HomeMy Public PortalAbout9406 DAINES DR_Mechanical__ •'16 A 96 4 C E 8 18- 5-7 3
APPLIC ION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
44
COUNTY OF LOS ANGELES BUILDING /
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY 000,
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER ,.
(PRINT OR TYPE ONLY) '
MAIL
No. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS
CITY TEL. NO.
ABSORPTION UNIT, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM l'
ADDRESS S / '].
BOILER, BTU 7 CITY`--��I/ � NQ�9I—ate/
COMPRESSOR, BTU STATE LIC.
LICENSE NO.,/ CLASSetl-�
VENTILATION SYSTEM DISTRICT J��PNO. ZONE PRO SSED BY
EVAPORATIVE COOLERQ
FURNACE: FAUGRAVITY !J V�
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED—UNIT—
WALL
USPENDED UNIT_WALL
a.
0
v
0
f—
U
W
CL
N
Plan check fee 25% of above. See reverse. z
PERiMIT ISSUING FEE 8 3 00
'r'oTAL FEE
PLAN CHECK APP.LICA
NAME
ADDRESS
CITY EL.I 3-
I HEREBY ACKNOWLEDGE THAT I HAVE READTHISAPPLICATION i
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL 0 INANCES AND LAWS. REGULATING HEATING, VENTI- APPROVALS D TE PECTO 'S G TU E p
EATING, AIR C 'TION ING, i. n
ROUGH
I HEREBY CER M- NOT ACTING IN VIOLATION .
OF CHAPTER 9, VISI. 3,�OF THE BUSINESS AND PROFESSIONAL FINAL - �' 7 �
CODE OF THE ATE OF RNIA. _
SIGNATURE PERMIT VALIDATION C- M.D. CASH
OF PE RMITT ,
PLAN CHECK VALID ' ON CK. M.0. CASH
6 7'2:LjUN 21 4.1" 0 1 0.5 0 ,698
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
364C CE
WORKERS'COMPENSATION DECLARATION 76A 8187(2-80) Ir Ir Q�i` 1T Q N' If R PERMIT
I hereby`affirm that, I have,a•,eertificate of consent to self
insure,or a certificate of WOI':(e� EOr 1pensatiOn Insurance,of - -
HEATING-VENTILATING-Alli C0F4D1T10N:6N�
a.ce*tified copy thereof.(Sec.. 3800,Lab. C.)
Pohe�y'Nu�: 7 as�Company 'T ?f R
�
COUNTY OF-LOS ANGELES BUILDING AND SAFETY.Certified copy is hereby furnished. - • � . ' -•' -,
r- Certified copy is.filed With the c-unty building inspection L
department FOR APPLICANT,TO FILL IN C�
ADDRESS /
• DDRES
Date Applicant_ (PRINT OR.TYPE ONLY)`
,
a
LOCALITY f%
CERTIFICATE OF.EXEMPTION FROM WORKERS' TYPE.OF APPLIANCE OR EQUIPMENT FEE
TV O. •
COMPENSATION INSURANCE NEAREST
(This section need not'be-completed if the work involved - ABSORPTION UNIT, BTU, 3 ' CROSSST. !� a
by.the permit is for one hundred dollars($100).or less.) DISTRICT'NO. PRocESSEo a UO
I;certify ihat in the performance.of the work for'which this AIR HANDLING UNIT,CFM -
permit-is issued,,'I shall not.employ any person in,any manner CC
so as to become subject to the Workers' Compensation Laws, BOILER, BTU Q "
APPROVALS DATE INSPECTOR'S SIGNATURE ;
Date Applicant COMPRESSOR,BTU W
•NOTICE TO APRLICANT: If,,after making this Certificate of V.E'NTILATION SYSTEM U)
ROUGH J �C' fL
Exemption,, you'should become subject fo the Workers' M FINAL
Compensation..provisions .of the Labor Code, you mustforth-
with comply with.such EVAPORATIVE COOLER
p y provisions or this permit shall be. VALIDATION
deemed revoked.
FURNACE: FRU GRAVITY
LICENSED CONTRACTORS'DECLARATION:,,,' FLOOR• BTU ry
hereby affirm that I*am -under provisions of Chapter HEATER: SUSPENDED ' `UNIT,
9 (commencing wiflf Section 7000)'of Division 3 of the Busi WALL
ti
ness and Professions Code, and my license is in full force and
effect. t
p
License Numb Cr Lie.Class
Contractor Date
I am exempt from the licensing requirements as I am'a'
licensed architect or a registered professional engineer Plan.Che&jee 2:5%Of above. - +
acting in my professional capacity (Section 705'1, Bus- .
iness and Professions'Code). PERMIT;fSSUii�1G`FEE$, `°'• _ =f
Lie.or Reg-No.: Date TOTAL FE
HOME'OWNER-BUILDER DECLARATION
PLAN CHECK APPLICANT s °
I hereby -affirm that I am exempt from- the Contractor's NAME
License Law for the following reason. (Section 7031.5, Busi-
ness and Professions Code): ADDRESS
I, as owner of the property,will do the work and the, q
CITY �� TEL. NO 7
structure is� not intended or offered for sale (Section rrG�'!7 /, �; r' , � ! 8 9 9.A
7044, Business and Professions Code). -• r r
OWNER .e%7cY� _ o 0
1, as owner of.,the property,'am exclusively contracting h �
with licensed- contractors to construct the project MAIL
0 0 0 8
p �9 N/ir/ s 2`o � 1 b 5 Q
(Section 7044, Business and Professions Code). -AD DR
eJ//7 �:
CONST.KUCTION LENDING AGENCY CITY T'C. TEL.'NO. o o,0 1 Q v
I 'hereby affirm'that there is a construction lending agency"
r
6
for the performance of the work for which, this permit is' CONTRACTOR ��1�� 0.2 O'_8 2
issued(Sec.3097,Civ.C.).
Lender's Name ADDRESS
Lender's Address - CITY "Oil/ TEL.NO. 7�-7
GYY
I certify that.1. have read this application and state that the STATE LIC.
above information is correct.I agree to comply with all County LCE SE NO � Y 7 CLASS
ordinances and State laws regulating Heating,Ventilating and
Air.Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County to enter, upon the above-mentioned property for
insper .• n purrose .
Signature of Permittee `//