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HomeMy Public PortalAbout4924 ENCINITA AVE_Mechanical__ 78"A364-- ce818 - 3-69 APPLICATION FOR PERMIT 1:4 �j HEATING - VENTILATING - AIR CONDITIONING/� LI ' COUNTY OF LOS ANGELES BUILDING 3 9 DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION JOHN A LAMBIE, COUNTY ENGINEER LOCALITY ,-OLEMAN W JENKINS,SUPERINTENDENT OF BUILDINGNEAREST CROSS STle d-- FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) MAI L NO TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS ABSORPTION SYSTEM, BTU 2000 CITY EL NO CONTRACTOR AIR HANDLING UNIT, CFM ADDRESS BOILER, HORSEPOWER -`p CIT L NO ,- COMPRESSOR, HORSEPOWER STATELIC/ LICENSE e NO 7 CLASS C r 2 c) VENTILATION SYSTEM DISTRICT NO GROUP ZONE PROCESSED BY EVAPORATIVE COOL jP" FURNACE FAU V GRAVITY FLOOR BTU U d INSPECTION RECORD HEATER SUSPENDED UNIT WALL �- rZ Q - U oe C H U LL a v NEW—ADDITION— PERMIT $ 3 00 ALTER--REPAIR_ TOTAL FEE PLAN CHECK APPLICANT NAME ' ADDRESS CITY TEL NO IHEREBY 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 DA E I PECTOR'S SIGNATURE LATING, AIR CONDITIONING IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH CHAPTER 9, DIVISION 3, OF THE BUS SS AND PROFESSIONAL FINAL CODE OF THE ST E OF CALIFOR A SIGNATUREJACK R ALLEN, SUPE SIN M HANICAL ENG'R OF PERMITTE PERMIT VALIDATION cK M O CASH PLAN CVCK VALIDAT1,0N L 5 8•=ice ADG2 5 4 1 D 1 2.00- SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT hereby offrrm that I have a certificate of consent to self Insure, or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING or a certified copy thereof (Sec 3800, Lab C ) Ate/ 76A364C Y i P Y� :`� CE 818(REV 10/81) Policy No e!f-cCOm an ❑ C rtifled copy Is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY rtlfled c py Is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING tion d pa ment 1 �— (PRINT OR TYPE ONLY) ADDRESS L. Date Applicant Lc ' ��`�� LOCALITY ' NO TYPE OF APPLIANCE OR EQUIPMENT FEE CE TI CATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST L_ (This section need not be completed if the work Involved by ABSORPTION UNIT BTU DISTRICT NO PROCESSED Y the permit Is for one hundred dollars ($100)or less ) �� I certify that 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 BOILER BTU so as To become subject to the Workers'Compensation Laws APPROVALS DATE IN PECTOR S SIGN RE Date Applicant COMPRESSOR BTU DO ROUGH NOTICE TO APPLICANT If, after making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deemed revoked FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU JW I hereby affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED—UNIT— (commencing USPENDED UNIT(commencing with Section 7000) of Division 3 of the Business WALL and Professions Code,and my license is in full force and effect CL CL ZSL� O License Number Lic Ciass ► V contractor/ -':TJe C2 Date - –99345A O OI am exempt under Sec p #"- - - -i- 8 W Plan check fee d in B 8P C for this reason I Date - 50,50 Z PERMIT ISSUING FEE $ - TOTAL FEE - o'- 5 0 5 0 50 Signature OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT O 4,0 8-8 8 I hereby affirm That I am exempt from the Contractor's License ► Law for the following reason (Section 7031 5, Business and NAME Professions Code) l ` ❑ 1, as owner of the property, or my employees with' ADDRESS wages as their sole compensation,will do the work and CITY TEL NO the structure Is not Intended or offered for sale (Section 7044, Business and Professions Code) OWNER ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- MAIL �� _ tion 7044, Business and Professions Code) ADDRESS CONSTRUCTION LENDING AGENCY CITTEL NO I hereby affirm that there is a construction lending agency for ► the performance of the work for which this permit is Issued CONTRACTO r (Sec 3097, Civ C ) i ADDRESS - Lender's Name �© CITY TEL NO Lender's Address STATE LIC /f I certify that I have read this application and state that the LICENSE NO -.CLASS- above information Is correct I agree to comply with all County ordinances and State jaws relatin to building construction, herebp au riz a es tat this County nter the/ b o d p for inspection (,or roses SEE REVERSE FOR EXPLANATORY LANGUAGE (/ Signature of Applicant or Agent to WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, 76A364C HEATING VENTILATING AIR CONDITIONING or a certified copy thereof (Sec. 3800, Lab. C.) �. CE-818(REV. 10/81) Policy No. Company Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY D Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING tion department. ADDRESS (PRINT OR TYPE ONLY.) Date Applicant LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO PROCESSED BY the permit is for one hundred dollars ($100)or less.) AIR HANDLING UNIT, CFM 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 become subject to the Workers'Compensation Laws. BOILER, BTU APPROVALS DATE INSPECTORS SIGNATURE t Date Applicant COMPRESSOR, BTU f ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION ¢} FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business HEATER: WALL d and Professions Code,and my license is in full force and effect. IO M V License Number Lic. Class , W _J Contractor Date I am exempt under Sec. Plan check fee a .� B.BP.C. for this reason PERMIT ISSUING FEE a d Date: T Signature TOTAL FEE OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and NAME Professions Code): ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Section CITY TEL. NO. 7044, Business and Professions Code). ❑ OWNER I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- MAIL lion 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY CITY TEL. NO. I hereby affirm that there is a construction lending agency for , the performance of the work for which this permit is issued CONTRACTOR (Sec. 3097, Civ. C.). ADDRESS Lender's Name CITY TEL. NO. Lender's Address STATE LIC. I certify that I have read this application and state that the LICENSE NO. CLASS above information is correct. I agree to comply with all County ordinances and State laws relating to building construction, and hereby awthorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date '