HomeMy Public PortalAbout9927 HOWLAND DR_Mechanical__ p'
76A366E- CE818B-9/75PpPLL. AICATION FOR
PERMIT
_
HEATING.- VENTILATING _ AIR- CONDITIONING
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO .FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS 9927 HOWLAND'DR.
LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST
r
CROSS ST.
ABSORPTION UNIT, BTU
OWNER UEZ" LUIS
AIR HANDLING UNIT, CFM MAIL
ADDRESS WE
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BOILER, BTU CITY 'FLF ElMO• 285-0050
1 COMPRESSOR, BTU 3,S HP 7 50
CONTRACTOR TRME HCC
VENTILATION SYSTEM ADDRESS 20 34 N. PECK P
EVAPORATIVE COOLER CITY, S. EL, IvDNM TEL. NO. 579-7982
FURNA1 T STATE LIC.
FLOORCE: FAU BTU ' 'd 1600. 7 50, LICENSE NO. 265094 CLASS C-20
HEATER: SUSPENDED UNIT_ DISTRICT NO. GROUP ZONE PROC SED BY
WALL r
d c -%1'
INSPECTION RECORD CD
LLA
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Plan check fee 25% of above. / -
PERMIT ISSUING FEE $ 4 50 .
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATETHATTHE-ABOVE- IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENT]- { _
LATING, AIR CONDITIONING. I , t
I HEREBY CERTIFY THAT I AM N ACTING-IN VIOLA ON APPROVALS DATE INSPECTOR'S SIGN TU
OF CHAPTER 9, DIVISION 3, OF T B I ESS ND PROFESS L
CODE OF THE STATE OF CA r o ROUGH "
SIGNATURE - / FINALS #IT
`
OF PERMITTEE A - Vff
PLAN CHECK VALIDA ION CK, M.O. CASH
PERMIT VALIDATION C0- mO. CASH
-
WORKERS'COMPENSATION DECLARATION A F1F C(�n 7 PO N :F 0 R P E RM T '
I hereby affirmQhat I have a certificate of consent to self (J�J �( �(
insure, mr a certificate of Workers' Compensation Insurance, �IEATIWG - !lEWTILATItdG - AIS C0�1)ITIOWiRIG
or a certifi copy thereof(Sec. 3800, Lab. C.) 76A364C
CE-818(REV. 10/81)
Policy Not-4Z&3 �, ompany ! �l�9r�i�/- l�r �L/t
❑ Certified copy is hereby furnished. COUNTY-OF LOS ANGELES BUILDING AND SAFETY
Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING O
tion department. ADDRESS
/� - (PRINT OR TYPE ONLY)
Date ` - e3Applicant- �e- 2 / ,9/7 LOCALITY
NO. TY. Ei
P�i?gc I�/NENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' C C� NEAREST
COMPENSATION INSURANCE CROSS ST.
(This section need,not be completed if the work involved by ABSORPTION UNIT; BTU DISTRICT NO. PROCESSED BY
the permit is for one hundred dollars ($100)or less.)
I 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,,
so as to become subject to the Workers'Compensation Laws. BOILER, BTU APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applicant COMPRESSOR, BTU ROUGH .� ...- .6,-
NOTICE TO'APPLICANT: If,•after making this Certificate. of VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Workers'.
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION
with comply with such provisions or this' permit shall be
deemed•revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED - UNIT "
(commencing with Section 7000) of Division 3 of the Business HEATER: WALL
and Professions Code,and my license is in.fullforce and effect.
f _ 0
License Number /SSSS Lic. Class D V
e7 0
Contractor Date
❑ I am exempt under Sec. LU
Plan check fee H
B.&P.C. for this reason'
�. PERMIT ISSUING FEE $ .. &e Z
Signature.Cj _/ �1'�+-y — TOTAL FEE.
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I herebyaffirm.that I am exempt from the Contractor's License D
Law for the following reason (Section 7031.5, Business and NAME
Professions Code):
❑ I, as owner of the property, or my employees with ADDRESS = 7 5 3 A
wages as their sole compensation,will do the work and e 0 o g
the CITY. TEL. NO.structure is not intended or offered for sale(Section •
7044, Business and Professions Code).. OWNEJ 2 o.'o
R t�PS U�.�--tl t�
❑ I, as owner of the property, am exclusively contracting �Q.2Q - ��cst
with licensed contractors to construct the project (Sec- MAIL
tion 7044, Business and Professions Code). ADDRESS
CONSTRUCTION LENDING AGENCYCITY 'TEL. N
I hereby affirm That there is a construction lending agency for
the performance of the work for which this permit is issued CONTRACTOR /� ''
(Sec. 3097, Civ.. C.). Com: 4/C /��/7 /V D .
ADDRESSGf
Lender's Name //
CIT�, CU5`12 TEL. NOSI,/8���'
Lender's Address
STATE �.tet-- .,
I certify that-1 have read this application and state that the. \ LICENSE NO. •j�J,> J�� CLASS - •. - '
above information is correct. I agree to comply with all County {k
ordinances and State laws relating to building construction,
and hereby authorize representatives of this County to enter
up `the ab o menti ne property for inspection pur oses..
SEE REVERSE FOR EXPLANATORY LANGUAGE _
/11 Signature of Applicant or Agent Dote
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