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HomeMy Public PortalAbout5526 ENCINITA AVE_Mechanical__ ' �rI 76A3�4G ' Ct 8181REV 45/781' ©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 5526 ENCINITA AVE. LOCALITY TEMPLE CITY NO TYPE OF APPLIANCE OR EQUIPMENT FEE - ' NEAREST CROSS ST ABSORPTION UNIT BTU OWNER FRANS ' AIR HANDLING UNIT CFM MAIL ADDRESS 5526 ENCINITA AVE. BOILER BTU I CITY TEMPLE CITY TEL N0285-1881 COMPRESSOR BTU CONTRACTOR WALNUT POOLS - VENTILATION SYSTEM ADDRESS' '21450 'GOLDEN-SPRINGS D EVAPORATIVE COOLER - CITY WALNUT TEL N0912-1541 FURNACE FAU � GRAVITY STATE LIC CLASS FLOOR BTU LICENSE NO 11 Q818 HEATER SUSPENDED UNIT_ APPROVALS DATE INSPECTOR S SIGNATURE WALL ROUGH FINAL � A INSPECTION RECORD V Plan check fee 25% of above PERMIT ISSUING FEE TOTAL FEE ' PLAN CHECK APPLICANT PLAN CHECK VALIDATION NAMEpo (.)T..ql 1 2 0.7 A ADDRESS 21450 GOLDEN SPRINGS- DR. - '# o' 4 1 CITYWALNUT • TEL N0.12_1541 2 - 27.00 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND - STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL o o o 2'''.Q Q 7- V ORDINANCES AND LAWS REGULATING HEATING VENTILATING AIR CONDITIONING PERMIT VALIDATION .' 1 1.07-78 I HEREBY CERTIF AT I,AM NOT ACT IN VIOLATION OF J CHAPTER 9 DIVISIO OF THE BUSINESS A ROFES NAL CODE - OF THE STATE OF ORNIA - SIGNATUR OF PERI?ITTEE , DISTRICT NO PROCESSED BY - WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT I uy offirm that I have a certificate of consent to self +� ms e!or atcertificate of Workers' Compensation Insurance, 76A36aC HEATING - VENTILATING - AIR CONDITIONING or a certified copy thereof (Sec 3800, Lab C ) I' • : CE 818(REV 10/81) - - - - -` '❑cy N Company 'Certified copy is hereby furnished COUNTY OF LOS ANGELES _ BUILDING AND SAFETY ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING 2- /^� C�h' ,e,y tion department (PRINT OR TYPE ONLY) ADDRESS C L 4 Date Applicant LOCALITY T,) C r NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' ` , NEAREST 0a 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 ($100)or less ) AIR HANDLING UNIT CFM I certify that in The performance of the work for which this permit is Issued, I shall not employ any person in any manner BOILER, BTU so Os to beco a subject to the Workers'Compe ti in Laws _ APPROVALS DATE INSPECT S SIGNATURE Date � s-T . ` Applicant COMPRESSOR BTU ROUGH NOTICE TO APPLICANT If, after making this Certificate'of VENTILATION SYSTEM FINAL / Exemption, you should become subject to the Workers' Compensation provisions of the'Labor Code, you must forth- EVAPORATIVE COOLER VALIDATI with comply with such prbvisions or this permit shall,be deemed revoked FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION _ FLOOR BTU I hereby affirm that I am licensed under provisions Of Chapter 9 HEATER SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business WALL and Professions Code,and my license is in full force and effect License Number Lic Class - 0 OC ❑Contractor Date - �I am exempt under Sec 21 9,$A rOW Plan check fee 1L B &P C for this reason PERMIT ISSUING FEE Q # e • o • o 8 Date TOTAL FEE - `oa I • • 3 Q 350 Signature OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT ,o e,• 3 0.5 0'I I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031 5, Business and NAME 0 05 -85 Professions Code) / j, 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 A MK A 111' �eTC� - ❑ , �. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- MAILy�-� 7-A C_ tion 7044,'Business and Professions Code) ADDRESS S S 26 l": CZ� , CONSTRUCTION LENDING AGENCY CITY 'rC-1 -fLL` C 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 jaws relating to-building construction, and hereby authorize representatives of this County to enter ` upon the above-me oned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of XPplicant or Agent Date _ '