HomeMy Public PortalAbout6127 KAUFFMAN AVE_Mechanical__ IPPLI� MIT
;6A364 - CE818 - 3-69
HEATING - VENTILATING -AIR CONDITIONING
COUNTY OF LOS ANGELES FU
DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION
JOHN A. L'AMBIE, COUNTY ENGINEER COLEMAN W. JENKINS,SUPERINTENDENT OF BUILDING
FOR APPLICANT TO FILL IN
OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
ABSORPTION SYSTEM, BTU CIT TEL. N
CONTRACTO
AIR HANDLING UNIT, CFM
A D 0 R E S
BOILER, HORSEPOWER �rIf
CI TEL. NO.
COMPRESSOR, HORSEPOWER STATE LI
LICENSE N
VENTILATION SYSTEM OISTRW NO. GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY
FLOOR BTU INSPE TION RECO D
HEATER: SUSPENDED UNIT Gi 7(
J 1114O
V
fie
� O
0
V
Lu
CL
N
NEW-ADDITION- PERMIT $• 3 00 Z
ALTER-REPAIR- TOTAL FEE $
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL. N0.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
LR
E THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
ORDINANCES AND LAWS REGULATING HEATING,VENTI- ,APPROVALS DATE INSPECTOR'S SIGNATURE
IR CONDITIONING.
BY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH9, DIVISION 3, OF THE BUSINESS AND PROFESSIONALFINALHE STATE OF CALIF NIA.
E JACK R. ALLEN, SUPE NG MECHANICAL ENG'R.
TTE -
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION
LAr 0-6-7-79F- SEP 10 4. 1 D� 7.00- q .
+EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
,vp12K,Ea5'COMPENSATION DECLARATION CEA 8 8 (2-80) APPLICATION FOR PERMIT
�oy�:4frm that I have a' certificate of consent to•self
insure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONING
a certified ropy t�r �
Policy No A�1mpany
El Certified copy is hereby furnished. COUNTY-OF LOS ANGELES`- BUILDING ARID SAFETY
Certified.co y is filed with th' coun'y buildir,I•s ection BUILDING a__ 1
'❑ p p FOR APPLICANT TO FILL IN /,Z �fi�'l
Datear len ADDRESS _�
Applicant_)__t— (PRINT OR TYPE ONLY) - ;
LOCALITY C �/ /J
CERTIFIC TE OF EXE;dPTION FROM`JORKERS' h10. TYPE OF APPLIANCE OR EQUIPMENT FEE
COMPENSATION INSURAN( E NEAREST
' CROSS ST. t�(7'�. CJS -s'• }'
(This section, nee¢ not be, completed• if the work involved ABSORPTION UNIT, BTU a
by the permit is for.one'hundred dollars (5100) or less.) DISTRICT NO. PRO aV _ O
I certify^that in the performance of the work for which-this AIR HANDLING UNIT,CFM b
permits issued, I shall,not employ any person in any manner ^'
so as to become subject to the Workers:Compensation Laws. BOILER, BTU O
O APPROVALS DATE INSPEC,OR'S SIGNATURE V
Date Applicant ( - COMPRESSOR,BTU
_ ROUGH,. �^ _ _ N
NOTICE TO APPLICANT: If, after making this Certificate.of -VENTILATION SYSTEM
Exemption, you should become subject• to the Workers' FINAL 1 z
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 IECLARATION 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- WALL
ness and Professions.Code, an my license is in full force and
effect. 7? -
License Number 17/ / _ Lic.Class
Contractok 0� O_'V Date
❑ I am exempt from the licensing requirements as I
licensed architect. or a registered professional engineer Plan Check fee 25%of above.
xrr .
acting in my professional'capacity (Section 7051, Bus- - - i•.-
iness and-Piofessions Code). PERMIT ISSUING FEE $ U � �`•
Lic.-or Reg:No. Date TOTAL FEE 30 Sv
.x;. ',\ � �r
-HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT A (4)0 LFS�iV r.
I hereby,affirm that 1. am exempt from- the Contractor's NAME
License Law:for the'following reason- (Section 7031.S,'Busi-
'riess and Professions Code): ADDRESS KAM
❑ I,,as owner of the property, will do.the work and the
structure is not intended- or offered for sale (Section. CITY ` /� d/Ij'O' TEL. NO 17
7044, Business and Professions Code).
❑ OWNER
'I, as owner of the property, am exclusively contracting
with licensed contractors to constructthe project MAIL ��
(Section 7044, Business and Professions Code). -ADDRESE612
CITY C TEL.NO.
CONSTRUCTION LENDING AGENCY �' (�•�•
.I .hereby affirm that' tht re.is''a construction lending agency - -
for -the performance of the work for which this permit is CONTRACTOR
issued (Sec. 3097,Civ.C.).
L
`Lender's Name ADDRESS /Z a 9�76 13_-91
Lender's Address - LLST
Y /1666( �� � TEL N0J-73_V-V.-! p
I certify'lhbt d.hale read this application.anis state that the TE S LIC.
above information is correct. I agree to comply with all County ENSE NO. CLASS
ordinances and -State laws regulating Heating,-Ventilating and
Air C Idi(ioning, and hereby authorize representatives of this SEE REVERSE FOR ,XPLANATORY LANGUAGE
- Co y .toWenter' on the above-mentioned property for, / �✓ .� p/— '
Signature of Per nittee Date