project (Sec- ADDRESS j J
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY CI t , TEL.NO" 7
I hereby affirm that there is a construction lending agency for CONTRALTO L 4149 5vat'a25 1111111.the performance of the work for which this permit Is issued
(Sec. 3097, Civ.C.).
ADDRESS
Lender's Name n
CITY !!!R✓✓✓�rjV•'1' /N TEL.N
Lender's Address STATE Q� LIC. I
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 relaV'N to building construction,and hereby authorize _
represe tatives o t s County to enter upon the above-mentioned
p y for ' e n p ^ SEE REVERSE FOR EXPLANATORY LANGUAGE Y
NA URAPPLICANT 01T AGEN DATE /y