HomeMy Public PortalAbout9035 HERMOSA DR_Mechanical__ 76 A364 - CE 8IB-I/75
APPLI ION FOR PE T
HEATING - VENTILATING - AIR NOITIONING
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COUNTY OF LOS ANGELES gDORE55 "Y
DEPARTMENT OF COUNTY ENGINEER 4
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST. esa �l
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
u0 TYPE&SIZE OF EQUIPMENT FEE MAIL
ADDRESS �'7 .�•`+-�' ---
SEE BACK OF APPLICATION'
CITY TEL. NO.
FORCE AIR FURNACE, BTU - -
CONTRACTOR
COMPRESSOR, BTU
ADDRESS -��� �/ SLC! 7 G.•��
VENTILATION FAN CITY TEL. N�7,,
LIST L OTHERS BELOW STATE LIC.
-. LICENSE NO. CLASS
DISTRICT NO. GROUP ZONE ESSED BY
INSPECTION RECORD
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Plancheck-fee. See reverse:-
I'F.HVIIT ISSUING FFh: S '
1
10
TA I. FI,E ..
PLAN CHECK APPLICANT
NAME
ADDRESS - -
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
L4T ING.
I HEREBY
CONDITIONING.BY CERTIFY i T I' AM NOT ACTING IN VIOLATION ROUGH
OF CHAPTER 9, DIV151 3, TXE BU 55 ANO PRO 5510 NAL FINAL
CODE OF THE STATE C '�IFORNIA.
SIGNATURE PERMIT VALIDATION CK. M CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M..0. CAS '
94, ' rT .1. 4.1 0 1 2.0 0 AS
./
WORKERS'COMPENSATION DECLARATION 76A364C
I hereby affirm that I have a certificate of consent to self CE -828 (2-80) APPLICATION FOR PERMIT
insure, or a certificate of Workers'Compensation Insurance,cr HEATING-VENTILATING-AIR CONDITIONING
u certified copy thereof(Sec.3800, Lab.C.) �
Policy NoAA2.586 Company__S1tate_FU71d
❑ Certified copy is hereby furnished. ' COUNTY OF LOS ANGELES BUILDING AND SAFETY
u Certified copy is filed with the county building inspection FOR APPLICANT TO FI LL IN BUILOING
department. .5�t ADDRESS
Date—6 ApplicantmA_CpIld,._.47T-s Inc, (PRINT OR TYPE ONLY) - 40 �HCTIDOSa—I�r1Ye
LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE TeMpLe_Clty
COMPENSATION INSURANCE NEAREST }
CROSS ST. 0.
(This section need not be completed if the work involved ABSORPTION UNIT, BTU O
by the permit is for one hundred dollars ($100) or less,) DISTRICT NO. PROCESSED a� U
I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM 'ecr
permit is issued. I shall not employ any person in any manner . Q O
so as to become subject to the Workers' Compensation Laws. BOILER, BTU ~
APPROVALS DATE p INR'S SIGNATURE LU
Date Applicant 1 COMPRESSOR, BTU_3_R.R. ROUGH Q�/x'27 - CL
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM I JF r Z
Exemption, you should become subject to the Workers' FINAL
Compensation provisions of the Labor Code, you must forth-
withcomply with such provisions or this permit shall be EVAPORATIVE COOLER VALIDATION
deemed revoked. FURNACE: FAUX r=PAt'IT
LICENSED CONTRACTORS DECLARATION I FLOOR: BTU-1O0- . 0U
1 hereby affirm that 1 am licensed under provisions of Chapter HEATER: SUSPENDED UNIT
9 (commencing with Section 7000)of Division 3 of the Busi. WALL
ness and Professions Code, and my license is in full force and -
effect.
License Number 293529 Lie.Class C20
Contlacto[_AAACond..Air Date 6/1$/82
❑ I am exempt from the licensing requirements as 1 am a
licensed architect or a registered professional engineer Plan Check fee 25% Of above.
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). PERMIT ISSUING FEE $
Lie.or Reg.No. Date TOTAL FEE
HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor's NAME �14�4 S,6 A
License Law for the following.reason (Section 7031.5, Busi- ,
nets and Professions Code): ADDRESS
❑ I, as owner of the property,, will do the work and the - ,Q 00,0j-08
structure is not intended or offered for sale (Section CITY TEL. NO.
00,00-0 8
7044, Business and Professions Code). 1,
. .
❑ - rA
r. and Mrs. Miller
I, as owner of the property. am exclusively contracting 1 .4'4 Jr,7 A
with licensed contractors to construct the project '
(Section 7044, Business and Professions Code). 9035 Hermosa QSlve .2j'�• 3,8 5 0
CONSTRUCTION LENDING AGENCY TEL.NO. ,
leCity 285=334-7 • �,a3950'�1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is ORissued (Sec.3097,Civ.C.). AAA Corld..—Airy—InQ' 00.00)-0 8
Lender's Name 10160 Valley Blvd.
Lender's Address MonteEL.N0I certify that 1 have read this application and state that the LIC.above information is correct. I agree to comply with all CountyO. CLASS
ordinances and State laws regulating.Heating, Ventilating and
Air Conditioning, and herebv authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County to enter upon above-mentioned property for
inspection purposes. /^�/
—David—Cross- 4/_1S/_82—
Signature of Permittee Date