HomeMy Public PortalAbout6345 ENCINITA AVE_Mechanical__ '•""°E `�_" ° " APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING I2�
r
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUIDDRESS
LDING l03 E,✓c/.v/y,� .�✓6
(PRINT OR TYPE ONLY) A
LOCALITY 6 4-17-9-
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST
CROSS ST.
ABSORPTION UNIT, BTU
OWNER.
A
AIR HANDLING UNIT, CFM MAIL
ADDRESS Sr.4 �iZF
BOILER, BTU CITY TEL. NO.-7-77/ 2997 COMPRESSOR, BTU4,
CONTRACTORC'O
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLECITYSTATEieiGEAr�D�//j6A TEL. NO.LIC, 27r¢
FURNACE: FAU BTU_GRA
Z0- n LICENSE NO. 40 L/�Z
FLOOR64 CLA55 —�
HEATER: SUSPENDED_UNIT DISTRICT NO. GROUP ^ZONE PROCE SED BY
WALL C-
S d o fir--
• 'j,,,T C_A4SPECTI, RECORD
U
in
Z_
Plan check fee 25%D of above.
PERMIT ISSUING FEE S
TOTAL FEE
PLAN CHECK APPLICANT 77-37-7
NAME
ADDRESS •
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY l
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI-
LATING. AIR CONDITIONING.
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION 'APPROVALS DATE INSPECTOR'S SIGNATURE
OF CHAPTER 9, DIVISION 3, OF TM USINESS AND PROFESSIONAL
GOOF OF THE STATE OF A ROUGH
SIGNATURE (,
OF PERMITTEE FINAL
PLAN CHECK VALIDATION
PERMIT VALIDATION cN. M.O. CASHCN. M.O. CASH
14 11
W IJ,
663MUC 1341
WORKERS'CQN PENS.A.TION DECLARATION 76A364C
1 hewby.affirmthat 1'have a certificate of consent to self
CE -818 (2-80) APPLICATION FOR PERMIT
insure, or a certificate of Workers'Compensation Insurance.or HEATING-VENTILATING-AIR CONDITIONING
a certified copy thereof(Sec.3800, Lab.C.)
Policy No. Company
❑ Certified copy is hereby furnished. COUNTY OF LOS ANGELES( BUILDING AND SAFETY
❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING '� Q
department. ADDRESS
Date Applicant �3z - /J' vj C' It
(PRINT OR TYPE ONLY)
LOCALITY T1:M P G/7
CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE l
COMPENSATION INSURANCE NEAREST ��)/__�r� }
(This section need not be completed if the work involved ABSORPTION UNIT, BTU— CROSS ST. `�-VV - �O
by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. PROCESSEDP ' <
I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM P
permit is issued, I shall not employ any person in any manner
so as to become subject to ri- Workers' CI I pen (tion Laws. I BOILER, BTU
d
IP, APPROVALS DATE INSPECTOR sIGNAT E W
Date - Ap...cant COMPRESSOR BTU ROUGH /} _ y
NOTICE TO APPLICANT: If, after making if s Certificate of VENTILATION SYSTEM % ( �-.> �+-`r Z
Exemption, you should become subject to the Workers' FINAL
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 HEATER: SUSPENf} D UNIT
9 (commencing with Section 7000) of Division 3 of the Busi- / WALL/ �• _, f/C/
ness and Professions Code, and my license is in full force and
effect.
License Number Lie.Class
Contractor Date
❑ 1 am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer Plan check fee 25%of above.
acting in my professional capacity (Section 7051. Bus- PERMIT ISSUING FEE $ 7 '
iness and Professions Code).
Lie.or Reg.No. Date TOTAL FEE
HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT -
I hereby affirm that I am exempt from- the Contractor's NAME m.O 4.6.4 A
License Law for the following reason (Section 7031.5, Busi-
ness
usi- -
nesss!r• Professions Code): ADDRESS # e:e a,0 . 8
Q I, as owner of the property, will do the work and the CITY TEL. NO. ,21'le 27+•OO
structure is not intended or offered for sale (Section
7044, Business and Professions Code). / W / Xl s
OW /V J _
❑ 1, as owner of the property, am exclusively contracting e eeL7.000
with licensed contractors to construct the project MAIL � i 0.7 2,2'-.8
(Section 7044, Business and Professions Code). ADDRESS
CONSTRUCTION LENDING AGENCY CITY TEL.NO.. If�s
I hereby affirm that there is a construction lending agency CONTRAC TO
for the performance of the work for which this permit is'
issued (Sec.3097,Civ.C.).
Lender's Name ADDRESS
°l.
Lender's Address
CITY TEL.NO. lo-611
1 certify that 1 have read this application and Stute that the STATE LIC. _
above information is correct. 1 agree to comply with all County LICENSE NO. CLASS
ordinances and State laws regulating Heating. Ventilating and
Air Conditioning, and hereby authorize representatives of this SITE REVERSE FOR EXPLANATORY LANGUAGE
County to enter upon the above-mentioned pn arty for
iuspa�on purposes O` 1-f
Signator of Nermittee Date _