HomeMy Public PortalAbout6219 GOLDEN WEST AVE_Mechanical__ .- 76 A364- CE 818- 5-73 '
APPLICATI07FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING .
COUNTY OF LOS ANGELES BUILDING L 6 Z/
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND-SAFETY DIVISION LOCALITY C�
NEAREST /� f
CROSS ST �0� O V G (�
FOR'APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) MAIL r eat v
•
NO TYPE OFAPPL,IANCEOR EQUIPMENT FEE ADDRESS t6.2/ [V L.S
CITY C' TEL. NO. �`�S'/y
ABSORPTION UNIT, BTU -
CONTRACTO fit. V
AIR HANDLING UNIT, CFM
ADDRESS LO-7,
BOILER, BTU CITY G TEL. NO r�s"LO3
COMPRESSOR, BTU STATE LIC �y p
LICENSE NO. O S CLASS`.
VENTILATION SYSTEM DISTRICT NO GROUP ZONE ESSED BY
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY INSPECTION RECORD
= FLOOR- - BTU
HEATER. SUSPENDED UNIT_
WALL
. lot _ CL
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_ CC
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Plan check fee 25% of above. See reverse.
Z
PERMIT ISSUING FEE S 3 00
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY NVEL NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ-THIS APPLICATION iw- B Yryin—
WITH
� /
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS ,DATE\� I/SPE �O 'SySIG;ATURE
LATING, AIR CONDITIONING ,
ROUGH Ll
IHEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION //
OF CHAPTER 9, DIVISION 3, �RTHE BU NESS AND PROFESSIONAL FINAL /�v
CODE OF THE STATE CALINIA
SIGNATURE PERMIT VALIDATION cK M O CASH
OF PER
MITTE
PLAN CHECK VALIDATION CK M 0 CASH
2 9-9 r MAR 29 10 D 1 0.5.0 e��
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE r"-
C . 1„, r,••
WORKER'S COMPENSATION DECLARATION 2a0046DPW 9f8s''•-' ''APPLICATION FO•R',.�GI�IYII 1,
78A364C` _ LIME "GREEN
hhereby affirm that I have.a certificate of consent to 'self Insure,
or a certificate of Worker's Compensation Insurance, or a certified ” AIR"
CONDITIONING,thereof/(�Serc7 38 '0 Lab-
'62
ab- HEADING.-�.._TNTIL'ATI_NG AIR CONDITIONING.
PohcyV C.�62mpariy' =�
❑„ COUNTY=OF LOS ANGELES "' 4, DEPT'OFfPUBLIC W6,O S, BUILDING+AND SAFETY DIV. '
Certified copy Is hereby furnished
Certified copy
twit
with the � budding msp Gbon - FORAPPLICANT TO FILL IN s: BUILDING(P.RINT OR TYPE ONLY) . ADDRESS NO TYPE OF APPLIANCEOREQUIPMENT'' y�„- p,FEE,
LOCAL�T � I
CERTIFICATE'OF EXEMPTION FROM WORKERS' NEAREST a }.
COMPENSATION INSURANCE ' ” 'CROSS ST- ���'[ r'
:1,`+ ABSORPTION•UNIT,BTU ASSESSOR• - S '
(This section need not be completed If the work Involved by the
e• .= ''- t MAP BOOK'• PAGE � 'PARCEL
permit"Is foi one hundred"dollars($100)or leas.) h'° AIR HANDLING UNIT,CFM ' DISTRICT,NO PROCESSED BY `
('certify that In'the performance-of the work for which this perrimrt
Is Issued, I shall not'employ any person-in•any manrier so,as'Co, • 1.4" BOILER,'BTU - ' �f • -`p- r ` '
become subject to the Workers',Compensation Laws
COMPRESSOR,BTU= '.
APPROVALS ' - +DATE' INSPECTOR'S SIGNATURE
Date'
n
Applicant -VE_NT_ILATION+SYSTEM •-- ' - - `
NOTICE TO APPLICANT If, after making,thls Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensationw - ,
a EVAPORATIVE COOLER ,,•' FINAL°
provisions of the Labor Code, you must forthwith comply with such % "
provisions or this permit shall be deemed revoked FURNACE FAU - G AVITY-- r+."
'LICENSED CONTRACTORS DECLARATION FLOORi, ' BTU �y VALIDATION v
I hereby affirm that I,am HEATER hcen
rised under-provisions of,Chapter 9 SUSPENDED - UNIT ;b
(comnSencmg with Section 7000)of Division 3 of the Business•and - WALL-
o
Professions Code,and my license.ls'm-full,force and effect
License Numb LIc Classor
JIL
Contractor , r Date _ ,y+' ` .0
❑' Plan check fee
I am'exempt'u e�Sec
0
B&P C=for,this reason' PERMIT ISSUING•FEE /L L-
` Date - e- l• ,- 0
TOTAL FEE. {` *> W
signature` r _ �" N
PLAN CHECK APPLICANT, 3 r
OWNER-BUILDER DECLARATION - Z_
I hereby-affirm thatyl am exempt from the Contractors License Law NAME
for the following reason (Section 7031 5, Business and,Professions `^ , M a{{ �':
Code) ADDRESS :r-. ,I .,. .-.�z, _ 'r,•..` - ` �t, ..' ti1.•4,•,[eH
�, - '
I, as owneCof the property, or my employees with wages i, ' �'1',>s; f;t•'' , �y.I ;�, ^t
as their sole compensation, will do the work'and,the CITY ;,1 TEL NO
structUre'is•not Intended or offered for sale (Section 7044, ' '�a: •I T�'i-b4i -
Busiriess and•Professrons Code) OWNER '' 'Q' r y +4. Y T ITE ' a
❑ I, as owner of•`the property;.am=exclusively contracting ;` t ItAL S
with li MAIL' _ .. �' •,+ ,�- '
censed contractors to construct the project,(Sec- ADDRESS. ``yIIG )fti
with
7044, BusmessTand Professions Code) " ' Thr Ui
CONSTRUCTION LENDING AGENCY CITY TEL NO � -5l t�'� v �•. =y `, - r:•;
CC
hhereby affirm that there is a constructionagency
d
lending a `enc
for s "� �G- Q
-the performance of'tlie`-woik for which this-permit Is issued CONTRACTOR' `f >' Mi
(SBc:3097,CIv•.C) ,a �14
�
ADDRESS * _@�� �1�t1+Ji.R.�iJIfJ i r3'l�1717 J
Lender's Nam*' /'� s p
V . CITY TEL NO •�•l✓/ :i`• 'e+ I t • 't` ,i L76QO' .-�= f �• <�t71111:V7
Lender'§'Address STATE �f IC
xl'certify that'( have read`this application and state that the above' LICENSE IJO� �/ CLASS aa'
Informatiowis correct I'agree to comply with all County ordinances. - r'•' '' " - .• +; F ` `
and-State laws relating to budding construction,and hereby authorize-
re
uthorizere atives,of this ounty;to enter upon the above-mentioned
ropert for in
SEE REVERSE FOR EXPLANATORY
.. S - ANATORY LANGUAGE
RE OF � � 'I DATE '+