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HomeMy Public PortalAbout5470 ENCINITA AVE_Mechanical__ 1 46A 364C CE-818(REV.6/78) - - ©s APPLICATION FOR PERMIT HEATING — VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT-TO FILL IN BUILDING (PRINT OR TYPE ONLY) - ADDRESS �' c LOCALITY p& C NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST CROSS ST. ABSORPTION UNIT,BTU -y OWNER AIR HANDLING UNIT,CFM- MAIL' ADDRESS 5 541'%9 r- AV I% BOILER,BTU CITY TEL.NO. COMPRESSOR,BTU CONTRACTOR VENTILATION SYSTEM ADDRESS 6,!Z0 /)r ;J-,. C EVAPORATIVE COOLER - CITY TEL.NO. FURNACE: FAU GRAVITY STATE LIC. FLOOR BTU LICENSE NO. CLASS - HEATER: SIL&EENDED UNIT_ APPROVALS--4.:-95VD5E INSPECTOR'S SIGNATURE WALL ROUGH FINAL - 0 INSPECTION RECORD Plan check fee 25% of above. PERMIT ISSUING FEE$ — TOTAL FEE J.7 — PLAN CHECK APPLICANT, �j- � ) PLAN CHECK VALIDATION NAME 1jE,4 '^//V ®0(/ ADDRESS T �� CITY iG1q p`-`. p.(� l I TEL NO. 3. 2 p.z4� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH-ALL 3 Jr 9 A ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR CONDITIONING. PERMIT VALIDATION # O o-o o 4 1 I HEREBYCERTIFY THAT I AM.NOT ACTING IN VIOLATION OF CHAPTER 9, DIVISION 3. OF THE BUSINESS AND PROFESSIONAL CODE OF THE STATE OF CALIFO.FOIA. ,2 ° 1700 SIGNATURE OF PERMITTEE O.O O 1 7,0 0 35 DISTRICT NO. - PROCESSED BY 004-79 ION DECLARAT WORKER'S I have a certificate of consent to 76A346DPW9,69 APPLICATION FOR PERMIT LIME GREEN 76A364C I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING -AIR CONDITIONING copy thereof(Sec. 3800 Lab.C.) � cy No. Company�f d�d� �/U COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING Certified copy is filed with the county b Iding i p n ADDRESS d:7pa (PRINT OR TYPE ONLY) Date v Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERSNEAREST CROSS ST. COMPENSATION INSURANCE ABSORPTION UNIT,BTU This section need not be completed if the work involved b the ASSESSOR ( P Y MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU become subject to the Workers'Compensation Laws. L'D CGS GG—t¢L COMPRESSOR,BTU APPROVALS - DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of I ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such I FINAL / provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY VALIDAT ON LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPEN•E UNIT / (commencing with Section 7000) of Division 3 of the Business and WALL �7 dos Professions Code,and my license is in full force and effect. License Number L7!�Lic.Class � f Contractor CL Date `�W7/6V , o yU 0 I am exempt under Sec. Plan Check fee – BAP.C.for this reason PERMIT ISSUING FEE$ (�� Y •i•i n a � 0 i— Date: TOTAL FEE �, _ys€ u t- W SignaturePLAN CHECK APPLICANT - t t i=3 s= U) OWNER-BUILDER DECLARATION _ d � Z I hereby affirm that I am exempt from the Contractor's License Law NAME , MAL I A 0 �52 = — for the following reason (Section 7031.5, Business and Professions 5M` ADDRESS F` Code): � "PECK •.;.:. 00 I, as owner of the property, or my employees with wages _i,r€€ j as their sole compensation, will do the work and the CITYTEL.NO. structure is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER 74 gg I, as owner of the property, am exclusively contracting MAIL �) n€ with licensed contractors to construct the project (Sec- ADDRESS v �• _ss ,+ = tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CIT TEL.NO'S J'� 0 1 hereby affirm that there is a construction lending agency for CONTRACTOR , the performance of the work for which this permit Is issued (Sec. 3097,Civ.C. ADDRESS v/G� Lender's Name CITY TEL.NO. Lender's Address STATE , � LIC. I Certify hat I have read this application and state that the above LICENSE NO. CLASS informati n is correct. I agree to comply with all County ordinances and Stat laws relating to building construction,and hereby authorize represe atives of this Cou to enter upon the above-mentioned propert for insp.cti ur oses. f SEE REVERSE FOR EXPLANATORY LANGUAGE E OFA LICA T R AGEN DATE