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Home My Public Portal About5106 FARAGO AVE_Mechanical__ I 76 A3r,4~ CE 818 1/75 APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CON0I1IONING 6 COUNTY OF LOS ANGELES ADDRESS O jTf/E DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ` LOCALITY NEA R EST CROSS ST E �� FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) MAI L NO TYPE&SIZE OF EQUIPMENT FEE ADDRESS SEE BACK OF APPLICATION FORCE AIR FURNACE BTU 4 CITY �� TEL NO ,(�[,[F ►g ?Q CONTRACTOR COMPRESSOR BTU ADDRESS VENTILATION FAN CITY TEL NO LIST ALL OTHERS BELOW STATE LIC LICENSE NO CLASS 1:1111Irk-ICT NO, GROUP ZONE PROC SSED BY a INSPECTION RECORD r } r d O K ti O r � x U W a Plan check fee See reverse z L PI NUI 11"5[,1\( hI I s 101 11 III "' Ij6 PLAN CHECK APPLICANT NAME/ (G'r✓ �`lI ADDRESSra� CITY 7 TEL NO �Q I HEREBY 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 DATE INSPECTOR S SIGNATURE LAT ING AIR CONDITIONING Z—f ?� I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION RO JG H OF CHAPTER 9 DIVISION 3 OF THE BUSINESS AND PROFESSIONAL FINAL CODE OF THE STATE OF CALIFORNIA SIGNATURE OF PERMITTEE PERMIT VALIDATION CK M o c sH PLAN CHECK VALIDATION "CK M 0 CASH s 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 coy there f (Sec 3800 Lab C ) 20 0046 DPW 9/88` a b Pol icx No"v ompany - 4 F-1Certified copy is hereby furnished /'I COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is filed with the county building Inspec FOR APPLICANT TO FILL IN [NEAREST DING /� tion depart T (PRINT OR TYPE ONLY) - RESS S V 4 N Date-L-11 Applicant + +- NO" TYPE OF APPLIANCE OR EQUIPMENT FEE ALITY CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE SS ST (This section need not be completed if the work involved by ABSORPTION UNIT BTU RICT NO PRSED BY� the permit is for one hundred dollars ($100) or less) AIR HANDLING UNIT CFM ►y�I w I certify that In the performance of the work for which this J 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 S GNATURE Date Applicant COMPRESSOR BTU ROUGH bit 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 deem d ed revoked r FURNACE GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR ID BTU z 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 cF3o6 i 3�^ r License Number Lic Cla CL ss , O ContractoAr' lmw6 2vtate 11-7' V ❑ - O I ani exempt under Sec I.- Plan check fee u W B&PfC for this reasonDate ' PERMIT ISSUING FEE $ Z i r 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 P 0 S Professions Code) Al ,7 ❑ I as owner of the property or my employees with ADDRESSS` 0 6 /v r F)4)eh 1 G wages as their sole compensation will do the work and t� a the structure is not Intended or offered for sale(Section CITY -� �i"7 TEL NO .tiC •s 7044 Business and Professions Code) OWNER 3,x07 , ,"'.>_ .50 ❑ P1)e-h-,,,,4J I as owner of the property am exclusively contracting i ITEM licensed contractors to construct the project (Sec MAIL / 0 Y y )� tion 7044 Business and Professions Code) ADDRESS i(,J PTAL ¢ 2050 CONSTRUCTION LENDING AGENCY CITY — (a/J TEL NO d'l�-�Lj i�1 m c I hereby affirm that there is a construction lending agency for — CHECK 20, iO the performance of the work for which this permit is issued CONTRACTOR (Sec 3097 Civ C ) `7 CHANGE .011 ADDRESS 3v.-2,YN �� -�v ; Lender s Name + CITY i �7/�-�,/ TEL NO�y,�y0000-0130 i 11/14/39 Lender s Address STATEv �� LIC ']� / r .f�. I certify that I have read this application and state that the (CENSE NO T CLASS tJ rY 1�76786 i t11Aft 111eV+3 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 r upon ab 9ve mentionep property for inspection purpos s ` SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date 0s 1 - ..