HomeMy Public PortalAbout10909 FREER ST_Mechanical__ T
-.1" a`SJSSl'S/TS APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
I
I
B DINQ� AND SAFE DIVISION
FOR APPLICANT TO FILL IN B"L' S�O��
(PRINT OR TYPE ONLY)
LOCALITY �r
NO. TYPEOFAPPLIANCE OR EQUIPMENT FEE NEAREST
CROSS
ABSORPTION UNIT, BTU
OWNER
AIR HANDLING UNIT, CFM MAIL
fDDR ESS
BOILER, BTU CITY TEL NO.
COMPRESSOR, OTU CONTRACT R
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY TEL. NO.
FURNACE: FAU (iRAVITY STATE / L . r
FLOOR BTU LICENSE NO. / CLASS
HEATER: SUSPENDED UNIT_ DISTRICT NO. OUP zone [SB[D er
WALL o
(iR
INSPECTION RECORD
x
Plan chock fee 2596 of above.
PERMIT ISSUING FEE 5
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE TH I HAVE R[AD THIS APPLICATION
AND STATE THAT THE ABOV ORR ECT ACRE[ TO COMPLY
WITH ALL ORDINANCEI LA I. REGU TI HATING, VENTI-
LATINS, AIR CONDITIO �.
LOFHERKRY CE FY AT I 'AM NO TINS IN VIOLAT ION APPROVALS DAT[ DnPECTOIRS SMKATURE
APT[R 9, f D, 0 E SU [ B AND PR FE9elolU.LROUGH42
OF TH[ B T F CA A.ATUR F1NAL �/ 77
ERMI TE
PLAN 6HECK VALIDATIONM.o. CASH PERMIT VALIDATION -�rRZ M.D. CASH
58.3z�r 844. D 1 5.753
V V<
WORKERS'COMPENSATION DECLARATION CE 81 C APPLICATION
P P L IC g T I O N FO® PERMIT
1 hereby affirm that .I have a' cettiflceta of•eopspnt to self CE -818(�80) t'i P`i 1 Y C IVY
tnsu�Fe, or a certiflcnte of Workers'Compensation Iruurance,or HVEATINGNENT1L.ATING-AIR CONDITIONING
r exifled copy thereof( c. 3800, Lab.C.) JJ
Policy Neny_,�A7 fir`
COUNTY OF. LOS ANGELES BUIL'DI:NG AND SAFETY
Certified copy.ls hereby furnished. - - .
Certified co y is flied'with the county nding Inspection
p AOR APPLICANTTO FILL IN BUILDING
pate'de artm
-1, Appucant (PRINT OR TYPE ONLY) ADDRESS
CER'TIFICA'TE OF EXEMPTION.I:ROM W_ORKER-S' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCAL{TY
COMPBNSA'f1ON INSURANCE NEAREST
(This sectlon need''not. be completed If the-work involved ABSORPTION UNIT, BTU C-ROS�ST.
by fhe perm#t L for-'one hundred dollen (5100) pr las) o+arAic r ra. F PRocFpeED BY .
•I gerttfy thatjn. the performance of the work for which this AIR HANDLING-UNIT CFM
Parrrlt kel.Mued, I shall not etnproy any person in any manner O�
,so as,to become aubie0t to the Workers' �ompertmfion• Laws. BOILER BTU
APPFIOVALS DATE l R9,8IO14ATURE
A.
Date _r�Appll*t COMPRESSOR BTU
ROUGH.
NOTICETO,APPLICANT: If, after Making this Certificate of VENTILATION S.YeTEM
Exemption,..you should- become subiact.to .the Workers' FINAL 2
Codipensetion provision of the Laboi-Cod O, you must forth-' EVAPORATIVI= COOLER' VALID ON
with comply With .such provtflgna or this pertntt MaB be
deemed reyvokpd.' FUI#�1ACh: . FAV GFIAVJTY
LICENSED COf4T.RACTO&3 DECLARATION FLOORL,__r -HTU `
I hereby affirm tbit 1 am licensed under rovialons of Chapter HEATER: SUSPENDEa UN17.' �
9 (commencing with S6ct16n'7000) of Dnlon'3 of the Buil-. .YyALL
nets and Ptofe Ens Code, and my license ft Ln full foECa Enid
effect. ••
►.i cense Numbdr-".366 4 L/Ic.CLass
`. Contractor -{Sate
1 am exempt froom the llcenalnlr requliemeptt as I am a
licensed arcllltact ora tpyistered profeaylonab englneer flan check fe9 2596,Of above,_ + .
actlug, in my pro>bwonal tapsalty (Section 7051. Bks-
iness and Professions code). PERMIT ISSUING FEE$ 16 0
ilcrot Rett-No._ . nate TOTAL FEE J/ -
r- ff61it OWNPR-BUILDER D_�QLARATION PLA4 CHECK'rIPPLICANT
=e f hereby•afftim that' I a$f exampt from- the Codtruct¢r's, NAME r -
•License TAw for the folfowtnir reason (Sectloti-704.5,-Butt,_ - yy ,r
nese gndrofadoris Code): ADDRESS.1 1 - , 4t■T .
owner:of the property, will do the work end the AM,
structute••l; not•Intended or offered for sale (Section CITY TE C,,NO,- . •+
7044, Business and Professions CpdC). OW-ti-ER Mk 4
1. as owobr of the property, em gzclusivaly_ contracting � ;
with Ilcenaad contractors -to construct tJie prosect MAIL
r' (Section 7044, BtWnau and Professlom Coda). AD13RE33. � �7��j,
CONSTRUCTION LENDING AGENCY - CITY' TEL. NO. d CWS. :P.5V
I hereby,.affirm,that-there is e construction lending agancy 00
Ter the performenee.of.the work for which this permit la CONTRACTO �,
.lisuod (Sec. 30Q7,0y.C.):
Lendertsl�eme ADDRESS 30.22
L.en,Wk Add ran* CITY TEL. N +�y 1 /�}�
1 f 1 1 AM 11:57
I cartlfy fhet 1 have, read this applic tion and state that thq STATE LI •
above lnforiAetfdn Is correct.I agree t comply wit4 all-County E Nq14 30 C 41 CLASS
ordinances-and State laws regurating Heating, V4nttlaUng and
AIr Cooditioning,and-heraby authorize representatives of this SEE REVERSS FOR EXPLANATORY LANQUAGE.
County -to enter u on the abovo-mentloned property for
upectlo Pur
mat Permit
Data-