HomeMy Public PortalAbout4929 GOLDEN WEST AVE_Mechanical__ 7"?G�+^-E 81'8'1/71Y
APPLI ION FOR RMIT
HEATING - VENTILATING - AIR CONOITIONIN
COUNTY 4OF LOS ANGELES ADDRESS
DEPARTMENT OF COUNTY ENGINEER s
BUILDING AND SAFETY DIVISION . LOCALITY GS
NEAR EST
GROSS ST. '
FOR APPLICANT TO FILL IN OWNER
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.(PRINT OR TYPE ONLY)
MAIL
NO.' TYPE 8 SIZE OF EQUIPMENT PE ADDRESS JeW
5FK ■,%CK OR APPLICATION
CITY Ld3 d/ TEL: NO.
FORCE AIR FURNACE, BTU
CONTRACTOR
COMPRESSOR, BTU
ADDRESS of
VENTILATION FAN CITY TEL. NO.
LIST ALL OTHERS BELOW STATE LIC.
LICENSE NO. CLASS
. ED
INSPECTION RF-CORD '
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Plan check fee. See rover".
PERMIT I.14.91tl\C FEE S
TOTAI. FEF. 4 A I!
PLAN CHECK APPLICANT.
NAME
ADDRESS .
CITY TEL.NO.
-1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
LLATING�
D STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ppy
TH ALL -ORDINANCES AND LAWS RE,ULATING HEATING, VENTI- APPROVALS DATE UCS PI rL� SIGNATURE
AIR CONDITIONING•• ROUGHI .'HEREBY CERTIFY THAT I AM NOT ACTING IM VIOLATION
CHAPTER D, DIVISION S, OF THE BUSINE AND PROFESSIONAL FINALDE OF TNS SPAT LI IA:•,aNATURE PERMIT �(ALIDATION cK. M,o. cAeH
P PERMIT
PLA CK VAL-IDAT PN CI(. M.D. CASH
r i 0 dC+.y 25 4 I ' D 1 .7
VPORKER'S COMPENSATION DECLARATION 20-OD46 DPW 9189
76ik%4C APPLICATION FOR PERMIT LIME GREEN
hegeby Affirm that I have . certificate of consent to self Insure,
or a certtfloate of Worker's Compensation Inaurdnoo, or a certlflad HEATING-VENTILATING-AIR CONDITIONING
copy thereof(Seo.3800 i.ab. C.) LJ
0 No. r'�ry COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
CerttW copy la hereby fumletled.
certtfiodcow Is,riled with the oourrty FOR APPLICANT TO FILL IN BUIL
(P / ++GD A f
RM OR TYPE ONLY) C
LOCALITY
Data Applkxirrt NO. TYPE OF APPLIANCE OR E CWIPNENT FE E
NEAFEErr
C FICATE OF E�IPTFON FROM WOE CROSS STT. CD AJ
COMPS N8ATFON INSURANCE ABSORPTION UNrr,BTU ASSESSOR
(This section need not be completed tf the work Invotved by the MAP PAGE PARCEL
pwmtt Is for one hundred doltare($100)or Ease.) AIR HA DLM UNTr CFM
osnrsar wo. aroc�eso BY
I oertlfy,that In the performance of the work for which this permit
Is Issued, 1-shall not employ any person In any manner so as to 1304LER,BTU
become subject to the Workers' GompenwWon Laws. ,Df
ellJ APPFK vtia ogre sass nrre exwnTua
DabsApplicant VE)MLAT10N SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exam ptlon, you should beoo ne subject to the Worker`Gompe. adl
naon EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwkh comply wtth such FINAL
provlabnp or this permlt shall be deem#d,revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU ALJDA ION
I hereby affirm that I em licensed under provisions of Chapter 9 8U8PENDED UNTf
(commencing with 8eotlon 7000) of Dlvl+Ion 3 of.the Business and HEATffC Wu i
Profeeslons'Code, and My Ildenae Is In full force and effect
Lk)enee Number Lk Claes -� / � .
Contract« Data. bs ' I ITEMS
I stn mrempt under Sec. Plan check tee TOTAL 38 - 5
5
B.sP.C.for this reason PERMIT ISSUING FEE G p Cif C , 32. ppCaME a3j
Date: TOTAL FEE W
CL
Signature PLM CHECK APPLICANTp N
OWNER-BUIL1aER gECLARATtON �f—�It I J94 Z
I hereby efflrm that I am exempt from the Contractors License Lew
for the following reason(Section.7031.6, Business and Profeeslons NAME Poo 7M I 'AM �'r
Code): ADDRESS
El 1, as owner of the property, or myemployees with wages
as their.sole compenealloh, will do the work and the CITY TIL NO.
structure Is not Intended or offered for sale ($aotlorl 7044,
Business And Profeeslons Code). OWNER
I, as owner of the property, am exclusively contracting MAIL
with floensed Contractors to oonstrugt the project (Sec- ADDS
tion 7044, Business and Proieasldne'Code). I
CONSTRUCTION 4ENOING AGENCY CITY4G Ta-NO.
I hereby storm that there Is a construction-lending agenoy for CONTRACTOR
the performance of the work for which this permit Is Issued
(Seo.3097, C,4.C.).
ADDRESS
Larder's Name
CITY TEL NO.
Larder a Address STATE / LIC.
88 -
I certify that I have read this applk:atbn and state that the above L.EC8t8E NO. Lo 15
IntonTatIcc le correct- I agree to oompty with all Courrty ordlnAnoee
and State lave relating to building cortstrucUm,and hereby aur tre
rep Ives o Is County to enter upon the above-mentioned
property r Ion rposes. / SEE REVERSE FOR E UN-AF ATORY L11NWAQE
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