The URL can be used to link to this page

Home My Public Portal About5833 GOLDEN WEST AVE_Mechanical__ ' L 76A364C CE-618 (REV'11/78) ^� ®s APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING D SAFETY FOR APPLICANT TO FILL IN F 33 (PRINT OR TYPE ONLY) Ps � �� NO TYPE OF APPLIANCE OR EQUIPMENT 7FEE, , �- ABSORPTION UNIT,BTU _, OWNER AIR HANDLING UNIT,CFM MAIL ADDRESS •� r" BOILER,BTU \ CITY TEL NO��,-.�� COMPRESSOR,BTU - - CONTRACTOR - -- r VENTILATION SYSTEM I ADDRESS J EVAPORATIVE COOLER �� ^ -� CITY`• `j=aw I` TEL NO' FURNACE FAU GRAVITY STATE LIC [FLOOR—BTU LICENSE NO CLASS HEATER SUSPENDED UNIT_ APPROVALS DATE INSPECTOR 5 SIGNATURE WALL ROUGH 0 G G(/ FINAL Q� V INSPECTION RE ORD at O Plan check fee 25% of above PERMIT ISSUING FEE$ Z. TOTAL FEE PLAN CHECK APPLICANT PLAN CHECK VALIDATION NAME ADDRESS CITY - TEL NO IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR CONDITIONING I PERMIT VALIDATION' 96779 A I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF , CHAPTER 9, DIVISION 3, OF TH BUSINESS AND PROFESSIONAL CODE # o o o o 4 OF THE STATE OF RNIA SIGNATURE , OF PERMITTEE 2 0 0 2 7 0 0 ' DISTRICT NO PROCESSED -0 o o 2 7, 0 0 U �� D 09.2'0-79 76A36+3`- cEeie 3-69 APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIO ING------- COUNTY OF LOS ANGELES BUILDING Q �}- DEPARTMENT OF COUNTY ENGINEER ADDRESS 8�� /✓ �`,S/ v` BUILDING AND SAFETY DIVISION ��J JOHN A LAMBIE, COUNTY ENGINEER LOCALITY R /E Li/ COLEMAN W.JENKINS,SUPERINTENDENT, OF BUILDING NEAREST / CROSS ST / v FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) MAIL NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS a- ABSORPTION SYSTEM, BTU CITY ��,�JJ' TEL./NO-2&5--- CO 2&5---104 AIR HANDLING UNIT, CFM CONTRACTOR . Al. /a•/ ADDRESS j !i(/. /N/9-/� ��• �/ BOILER, HORSEPOWER CITY 40eTEL. NO. COMPRESSOR, HORSEPOWER STATE LIC. LICENSE NO. ��95 CLASS a VENTILATION SYSTEM DISTRICT NO. GROUP dNE ROCESSED BY EVAPORATIVE COOLER [ 0`0 FURNACE- FAU/AP GRAVITY E7 V INSPECTION RECORD FLOOR BTU HEATER SUSPENDED UNIT WALL d O U O H V w a NEW_ADD TION_ PERMIT $ _ _ z ALTER PAIR_ TOTAL FEE $ PLAN CHECK APPLICANT /V• S NAME ADDRESS CITY TEL. N0. 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- LATING, AIR CONDITIONING. APPROVALS DATE INSPECTOR'S SIGNATURE I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH - -k � CHAPTER 9, ADIVISIOOF THE USINESS AND PROFESSIONAL FINALCODE OF THEIFORN SIGNATURE JACK R. ALLEN, SUPERVI GME ANICAL ENG'R. OF PERMITTEPERMIT VALIDATION CK. M.O. CASH PLAN CLIDATION .6�1- SEP-,-10 4 1 1 0.5 0 SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE , - 1 AA WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT • I hereby affrrm'that`I have a certificate of consent to self � ' - , il�Surz, or_a certificate of Workers' Compensation Insurance,- HEATING - VENTILATING - AIR CONDITIONING or a certified copy thereof (Sec 3800, Lab C ) 76A364C- ^ '05T CE-818(REV 10/8}) ` PolicyNo Company COUNTY OF,LOS ANGELES BUILDING AND SAFETY FT Certified copy is hereby furnished Certified copy Is filed with the county building-inspec- FOR APPLICANT-TO FILL IN r - - BUILDING �-5— tion department ADDRESS ./ ✓✓ �`V ,_,r,��,/� �,Q,� (PRINT OR TYPE ONLY) Date Applicant �'�+04AW IN -LOCALITY G NO 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.) r Us, I certify that in the: AIR HANDLING UNIT, CFM performance of the work for which this _ - - -permit is issued, I shall not employ any person in any manner , I so.as to become subject to the Workers'Compensation Laws BOILER, BTU APPROVALS DATE '.INSPYCT 'S SIGNAT RE Date !Applicant - - COMPRESSOR, BTU ROUGH - r - , ,NOTICE TO APPLICANT If, after making this Certificate of VENTILATION SYSTEM FINAL _ Exemption, you should become suF ject to the Workers' Compensdtion provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATI N 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 with Section 7000) of Division 3 of the Business WALL and Professions Code,and my license is in full force and effect "Co rjuc?_T' Q kfj , O License Number`nl4�Jl d V ��pjj ��//'n aC Contracto� ►`Y►NV t"`r` Date 0 02 I am eiempt under Sec I, 0 3 1 7,50 d - Plan check fee '- ' B&P C for this reason H 1 PERMIT ISSUING FEE $ ° c 1'7.5.0 5 Z Date Signature TOTAL FEE = 01,08-86 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 Or 13 NO Q ' wages as their sole compensation,will do the work and C� the'structure is not intended or offered for sale(Section CITY TEL NO _4+1 ,,D 7044, Business and frofessions Code) - `OWNER � ❑ I, as owner of the property, am exclusively contracting AA TqLAIz- with licensed contractors to construct the project (Sec- MAIL ADDRESS tion 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY , CITY _TEL 'NO I hereby affirm that there is a construction lending agency for, the performance of,the work for-which this permit is issued CONTRACTOR 0 - , (Sec 3097, Civ C ) — - _ ADDRESS- ie •- •- •• - - •� -J+• ..�R ti� _ '�:� .. .• _ _ Lender's Name fG ,r CITY _ TEL,NO q y+- „O Lender's Address r v STATE LIC I certify that have read this application and state that the LICENSE NO - �/ CLASS .�. -. above information is correct I agree to comply with all County ordinances and State laws relating to bbilding construction, and reby thonz;tX,ves of this,County to enter upo he a rry for inspection uorposeserste SEE REVERSE FOR EXPLANATORY LANGUAGE . - - Signature of Applicant or Agent, Date _n