HomeMy Public PortalAbout9841 HOWLAND DR_Mechanical__ -gL'D G.P�l2Nn I r •-r r C.^
76 A7364 - C E 8 18- 5-73
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDI ADON 9g . I I-IowL
DEPARTMENT OF COUNTY ENGINEER _.
BUILDING AND SAFETY DIVISION LOCALITY PL._
Y CAU F,
NEAREST
CROSS ST. I-I C W LA} JI—t> ._ /4 G NESS
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OF APPLIANCEOR EQUIPMENT FEE ADDRESS
NO-
AIR
ABSORPTION UNIT, BTU TEL. NO.
CITY
CONTRACTOR 0 N-C�
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CITY TEL. NO.
COMPRESSOR, BTU STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP xONE SSEO BT
EVAPORATIVE COOLER
�:Ufi' _�
/ FURNACE: FAU ✓ GRAVITY_
FLOOR BTU Aa Oi 000 go INSPECTION RECORD
HEATER: SUSPENDED—UNIT_
WALL
d
0
U
O
H
U
d 1
h
Z
Plan check fee 25^ of above. See reverse.
PERMIT ISSIJUNG FEE S 3 00
'TOTAL FEE Al a0
PLAN CH CK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM PLT
WITH ALLORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING.
ROUGH w
HEREBY CERTIFY THAT E NOT ACTING IN VIOLATION
OF CHAPTER 'S ATEOF 3, OF THE BUSINESS AND PROFESSIONAL FINAL �I�9f79 w�1'`
27
CODE OF THE STPTE OF CALIFORNIA. _
SIGNATURE PERMIT VALIDATION CH. M.O. CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.O. CASH
SUyi: inL X41 U
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE J
WORKERS'COMPF NSATION DECLARATION 76A364C APPLICATION
p y p� 1� I�I�p/�
I hereby affirm that I have a certificatg of consent to self CE-818 (2-80) - i"i P P L ICA 1 I O 1 tl FCR P E Y'C IV0 I
insure,or'a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONING
a certified copy thereof(Sec.3800,Lab.C.)
Policy No. Company
❑ Certified copy is hereby Iurnlshed. COUNTY OF LOS ANGELES - BUILDING AND SAFETY
[1 Certified copy is filed with the county building inspection BUILDING
department. FOR APPLICANT TO FILL IN ADDRESS
Date Applicant (PRINT OR TYPE ONLY)
LOCALITY
CERTIFICATE OF FXFMPT)ON FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
COMPENSATION INSURANCE NEAREST j.
(This SeL'liOn need not be Completed if the WOIk involve) ABSORPTION UNIT, BTU CROSS ST. O
by the permit is for one hundred dollars (SI00) or less.) DISTRICT NO. P".rCE55,Jax' V
1 certify that in the performance of the work for which this AIR HANDLING UNIT,CFM
permit is issued. I shall not employ any person in any manner J z U U x Q
so as to become subject to the Workers' Compensation Laws. BOILER, BTU
APPROVALS DATE INSPEQTOR'S SIGNnT'1RE lU
Date Applicant COMPRESSOR, BTU _ //_/ in
a
NOTICE TO APPLICA�N'T: If, after making this Certificate of VENTILATION SYSTEM FINAL H '�tr/ Z
Exemption, you should become subject to the Workers' -i Compensation provisions of the Labor Code, you must forth-
with comply with such provisions or this permit shall h- EVAPORATIVE COOLER VALIDA. ION
deemed revoked. FURNACE: FAU- _ GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR: bT
1 hereby affirm that I 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.
- Upense Number Lic.Class
Contractor Date
❑ I am exempt from the licensing requirements as I an a
licensed architect or a registered professional engineer PIED check fee 25%Of above.
acting in my professional capacity (Section 7051, Bus �7
Incas and Professions Code). PERMIT ISSUING FEE $ /
Lic,or Reg.No. Date TOTAL FEE 1/7 -�
HOME OW'NF.R.BUILDER DECLARATION PLAN CHECK APPLICANT
1 hereby affirm that 1 am exempt from the Contractor's NAME CYC-n-I---T - r-; -i--O
License Law for the following reason (Section 7031.5, Busi-
ness
usi- �r
nessand Professions Cod:): ADDRESS t.1 Glr. ) )-It,eJ( AN _7) IZ
10 I, as owner of the property, will do the work and the 'j'
CITY 7 T TEL NO.�gG D
structure is not intended nr offered for sale (Section @7-i,n,PLac_I;,1_l--s-� —�(t
7044, Business and Professions Code).
❑ OWNER S . C.
I, as owner of the property, am exclusively contracting 2 1 49.6A
with licensed contractors to construct the project MAIL
(Section 7044, Business and Profession.- Code). ADDRESS
# •I•'•j• 4.1
CONSTRUCTION I.ENDING AGENCY CITY TEL.NO. ,
I hereby affirm that th.re is a construction lending agency 2'0'• 1 7.00
for the performance of the work for which this pe•mit is CONTRACTOR
issued(Sec. 3097,Civ.C'.). e e o 1 �], 0 5
Lender's Name ADDRESS 1
Lender's Address CITY TEL. NO. a O fl,_.8 0
1 certify that I have read this application and stale that the STATE LIC.
above information is correct. I agree in comply with all County LICENSE NO. CLASS
ordinances and Stale laws regulating Heating. Ventilating and
Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County to enter upon the abovementioned property for
inspection purposes.
� gl.,7-3 i=FJ
Signature of Permittee Date