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HomeMy Public PortalAbout5218 FARAGO AVE_Mechanical__ 76 A364 -PCE 818-1/75 0 APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDIN .� DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY i NEAREST CROSS ST. FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) MAIL NO. TYPE&SIZE OF EQUIPMENT FEE ADDRESS Z_ J_3 . SEE BACK OF APPLICATION / FORCE AIR FURNACE, BTU CITY -TEL. NO. / .�e�S, tJ CONTRACTOR COMPRESSOR, BTU ADDRESS VENTILATION FAN CITY TEL. NO. LIST ALL OTHERS BELOW STATE LIC. LICENSE NO. ZONE AC CL/AASSR�►�/�/ DISTRICT NO. GROUP `J E5�� INSPECTION RECORD } a O _ U O W IL Plan check fee. See reverse. r z PE11011T ISSI-ING H.'J� S 1'0'1'A 1, F'LV PLAN CHECK APPLICANT NAME ADDRESS .Z 3 Ctlre-- CITYTEL.NO /,37 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 LATING, AIR CONDITIONING. ROUGH I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL CODE OF THE STATE 0 A FORNIA. SIGNATURE r PERMIT VALID T ON CK. M.O. CASH OF PERMITTEE c PLAN CHECK VALIDATION CK, M.O. CASH 988rmoil 2441 0 1 2.00 �� 76A364E(CE-81 BA)-9/77ISW L1 fm f>711 �P A 5pp7 Q�7®MM ff®� ftfl R lm)?!�O p HEATMIG - V lsW 0 o6W II O WWw - A��� COMDM OMM COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN BUILDING (PRINT OR TYPE ONLY) ADDRESS f LOCALITY V , NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST CROSS ST. ABSORPTION UNIT,BTU OWNER AIR HANDLING UNIT,CFM MAIL ADDRESS• BOILER,BTU do GITTEL.NO. COMPRESSOR,BTU CONTRACTOR e�_ VENTILATION SYSTEM ADDRESS EVAPORATIVE COOLER CITY TEL.NO. FURNACE: FAU GRY STATE LIC. FLOOR BTU _JW' CP d QQ 00 LICENSE NO. CLASS HEATER: SUSPENDED UNIT- DISTRICT NO. GROUP ZONE PROCESSED BY WALL INSPECTION RECORD O V oC O Plan check fee 25% of above. PERMIT ISSUING FEE -4— �� ® 611V Z PLAN CHECK APPLICANT NAME *, ADDRESS Y :i. CITY TEL.NO. 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, VENTILATING. AIR w CONDITIONING. I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION'OF APPROVALS DATE INSPECTOR'S SIGNATURE CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL CODE '{ OF THE STATE OIF NIA. ROUGH 11 SIGNATURE FINAL OF PERMITTE "xI PERMIT VA:LIDATldff M.O. CASH PLAN CHECK VALIDATION CK. o. CASH Jtr ORXERS 9 s 0 JUN 15 4. U ri"' iC`l HOL®ERod� =1 _ tJ.p,ScY NUMBER:aW76-s'��I2 ©= I WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affi+m 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 Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING tion department. (PRINT OR TYPE ONLY) ADDRESS t _ r Date Applicant LOCALITNO. 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.) I certify that in the performance of the work for which this AIR HANDLING UNIT, CFM G� 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 INSPECTOR'S SIGNATURE Date Applicant COMPRESSOR, BTU ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL - E 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 HEATER: SUSPENDED—UNIT— '(commencing USPENDED UNIT'(commencing with Section 7000) of Division 3 of the Business and Professions Code,and my license is in full force and effect. O License Number Lic. Class , U Contractor Date O I am exempt under Sec. u� Plan check fee � B.BP.C. for this reason' Date: -PERMIT ISSUING FEE $ _ 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 o wages as their sole compensation,will do the work and 2 5 8 Q,9 A the structure is not intended or offered for sale (Section CITY TELNO. o o'0 0 0 5 7044, Business and Professions Code). ' OWNER El I, as owner of the property, am exclusively contracting 2 0,'5 0 with licensed contractors to construct the project (Sec- MAIL ADDRESSx tion 7044, Business and Professions Code). '0'0 0 2 0 5 0 CONSTRUCTION LENDING AGENCY CITY TEL. NO. 0, 06-83 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.). 96 o/! ADDRESS Lender's Name CITY TEL. NO. V+ �J Lender's Address _r STAT&01' — LIC. I certify at have re t is application and state that the LICENSE NO. CLASS above ' fo a ion 'a c rrec. agree to comply with all County ordin nc to la lating to building construction, and er byp ut iz r entatives o h s my to enter upon th ov i property f ih p cti n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sign ppliV or gent Dote