HomeMy Public PortalAbout10134 GREEN ST_Mechanical__ 7eA3e4-5:SG1 S—G-eG APPLICATION FOR PERMIT `I
HEATING - VENTILATING - AIR CONDITIONING
v COUNTY OP LOSANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS 3
JOHN A. L4MBIE, COUNTY ENGINEER
COLEMAN W. JE,NKINS, SUPKRINTKMDKNT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
(Print or type only) +
OWNER ,
No.. TYPEIOFAPPLIANCE OR EQUIPMENT FEE
MAIL
A D DRESS
ABSORPTION SYSTEM, BTU CITY TEL NO. d
AIR HANDLING UNIT, CFM CONTRACTOR
BOILER, HORSEPOWER ADDRESS O
COMPRESSOR, HORSEPOWER CITY , TEL. NO.
STATE LI C.
VENTILATION SYSTEM LICENSEfNO. 4 1 CLASS
DISTRICT NO. GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY- �O (�
FLOOR-BTU INSPECTION RECORD
HEATER:.SUSPENDED UNIT
WALL
p�
8
W
d
N
Z
NEWADDITION PERMIT $ 8 00
ALTER--REPAIR TOTAL FEE S a SQ
Plan check applicant
Name
Addreee
Cit Tel. No.
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STAT[ THAT THE ABOVEIS CORRECT AND AGR[[ TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DAT[ CTOiI'1 SIGNATURE
LATINS, AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTIN IN VIOLATION FINAL
OF CHAPTER 9, DIVISION S OF THE SUSINESS AN ROFESSIONAL
COO[ OF THE STATE C ORNIA.
JACK R. ALLEN,
SUPERVISIN CHANICAL ENG•R.
SIGNATUREPERMIT VAr ATION CK. M.0. CASH
OF PERMITTE
PLAN CHECK VALIDATION
0 5 6 9-6 A 11 P 4 1 D 1 0,5. 0-
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
76 A36W- CE B+B APPLICATION FOR PERMIT
w
HEATING - VENTILATING - AIR CONDITIONING
r
COUNTY OF LOS ANGELES BUILD'NSG
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LQCALITY 7�
'NEAREST `
GROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPEOFAPPLIANCE OR EQUIPMENT FEE ADDRESS
CITY TEL NO.
ABSORPTION UNIT, BTU '
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU
CITY TEL. NO.
COMPRESSOR, BTU d� -0 STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM �DISr Cr No. :RouF ZONE PROCESSED BY� p
EVAPORATIVE COOLER p�
FURNACE: FAUGRAVITY INS CTION D U
FLOOR BTU
HEATER: SUSPENDED UNIT_ Z o
WALL u
Lu
Z
z,
Plan check fee 25% of above. See reverse. �
PERMIT ISSUING FEE i 9 00 1 0, hell 7
TOTAL FEE +
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HERESY ACRNOWLEDSE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AMIE[ TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DAT[ CTOR'S SIGNATURE
LATING, AIR CONDITIONING.
RO UG H
1 HERESY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION S, OF TU BUSINESS AND PROFESSIONAL FINAL Z
CODE OF THE STAT[ OF C FO
SIGNATURE PERMIT VALIPAItA' CK. M.O. CASH
OF PERMITTE
PLAN CHECK VALIDAT ON CK. M.O. CASH
LAC07530;3 AM1741 p 8.00~ q
SEE BACK OF APPLICATION F92_Q2KRUrL_ffE SCHEDULE
h;,. WORt<A'S COMPENSATION DECLARATION 20-OM DPW 9180
Ibex atflrm thV I have ■ certif,cate of content to self Insure, '°k%'C APPLICATION FOR PERMIT LIME GREEN
ora to of Worker's Compensatton Insurance, or a certlfled HEATING-VENTILATING-AIR CONDITIONING
copy the (Seo.3B00 Lab.C.)
Poacy No.SYS rrperry C« �` COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
fCe-MW copy M hereby f unUthed.
❑
Certified!copy I.ned„Ith the T,Tyb he peotkonFOR APPLICANT TO FILL IN ����
L (PFUNT OR TYPE ONLY) AWRESS
Dale LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEF
CERTIFICATE OF EXEMPTION FROM WORKErIS' NEAREST
i CROSS 8T.
COMPENSATION INSURANCE AB80RPnON UNrr BTU
ASSESSOR
(fhb seaUon need not be oompkted tf the work Invohf d by the �� MAP BOOK PAGE PARCEL
perrntt la for hundred dollars($100)or less.) AIR HANDLING UNIT CFM
oenscT wo. rrroca"M sv
I certify that In a performance of the work c lisle permll
Is issued, I.ehall t employ any pe n ■ny'manner so as to BTU
become subject to tis orken'Co nsatlon Laws.
COMP BTU
w�novru DATE surecroers WowATure
Data VENTILATION 8YSTB1
NOTICE TO APPLI T: IT, a making this Certificate of ROUGH
Exemptbn,you e d beoorne sub)ect a Workers' Compenaaibn EVAPORATIVE COOLER !
provisions of Labor Code, you must f wish comply with such FR�AL L1
provlslona o t•permit shall be deemed revoked. FUFINACF- FAU
UCEN8ED D -T�D�,R,� FLOOR BTu _ VALIDATION
I hereby affirm that I Am licensed under provisions of Chapter g � SUSPENDED UNIT
(commenoing wtth Section 7000) of Dtvlelon 3 of the Business and HEAW
Profsss4one Cods,and my license Is In full foroe and OW.
Lkxxm Number s67 Li",class
contraofor D.te 8
I
Plan check fee
❑ am exempt raider O
B.BP.C.for thls reason PERMIT ISSUING FEE$
Date: TOTAL FTS
IL ZPLAN CHECK APPLJG,NT
OWNH3�UIlD�i DECLARATION
I hereby affirm that I am exempt from the Contractors License Law NAME
for the following reseon (Section 7031.6, Business and Professions u
Gods): ADDRESS F CT.A
❑ I, as owner of the property, or my employees wlth wages 37.CTfI
as their sole compensation, will do the work and the TEL NO. 3307
structure Is not Intended or offered for sale (Section 7044,
Business and Profasatons Code). OWNER I 1[1 h7
❑ I, as owner o1 the property, ■m exclusively contractingMAl1 r;yT 37 -00
with licensed contractors to construct the project (Sec- ADDRESS t�V! 7
AL
tion 7044, Buelnmm and Professions Code). CITY TEL NO. I.fEM 3f
`3 •I313
CONSTRUCTION LENDING AGENCY ��I� .01
I herebyy affirm at there Is a constructlon lending agency for CO CI HE J
the pertormance the work for which this permit le Issued
(8eo.3087,Civ.C.).
Lendoes Name ADDRF88 ` rA1LAJ +1 r 2, 12/W
CITY TEL.NO.f t! i DAM n
Lendef a Address STATE LIC. 'tt,^'7 1 Ff r 1 V%?f
I cerdfy that I have this appl and state that the above LIC111 t N.O. CLASS G
ttformarion Is I agree tc comply all County ordtnancee
and State fawn to NAdtng cortstruodw,and hereby atrthortze
repreeentatfvee of thle County to enter upon the above-mentioned
property for Inspection purposes. SEE REVERSE FOR 001- NATORY LANGUAGE
MANATUM