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HomeMy Public PortalAbout5728 KAUFFMAN AVE_Mechanical__ 76A364-CE818-1/70 APPLICATION FOR PERMIT KEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING CROSS ST. _ FOR APPLICANT TO FILL IN OWNER / (PRINT OR TYPE ONLY) (5- 5*To MAIL I / IV NO. TYPE OFAPPLIANCE-OR EQUIPMENT FEE ADDRESS 1 X A /V CITY / TEL. NO. 7 8 .-3.S' ABSORPTION SYSTEM, BTU CONTRACTOR S - AIR HANDLING UNIT, CFM ADDRESS C i BOILER, HORSEPOWER CITYV 7 TEL. NO. ;2 � - -y COMPRESSOR, HORSEPOWER STATE LIC. LICENSE NO. (J q CLASS �i VENTILATION SYSTEM DISTRICT N0. CLASS GROUP ZONE ROCESSED Y EVAPORATIVE COOLER -3,OF �' FURNACE: FAU_GRAVITY FLOOR BTU INSPECTION RECORD HEATER: .SUSPENDED UNIT_ 0 /11-le- WALL y/ 0 U I- LL /,,((/� /� j[ all NEW—ADDITION— PERMIT $ 3 00 �{ -/' G 9 ALTER—REPAIR, TOTAL FEE $ PLAN CHECK APPLICANT -7'1-72- 4�% ll *® NAME 76 ADDRESS CITY TEL.NO. - 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCESAND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE LATING, AIR CONDITIONING. ROUGH r✓a 1 HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL CODE OF THE STATE OF CALIFORNIA. SIGNATUREJACK R. ALLEN,SUPERVISING EC ICAL ENG'R. OF PERMITTEE PERMIT VALIDATION CK. O- CASH PLAN CHECK VALIDATION 021 L,A1 O 7 7 � 2-1-- GLG 17 4 1 D E.".0 JM SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 'WORKM�S'COMPENSATION DECLARATION 76A364C p (o no (� p (off o (� 0 �/� I hereby affirm that I have a certifidate of consent to self CE-818 (2-80) Q Ir– If_ Lam. C Q T�0 N FOR FI E R U�/lt �T insure, or a certificate of Workers'Compensation Insurance,o,r HEATING-VENTILATING-AM ILATBNG_pM GONDMO(v MG a t^.entified copy thereof(Sec 3800 L-b.C.) Pr_.ft ��1ye-- pan — COUNTY OF LOS ANGEL ��. BUILDING AWDZAFETY L-I' Certified copy is hereby furnished. Q Certified copy is filed with ti.a rpu y building inspection BUILDING FOR APPLICANT TO FILL IN depart nes �� T. - ADDRESS Date_ _ _` - pplicanty (/_/�_ _ _ (PRINT OR TYPE ONLY) --7 -. - LOCALIT CERTIFICATE OF EXEMPTION FROM WORKERSNO. TYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE .. .. NEAREST } _ ' CROSS ST. �- (This section need not be completed if the work involved ABSORPTION UNIT, BTU _ — —=- O by the permit is for one hundred dollars (000) or less.) DISTRICT NO. PRO(- SED BY 0- I certify that in the performance of the.work for which this AIR HANDLING UNIT,CFM /j permit is issued, I shall not employ any person in any manner !/ so as to become subject to the Workers' Compensation Laws. BOILER, BTU /���� `q APPROVALS DATE INSPECTOR'S SIGNa URE U' Date Applicant COMPRESSOR,BTU_�t7[7�`� vt w a ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM 1( z Exemption, you should become subject to the Workers' FINAL 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 `;RA�rITY / LICENSED CONTRACTORS DECLARATION FLAOR: _ BTU `3.�j —�'�' I 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. '''77 {^ jj /9tJ�/ 7� License Numbe"___ __ Lic.Class '.�2Vy OContraakm �from Date DI ensing requirements as I am a licensed architect or a registered professional engineer Plan check fee 25%of above. acting in my professional capacity (Section 7051, Bus- PERMVT 9SS�D9itl ��� iness and Professions Code). Lic.or Reg.No. DateTOTA) HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from-the Contractor's NAME 2.317'6 A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): ADDRESS j# o'.o,�o ro o 8 ❑ 1, as owner of the property, will do the work and the TEL.NO. 2 olto 4a50- ' structure is not intended or offered for sale (Section CITY 7044, Business and Professions Code). ❑ . . �s o 0 0 I, as owner of the property, am exclusively contracting OWNER 4$506 with licensed contractors to construct the project MAIL (Section 7044, Business and Professions Code). ADDRESS_ _ ( 2.18„=8 CONSTRUCTION LENDING AGENCY CIT _C TEL.NO 6 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is CONTRACTUP —j4 „© issued(Sec.3097 Civ.C.). Lender's Name ADDRESS Lenders Address CITY TEL.NO. 1� (, I certify that I have read this application and state that the. STATE �+ LIC. above information is correct.I agree to comply with all County LICENSE NO. _�y2J_ _d / CLASS ordinances and State laws regulating Heating, Ventilating and Air Conditionll g, and hereby authorize representatives of this - SEE REVERSE FOR EXPLANATORY LANGUAGE County o ,rater upon the above-mentioned prop rty for iusp ,.rposes . igi atu.e of Permittee Date