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HomeMy Public PortalAbout5037 KAUFFMAN AVE_Mechanical__ z +76A 64C CE-818(REV.6/78) ©s 'APPLICATION FOR P.. . FAIT .`: EATING , VEMTILATING;'- A-0R CONDITIOOIING,. COUNTY OF LOS ANGELES r "BUILDING AiS� iAFETY FOR. TO-F'ILL IN BUILDING } •" yy (PRINT OR TYPE.ONLY) ADDRESS • • CALITY NO. TYPE APPLIANCE O.R1EQUIPMENT-:.•- �r FEE' �, • _ , _ LO . . 'NEAREST..;.. 'CROSS ST. /•� ',�'GS/a . ABSORP_TIONUNIT,BTU, 'OWNER " AIR,HAND.LING UNIT,CFM ` MAIL '. cls ..ADDRESS. - ,BOILER.BTU .. -CITY �"C- .TEL.NO. COMPRESSOR BTU ' - CONTRACTOR,� �^��•-_ . ION:`SYST•EM' l- VENTILAT - ADDRESS' "l-`�GLj/ /✓ya�,? !��•�j� - EVAPORATIVE COOLER ' .. .. CITY .L TEL.NP,, ' FURNACE: ; F A U GRAVITY STATE LIC v FLOOR -STU� � - � LICENSE NO � - . CLAS HEATER: •SUSPENDED • UNIT_ - APPROVALS - ^DATE- .INSPECTOR'S5IGNATU RE WALL , .- ROUGH..,,. FINAL.,- _5 s. " INSPECTION RECORD Plan check fee 25% of above e'PEIRMIT.ISSUING FEE Z'. TOTAL FEE .. PLAN'C,HECKAPPLICANT PLAN CI„IEGI'C.VALIDATION :NAMEz .ADDRESS. CITY - TEL.N6 .. - ''r. IHEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATIONAND , STATE THAT-THE ABOVE IS CORRECT AND AGREE;TO COMPLY WITH ALL-ORDINANCES .AND LAWS REGULATING HEATING; VENTILATING,,. AIR t' 2,x4:9.4R CONDITIONING. PERMIT VALIDATION I HEREBY CERTIFY.THAT, I AM� NOT ACTING- IN VIOLATION .OF. # O`O:O 0,4 1 -CHAPTER 9. DIVISION 3, OF THE BUSINES PROFESSIONAL CODE :OF THE'STATE OF CALIF y _ ' 210-o1 -300 SIGNATU RE,' ,l/�/,•c{ ,. - . OF PE RMITTEE� � "` O.O 0'0 DISTRICT NO. PRO BY 'v p 11 2-7.9 i 1 • WORKERS'COMPENSATION DECLARATION CE'-8 4C /A I�lid p �(�A T�O N FOR lid E oR� T I hereby affirm that I have a certificate of consent to self CE-818'(2-80) 6=�If- Ir L-a �v o v Ir If�S Il- insure, or a certificate of Workers'Compensation,Insurance,or HEATING-'VENTILATING_l�l(� CONDITIONING certified'copy thereof(Sec. 3800,Lab.C.) Policy No.�:k(&d3:Company PAOIu�a+A-t. Certified copy is hereby furnished. COUNTY OF LOS'A,NGE IES. ` BUILDING ARID.SAFETV aCertified copy is filed with the county building inspection BUILDING department. FOR APPLICANT TO FILL IN Date �4 Applicant CL1NtATE edit. t (PRINT OR TYPE ONLY) ADDRESS b3 7 le-AUt=�wtana LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' ` NO. TYPE OF APPLIANCE OR EQUIPMENT FEEI�PL� C Pry, COMPENSATION INSURANCE NEAREST } (This section need not be completed if the work involved ABSORPTION UNIT, BTU CROSS ST. ®S°tf a0 by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. Pt4 c E v U I certify that in the.performance of the work for which this AIR HANDLING UNIT,CFM Cr permit is issued, I shall not employ any person in any manner . '� so as to become subject to the Workers' Compensation Laws. BOILER, BTU Lt pP f— APPROVALS DATE ECTOR'S S TUR. U LU Date'/O- "ko Applicant C61-IP GLtr.rn iii `' IVML � COMPRESSOR, BTU _ O 0_U_ 10 �a ROUGH CL NOTICE TO APPLICANT: If, after making this Certificate ofVENTILATION SYSTEM z Exemption, you should become subject to the Workers'. FINAL _ Compensation provisions of the Labor Code, you must forth-' with comply with such provisions or this permit shall be EVAPORATIVE COOLER VALIDATION deemed revoked. FURNACE: FAU GRAVITY . BTU—!2 Fi,_Ood ' LICENSED CONTRACTORS DECLARATION � FLOOR: -2c, . Do ' 1.hereby affirm that I am licensed under provisions of Chapter HEATER: . SUSPENDED UNIT 9 (commencing with Section 7000) orf Division 3 of the Bu WALL ness and Professions Code, and my license is in full force and effect. e� + License Number._S416", Lic.Class� G-Lts► G—ro' • cL�-►JC Contractor CL►M Date— Q_ q' t ❑ Gb I am exempt from the licensing requirements as'I am a e 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 $ '7 p 0 Lic.or Reg.No. Date TOTAL FEE 37 np 3 HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from- the Contractor's NAME License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): ADDRESS I, as owner of the property, will do the work and the ; TEL. NO. structure is not intended or offered for sale (Section CITY.. 7044, Business and Professions Code). 0 OWNER C3 IC fits FFM7�n1 1 I; as owner of the property, am exclusively contracting _ � 2`.4 8 7 A with licensed- contractors to construct the project MAIL (Section 7044, Business and Professions Code). ADDRESS SA-L A-V I L s9 # 0,0,0:0 41 CONSTRUCTION LENDING AGENCY ' 'CITY'-r&-mpG.a C 19 y TEL.NO. _41LY3 I.hereby affirm that there is a construction lending agency Z o io 33.0 0. for theerformance of the wo`k for which this permit is CONTRACTOR L issued (Sec. 3097,Civ.C.). ' 0 0 0 Lender's Name ADDRESS 1Z d � 1 /`eier � `y-r 3 7, D U Lender's Addressof NO.CITY TEL. _ O 0,6 8,0: p us r�Y .�`2 I certify that I have read this application and state that the 'STATEo LIC. above information is correct.I agree to comply with all County LICENSE NO. l bl CLASS C- G-tO ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter upon the above-mentioned property for inspection purposes. Signature of Permittee Date