HomeMy Public PortalAbout8817 ELM AVE_Mechanical__ 76A3'64 - cEB,B - 3=69 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIO NG
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION j
JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY 'r b q /
COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING NEARESCROSS ST. vS@f1 ngL
FOR APPLICANT TO FILL IN OWNER � f/
(PRINT OR TYPE ONLY) _
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE, ADDRESS /
ABSORPTION SYSTEM, BTU CITY E TEL. NQ;2: 'S
AIR HANDLING UNIT, CFM CONTRACTOR
ADDRESS
BOILER, HORSEPOWER
CITY V Lj TEL. NO.
COMPRESSOR, HORSEPOWER STATE LIC.
! LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP QONE ESSED BY
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY ✓v E
FLOOR BTU INSPECT] RECORD
HEATER: SUSPENDED UNIT
WALL
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NEW-ADDIT10N_ PERMIT $ 3 00 N
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ALTER_REPAIR_ TOTAL FEE $ �)
PLAN CHECK APPLICANT
NAME
ADDRESS lfl v
CITY TEL..N
L.HEREBY ACKNOWLEDGE TH T 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE S CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS R&IN -HEAT ,VENT I- APPROVALS DATE IN P CTOR'S GN TURE
LATING, AIR CONDIT10 1 HEREBY CERTFY TH I AM NOTION OF ROUGHV 64
CHAPTER 9, DIVIS OF THE BUSSIONAL FINAL
CODE OF THE E 0 CALIFORNIA, i -
SIGNATURE JACK R. ALLEN, SUPERVISING MECHANICAL EN
OF PERMITTE
PERMIT VALIDATION CK. M.0. cnsH
PLAN CHECK VLIDATION
(' G 5 3 073 APR 12 4 1 D -_ 0,5 0-"
"�E BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE �!
WORKER'S,COMPENSATIQNDECLARATION 720-0046,6A364CPW9�89L�dPP��CA �®II�1 ®�4'1!✓L�R ff �
I hereby aif,p%at'l have'a Certificate of consent to self Insure,
or a certificate of.)IVorker-s Compensatloh Insurance, or a certified HEATING
copytheFeof(Sec.3800 Cab..C.) ' ell
, ,VENTILATING-AIR CONDITIONING'-
I
1
P Iic o Company �. �'h .000NTY..OF LOS-ANGELES DEPT,OF PUBLIC WORKS BUILDING AND SAFETY DIV
�pyyN/
LYJ Certified copy is hereby furnished.
"
C T'
BUILDING
Certified copy is flle8 with the county building:inspection, FOR,APPLICANT TO;.FILL IN% ADDRESS
dep ment
/'1 / �1
l/on. (PRINT OR TYPE ONLY) ;• �` 1'
Ct'► G ? V'1,� LOCALITY
Date Applicant NO., TYPE OF APPLIANCE OR EQUIPMENT FEE :. 1
NEARESI
CER IFICATE OF,EX,EMPTION.FROM WO'RKERS• • CROSS ST
COMPENSATION INSURANCE I
ABSORPTION-UNIT,BTU
ASSESSOR
(This section reed not be completed;_if.the work involved by the MAP BOOK PAGE O''' PARCELV
ermit is for."one hundred dollars $100),or less. ''
p ,,, ( ". ) ._ , AIR HANDLING,-UNIT CFM s
I certify that in the-performance of the work for which.-this permit x, t
.DISTRICT NO. PROCE SED BV
is issued, I•shall not employ any person'in i any manner so as to BOILER,BTU
become subject to Uie.Workers' Compensation Laws
APPROVALS. _ r DATE INSPECTOR'S SIGNATURE -
. 9
COMPRESSOR BTU
Date Applicant VENTILATION SYSTEM
NOTICE TO;APPLICANT, If°`,after makinggthis Cerdfibate of.
Exemption,you'shouId become subject:to Ihe.Workers'Compensation y
EVAPORATIVE COOLER
ROUGH,.
provlstons,of,the,Labor Code,'you•,must forthwith'comply.with such
provisions or;this'permit shall' deemed revoked.. _ FURNACE. ="- FAU GRAVITY "
FINAL
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that`I amMlicensed-under°provisions,of Chapter 9 ' SUSPENDED I•• UNIT
; -
' Commencin with,Section"•7000 of Division''3'of the Business.and HEATER. "
VALIDATION
( ,, .9 . .... : )` ....,.. .. . .�. WALL .. -
Professions Code; and myAicense Is;in full force and effect.
License Number Llc.Class' DJtAZ
_"' s
I
,
J/� i
Contractor r '1 i {' ,
❑ I ani exempt under Sec. Plan'Cheek,fee '• - - .V
_ HL
FII
B&P.C.for this reason ° > ° a 0.
PERMIT ISSUING FEE..$
bate:
HAN _
.. TOTAL FEE
Signature n. . i .
PLAN CHECK APPLICANT
r,
OWNER-BUILDER,DECLARATION
I hereby affirm that I am.exempt from:.the Contractor's License Law NAME t f ,
for the'following.reason (Section 7031 5;'Business and•Professiohs DI-}fltl Itl i _
Code) _
❑ ADDRESS
I,-as:owner of the°property,'or my'Employees with wages' hest ttFt t
as their sole compensation;;)will'do the work and the CITY TEL.NO:
structure is not intended or offered for sale (Section 7044,
Business,and"Professions COde). 01NNER,. .
Jr as'owner of thea" t t7
y, am exclusive) contractin
proper,
Y 9 ' MAIL
with-licensed.contractors to construct the'project (Sec, ADDRESS,
tion 7044-Business and Professions Code). Q
CONSTRUCTION LENDING,AGENCY CITY r TEL.NO. Jr 0 1
I hereby affirm that there is a construction lending agency rfor
the performance of the"work for which this permit is issued CONTRACTOR L• ) G �.
r I
(Sec.3097,Civ.C.).,
ADDRESS
Lender's Name
CITY, TEL.NO.$0
..
Q
Lender's Address STATE- LIC. _
I certify that I have read this application and state that'the above LICENSE NO. �. 1 CLASS
information is correct. I agree to comply with all County ordinances
and Stateaaws relating to building construction,and hereby authorize
representatives.of this County to enter upon the above-mentioned
,proper for inspectio urp es. SEE REVERSE-FOR EXPLANATORY LANGUAGE '
( {'
SIGNA RE OF APPLICANT OR'AGENTVATE - '.