HomeMy Public PortalAbout8626 GARIBALDI AVE_Mechanical__ C`G'G''G/'G APPLICATION FOR PERMIT {�
HEATING - VENTILATING - AIR CONDITIONING u
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO-FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS
LOCALITY
NO. TYPEOFAPPLIANCEOR EQUIPMENT FEE
NEAREST �E,�
CROSS ST.
ABSORPTION UNYT, BTU M
OWNER �.
AIR HANDLING UNIT, CFM MAIL
ADDRESS �.U, Q�• �/
BOILER, BTU CIT TEL NO.
COMPRESSOR, BTU CONTRACTOR l
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER C IT Yvvv TEL. NO
FURNACE: FAUGTY STATE 7_ / LIC.
F R BTU LICENSE NO. 7 / r CLASS J
FATE S NDED UNIT_ DIST ICT NO. OROUF ZONE EBBED BY p�
A L J_ H
INSPECTION RECORD
Plan check fee 2596 of above.
PERMIT ISSUING FEE
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.-
I HEREBY ACKNOWLEDGETHAT I HAVE READ THIS APPLICATION
AND STATE THAT TH[ ABOVE 18 CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI-
LATING, AIR CONDITIONING.
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION APPROVALS DAT[ GtB P2CTOAY SIGNATURE
OF CHAPTER 9. DIVISION 3, OF HE DUSIN S AND PROFESSIO ROUGH
COD[ OF THE )TATE OF IA.
SIGNATURE FINAL
OF PE
PLAN CHECK VALIDATION PERMIT VALIDATION CK. M.O. cABH
CK, M,O. CAS
& 7'.6 8.41- A 6 D
�\ a
WORKER'S,CqiAPENSATION° '`°" 20-004°°P`"°'8°
7aA9APPLICATION FOR.PERMIT
BiC
I hereby affirmtTiatl have a certificate of consent to sal} Insure,
or a certificate o1 Worlur a Compensation Insurance, ora certified HEATING-VENTILATING-AIR CONDITIONING
copy thereof(Sao.3800 lab.C.)
PoAcy No. Comparry UNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
Certified Dopy M hereby fumFrhed.
❑ CerM d copy r fled wtth the cots ty bulkAN Inspection FOR APPLICANT TO FILL IN l z 6 6;0R/g&D A i1
(PR?fT OR TYPE ONLY) .
Date t NO. TYPE OF APPLIANCE OR EQUIPMENT • FEE LOGAtm E h LE CI T
C=FICATE OF EXEAAPTION FFK)M WORKERSCF8T. fl
COMPENSATION.INSURANGE ABSDRPTK)N UNrT BTU
ASSESSOR
(This peotion need not be oompleted H the work Invotved by the MAP BOOK PAGE PARCEL
permit Is for one hundred dollars(8100)or tees.) AA HANDLING UNLT CFM ownVCrno PnocEASHE)sY
I oarllfy that In the performance of the work for which this permit n
Is Issued, I shell not employ any person In any manner so as to BORER,1371J
become subject to the Workers'Compensation Laws.
COLI BTU -
�Dete APpk-rt VENTILATION SYSTEM AP4r1P/Ale are rrna a esrrurue
NOTICE TO APPLICANT: If,'after making this Certificate of ROUt3H
Exemption,you should become sub)eot to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FWAL
provlsbna or this permit shall be deemed revoked. FURNACE= FAU GRAVITY
CONTRACTORS DECLARATION FLOOR BTU VALIDATION
I hereby affirm that I em Ilosnsed under provisions of Chapter B iF64T� SUSPBIDED UNIT
Division(oommerkAng with Section 7000) of 3 of the Business and / WPI I e74
`9
Professions Cods,and my Iloense is In full foroe and effect.
License Number L.lo.Clew
s i $Contractor Date
I am exempt under Seo. Plan Check fe6 •* 53■7 ply V
B.nP.C.}or trio.meson PERMIT ISSUING FEE$
Date TOTAL FEE �, LU
S$gn"n'rs PLAN CHECKAPPLICANT TOW ITEM53 v 91D 00Z
OWNERLA
-EWILDER DECRATION
pc . o —
I heroby affirm that I am exempt from the Contractor's License taw NAVEPOO. �.I1ALy''�
for the following reason (Seotlon 7031.6, Business and Professions S[A]G .00
O ADDRESS
I, u owner of the property, or my employees with wages
as their sole compenaatlon, will do the work and the CITY TE_NO. QfL7rC1
structure is not Intended or offered for sale (Seotlon 7044,
Bualnses and Profession@ Cods).
® I, as owner of the property, am exclusively contracting
with licensed oontractore to oonstruct the project (800- ADqRE68 3 /eT/ �/fJ ✓�
tion 7044, Business and Profeealons Cods).
CONSTRUCTION LENDING AGENCY CrTI a ►t YC t TEL NO�i(f-1 33rd
1 hereby affirm that there to a construction lending apenoy for CONTRACTOR
the performance of the work for which this permit Is Issued
(Sec.3007,Ctv.C.).
ADDRESS
Lenders Name
CITY TEE_NO.
Lenders Address STATE IOC.
I certify that I have read this appllcaUon and state that the above LICQE NO. CLASS
Information Is correct. I agree to comply with all County ordlnancee
and State laws rotating to bultding conatrrction,and hereby authatre
representatives of this County to enter upon the above-mentioned
property for Inspection ppuurr�poses. SEE REVERSE FOR MUM ANATORY LANGUAGE
r 8*NA { �oFt AGENT DATE