HomeMy Public PortalAbout5214 HALLOWELL AVE_Mechanical__ 78A364-,&E81 8-8-68 APPLICATION FOR PERMIT
-.�._.. . }� HEATING - VENTILATING - AIR CONDITIONIN
COUNTY OF LOS ANGELES `-
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND'SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS �.
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSSEST.
(Print or type only)
OWNER —�
'N o. TYPEJOFAPPLIANCE OR EQUIPMENT .F•EE
MAIL '
ADDRESS L
ABSORPTION SYSTEM, BTU! 'CITY TEL. NO.
AIR HANDLING UNIT, CFM CONTRACTOR
BOILER, HORSEPOWER ADDRESS
COMPRESSOR, HORSEPOWER CIT '� EL. NO, __o
STATELIC.
VENTILATION SYSTEM LICENSE NO. CLASS 2d9
DISTRICT NO, GROUP ZONE J. PROCES D BY
EVAPORATIVE OLER
FURNACE: FAU GRAVITY -
FLOOR—BTU Q INSPECTION RECORD
HEATER:'SUSPENDED UNIT ee JJ� �j
WALL ,A1 /.
I 3 - o
U
1 7 � v '
W
GO
} N
Z
NEWADDITION 'PERMIT S 3 00 ;
I j At
ALTER REPAIR TOTAFEE $
9/////
Plan check plicant +
I
Name - ;
Address ,— �4
City
;
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- APPROVALS TE INS OR'S SIGN E
LATING, AIR CONDITIONING: -
ROUGH
L
BY CERTIFY THAT I AM NOT ACTING IN VIOLATION FINAL
R 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL
ME STATE CAL FO I
JACK R. ALLEN,SUPERV�IIS ECHANICAL'ENG'R.
RE PERMIT VALIDATION CK. M.O. CASH
ITTEE
PLAN CHECK VALIDATION _
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORKIER'SCOMPENSATIONDECLARATION 200046DPW9/89 "LIME . GREEN
' 7f3A3fi4C APPLICATION FOR PERMIT
I hQreby afRim that I haye a-certificate of,conserit to self Insure,
or a certificate of,Worker's Compensation Insurance, or a certified !' "-, HEATING 'VENTILATING---AIR CONDITIONING'
copy thereoY(Sec.3800 Lab'.•C) ."•
Policy No. = Company COUNTY OF-LOS ANGELES-"'- ; DEPT OF PUBLIC;WORKS- BUILDING AND SAFETY DIV.
❑ Cer lfied co"py is hereby'fumished '
'certified is filed with the count building inspection FOR APPLICANT TO FILL IN BUILDING, J
PY Y 9 ADDRESS ,.�•Z/, r�[�� 11
department. i (PRINT OR;TYPE ONLY) . ' ,
:. LOCALITY
Date Applicant
' • " NO y, TYPE OF APPLIANCE OR EQUIPMENT ,FEE
CERTIFICATE OF EXEMPTION FROM WORKERS_ NEAREST';' CROSS ST ro
COMPENSATION INSURANCE , r
ABSORPTION UNIT,BTU ASSESSOR
(This section need not tie"completed if the workinvolvedby tie'. a MAP BOOK PAGE ', PARCEL, '•
Permit Is for one hundred dollars($1'00),or less.) 'AIR HANDLING UNIT,CDISTRICT NO PROCESSED BY
FM +• r _
•,
' •'I certify that in,the'performance of the work for which'this permit. r"
is Issued, I shall riot employ any person in'any manner so as to BOILER,BTU •Y G ~
become,subject to th'e Workers'Compensation-Laws e.' DO
r COMPRESSOR,-BTU
Date —2' A Iicant APPROVALS DATE• INSPECTOR'S SIGNATURE
pP " VENTILATION_SYSTEM
NOTICE TO APPLICANT: If, after maks this Certificate of ` I` ROUGH IZ `
Exemption,•you.should become subject to the Workers'Compensation '
EVAPORATIVE COOLER
provisions of the Labor Code, you must.forthwith comply with such FINAL `L
provisions or this permit shall be deemed revoked. FURNACE FAU GRAVITY -
'LICENSED,CONTRACTORS DECLARATION - / FLOOR • BTU VALIDATION'- ,' ' • '
_ I hereby affirm that I am licensed under provisions of°Chapter'9 'SUSPENDED UNIT
(commencmg with Section 7000) of Division 3 of the Business and HEATER: WALL -
'Professions,Code;and my license is in full,force and effect '
License Number 6'3:TJ"L�GZ Lic.Class C —iZp /i �1 + _li it i o$ ,1•
FJ
Contractor •�S �N�( i���f� Date y [ ,- .� �.
F-1Plan check fee _ I '' (�
-1 am exempt,under Sec.
r PERMIT ISSUING FEE T�Ir1� m
B.&P.C.for this reason = $
Date,` " TOTAL FEE` .7` �,! t
Signature i. 1-Ai't�� .0,
PLAN CHECK APPLICANT,• 7 •- (n
OWNER-BUILDER DECLARATION = Z
I hereby affirm that I,am'exempt,from the Contractor's License Law NAME, �{ j (�—(� ±f I i j r";•PI-17
for the following reason'(Section,7031.5, Biisiness and Professions t t-'1 �l�h't i =
Code) _/ ADDRESS .if�l .f. 1'It! �S'efl•ti
I„'as owner of
the property, or my employees wrt6'wages '
as their sole compensation, will do'the work and the CITY TEL NO
structure isnot intended or•offered•for sale (Secuon,7044, „
Business and Professions Code). OWNER
:❑ I, as'owner of the'property, l
;arri'exclusively contracting .,
MAIL`' > -
, with licensed contractors to`construct the protect (Sec- ADDRESS 4 ',',�J'- �T ';r -•-, _
z,tion 7044, Business and Professions Code). Alt p
CONSTRUCTION LENDING AGENCY _ CITY /f LFII f.'g •- TEL.NO. �j�,_`
."I hereby affirm that'there is a'construction lending agency for
Iperformance 'of the work for which this permit is issued ONTRACTOR �w �� T
(Sec.3097, Civ.C.): - .- J ,=- i• ,rig '4:
r ADDRESS
.Lender's Name ` r _ _
CITY. ' TEL'_NO: -. -, _ ......
Lender's Address STATE LIC.., _
I certify that I have read this application and'state that the above LICENSE NO.. L CLASS _
information is correct.,I agree to-comply.with,all County ordinances
and State laws relating to building construction;and hereby authorize -
representatives of this County to enter'upon the-above-mentioned
pro ierty,for Inspection purposes. SEE REVERSE,FOR EXPLANATORY LANGUAGE '
r�
�SI T OF ICANT OR I ENT _ DATE - ` --�;•� -- - _•.'- •,f,