HomeMy Public PortalAbout4843 DOREEN AVE_Mechanical__ ' isn'B'-"` aIB -'no APPLICATION FOR PERMIT
HEATING -'VENTILATING - AIRCONDITIONING
COUNTY OF •LOS ANGELES ADDRDEI NG
DEPARTMENT OF COUNTY ENGINEER - '
BUILDING AND SAFETY DIVISION LOCALITY -
JOHN A. LAMBIE,.COUNTY ENGINEER - NEAREST '
COLEMAN W. JENKINS,;SUPERINTENDENT OF BUILDING NEAREST. cA_�
< FOR APPLICANT•TO FILL IN OWNER ` -
(PRINT OR TYPE ONLY) MAI L -
NO. TYPE OFAPPLIANCE OR EQUIPMENT FEE ' ADDRESS
CITY �. - TEL. NQS41V_ –W
ABSORPTION SYSTEM, BTU
CONTRACTOR
. AIR HANDLING UNIT, CFM -
ADDRESS
BOILER; HORSEPOWER CITY TEL. NO.
COM-PRESSOR,,HORSEPOWER STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. CLASS GROUP ZONE, 'PROCESSED BY'
EVAPORATIVE COOLER
t y
FURNACE: FAU_GRAVITY UlJ INSPECTION •RECORD
FLOOR BTU _
HEATER: SUSPENDED_UNIT_
WALL
U
L
a
NEW—ADDITION— 'FE EMIT R .3 00 , - _ ?
ALTER—REPAIR— TOTAL FEE
'PL'AN CH K APPLIC T
NAME. - -
ADDRESS
CITY 1 ,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, VENTI APPROVALS 'DATE PECTOR'S SIGNATURE
LATING, AIR CONDITIONING. , T
ROUGH
I - HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION.
OF CHAPTER 9, DIV'SIO OF, THE.BUSI SS AND PROFESSIONAL FINAL
CODE OF THE, TATE OF LI FORNI A.
-SIGNATURE ^JACK R. ALLEN,SUPERVISING MECHANICAL ENG'
OF PERMITTEE
PERMIT, VALIDATION ' : CK. M.O. CAS
PLAN CHECK VALIDATI ,N
7.00-
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
ION
, . -WORKER'SthatIhave a certificate
of consent to 26316,tC DPW 9/89 APPLICATION FOR PERMIT UME GREEN
I ftereby affirm that I have a certificate of consent to self insure, 76A364C '
or a certificate of Worker's Oompensation Insurance, or a certified HEATING- VENTILATING--AIR CONDITIONING
copy thereof(Sec.3800 Lab. C.) ll
Policy No. CompanyCOUNTY 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 BUILDING111W-3 r/ _
department. y 9 F (PRINT OR TYPE ONLY) ADDRESS
LOCALITY
Dale Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS'. NEAREST
CROSS ST.
COMPENSATION INSURANCE ABSORPTION UNIT,BTU ASSESSOR
(This section need not be completed If the work Involved by the MAP BOOK PAGE PARCEL
permit Is for one hundred dollars($100)or less.) qIR HANDLING UNIT,CFM
OISTRILr No. PflOCr..er
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU
become subject to the Workers' Compensation Laws n O
_ /1 //I COMPRESSOR,BTU APPROVALS DATE INyECTOR'e$IGNATURE'
Date G /9 9pplicant ` A VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making.this Certilificate,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 S-sst2
provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000) of Division 3 of the Business and HEATER: SUSPENDED' UNIT_
Professions Code,
�and
-myy license is in full force and effect. WALAA -
License Number / A A Z6�//1Lic.Class —r c� T I I FO
D }
actor eAzl-C�C �L/.7 ///�/�Gte h-/q-9Z A�,_.�sq V
I am exempt under Sec. Plan check fee I Q
B.BP.C.for this reason PERMIT ISSUING FEE $ 4:7' Or
r,
1J "� r0
i 1TC MS
UJI
V te: TOTAL FEE. TOTAL 10 1 au 11
Signature
O BUILD R DECLARATION PLAN CHECK APPLICANT CA^_t)1 1 j')i `_Z
I hereby affirm that I am exempt from the Contractor's License Law NAME
for the fallowing reason (Section 7031.5, Business and Professions -
Code): ADDRESS 6 r 2y
❑ I, as owner of the.property, or my.employees with wages V
as their sole compensation, will do the work and the CITY TEL.NO. ,Q O IJI�I�I_-f�l Ilii .11 f'f7
structure is not intended or offered for sale (Section 7044, u
y:- i
Business and Professions Code). OWNER z�lt4 .( ii:t 1L I•_�1
❑' 1, as owner of the property, am exclusively contracting MAIL
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044,Business and Professions Code).
CITY TEL.NO.
CONSTRUCTION LENDING AGENCY - -
1 hereby affirm that there is a construction lending agency for CONTRACTOR D
the performance of the work for which this permit Is issued
(Sec.3097, Civ. C.).
ADDRESS
Lender's Name
CITY
L TEL.NO. -�
Lender's Address A
L
I certify that I have read this application and state that the above LICENSE NO. CUSS
information is correct. I agree to comply with all County,ordinances
and State laws relating to building construct n,and hereby authorize
representatives of this County to ente p n the above_mentioned
propert I o $pectin urposes. T SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGN �PA eR
I