HomeMy Public PortalAbout6036 KAUFFMAN AVE_Mechanical__ 76A364C
CE-818 (REV TI:/78)
®s APPLICATION FOR PERMIT
HEATING - VENTILATING -,,AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN UAD
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(PRINT OR TYPE ONLY) SS "0,3 t %
ITY.NO TYPEOF APPLIANCE OR EQUIPM NT FEEST
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ABSORPTION UNIT,BTU .�
OWNER —_ n) rxt
AIR HANDLING UNIT,CFM % L/✓ MAIL -
ADDRESS let ex7i
BOILER,BTU
/� 0 CITY77 C TEL NO-2(//�/q
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COMPRESSOR,BTU CONTRACTOR
VENTILATION SYSTEM -
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ADDRESS 3U`
EVAPORATIVE COOLER CITY -- TEL NO S3`
FURNACE FAU GRAVITY STATE LIC
FLOOR BTU• LICENSE NO /.S CLASS
HEATER' SUSPENDED UNIT_ APPROVALS DATE INSPECTOR'S SIGNATURE
WALL
ROUGH 8�4- .�-. d•..✓ �.
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FINAL O
V
INSPECTION RECORD pm
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Plan check fee 25% of above.
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PERMIT ISSUING FEE$
TOTAL FEE
PLAN CHECK APPLICANT PLAN CHECK VALIDATION f �/
NAME � ,r j�Y��"�//,p /�,y�/f/ � / .�`•Z 9�i O
ADDRESS
CITYTEL NO.;•
. Al ff• q\ •
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND Il\
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL V \\�1
ORDINANCES AND LAWS REGULATING, HEATING. VENTILATING, AIR n �0 5 0,q A
CONDITIONING PERMIT VALI AT N ` c
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF 2 1.02\0 0
CHAPTER 9, DIVISION 3. OF THE'BUSINESS AND PROFESSIONAL CODE '
OF THE STATE OF CALIFORNIA O 1,00'
1 0 0 J
SIGNATURE n p Na � 1 �~
OF PERMITTEE_/ ( � 0527-.. 0
DISTRICT NO PROCESSED BY O O O Q. �J
No Q 1� O _
!• O ?Si
O O O ]�
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WORKERS'COMPENSATION,DECLARATION CE 81 C P P y� N (� �/�
" : : CE-818 (2-80)' �I�II— LS���/i—"�1��®tlCl �®� Ir��UVUO� ,
I heie• y affirm that'l have a' certificate of consent to self
insure,or.-a certificate of Workers'Compensation Insurance,Or H EATING_ NTIL:ATING-AIR CO
a'cer fled co�•¢thereof(Sec, 3800,Lab.C.) `
'Policy No. Company COUNTY OF ANGELE B I 'r'AND SAFETY
Certified copy is hereby furnished.
Certified copy is filed with the county building inspectionBUILDING ' '
department. FOR APPLICANT TO FILL IN ADDRESS
Date Applicant (PRINT OR•TYPE ONLY_)
LOCALITY �C J
CERTIFICATE OF EXEMPTION FROM WORKERS' No. TYPE OF APPLIANCE OR EQUIP MENT FEE _G '��"i-
COM-PEN,SATION INSURANCE NEAREST }
(This "section need not be completed if'the work involved ABSORPTION UNIT, BTU CROSS ST. /L :� 0'
by the permit is for one-hundred dollars ($100) or less.) DISTRICT PRS, ss B U
I certify that in the performance of the work for-which this AI"R HANDLING UNIT,CFM
"permit is is'sued,'I,shall,not employ any person imany manner _
so as to become subject to the Workers' Compensation Laws. B01LER, BTU ~
APPROVALS DATE INSPECTOR;SS1 +'SURE tU
Date Applicant ..COMPRESSOR,BTU ROUGH
NOTICE T.O,APPLICANT.: If,after making this CertiffcAe.of VENTILATION SYSTEM. z
Exemption;. you' should become subject to the Workers' FINAL
Compensation provisjons.of the Labor Code,you must forth- EVAPORATIVE1COOLER VALIDATION
'wi'th' comply with such provisions' or t4is permit shall be
deemed.revpked: FURNACE: 'FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR: BTU-
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- . WAl'L
ness•and Professions.Code, and m license is in full force and
-effect.' y �� �:
L
License Number Lie.Class
Contractor 'Date
I am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer Plan check fee 25%of above.
acting in.my professional capacity (Section 705.1, Bus-
iness and Professions Code). PERMIT-ISSUING.'FEE $
Lie.or Reg.No: Date TOTAL FEE67
HOME OWNER-BUILDER,DECLARATION. PLAN CHECK APPLICANT, �1 a
I hereby affirm that l.,am exempt from- the Contractor's NAME
Lice/e Law for the following reason (Sg6tion-7031.5, Busi= p�V
nes,and ProfesSions Coda) gDDRESS
1 r' [, as owner of the property,will do the work and the TEL. NO. 'l 1 2
n 5 1 A
structure'is not intended or.offered tosa (le Section CITY ;
7044, Business and Professions Code). - 1# o o o•o 4-1
❑ OWNER
I, as owner of he.property, am exclusively contracting I - 0 Z— • 2 ° ° 1 :Z 0 0
with" `licensed contractors to construct the project MAIL
(Section 7044, Business and Professions Code). ADDRESS (�� ��� o' o 0 1 7,0.0
CITY J,Q TEL.NO. Q�, /�
CONSTRUCTION LENDING AGENCY- ' ' „JE11,v 0 7'1 5-80
I hereby affirm that there is a construction lending agency CONTRACTOR
for the performance of the work for which this permit is
issued (Sec. 3097,'Civ.C.).
Lender's NameADDRESS
Lender's AddressCITY , TEL.NO. -
I certify that'1 have read this-application and state that the STATE LIC.
above information is correct. I agree to comply with all County LICENSE NO. 'CLASS
'ordinances and.State laws regulating Heating, Ventilating and
Air Conditionipg, and hereby author ,e representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE r
County to ent upon tl a*^ „�ennoned pro arty f;r v
i spection pur as.
nature-,! Permittee Sate