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Home My Public Portal About9460 KENNERLY ST_Mechanical__ 74 A364- CE 818- 5--73 APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING ,. DEPARTMENT OF COUNTY ENGINEER ADDRESS O /� �— BUILDING AND SAFETY DIVISION LOCALITYINEAREST e, G CROSS ST. /(�C!�/ 7 .. FOR APPLICANT TO FILL IN OWNER �LrT �'� (PRI INT OR TYPE ONLY) A/ MAIL ] UN�s NO. TYPE OFAPPLIANCE OR EQUIPMENT FEE ADDRESS �- CITYrT TEL. NO. S 7/ABSORPTION UNIT, BTU ,/ Q CONTRACTOR#j Ll L U In,./// AIR HANDLING UNIT, CFM 1' C ADDRESS O BOILER, BTU CITYC��q-�� TEL. NO.� �a �- COMPRESSOR, BTU STATE LICENSE NOF? 6(016 LIC. 57// 6 CLASS li l^X. VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED BY EVAPORATIVE COOLER 6) Al 1GJe-L- FURNACE: FAUGRAVITY INSPECTION RECORD FLOOR BTU HEATER: SUSPENDrFA UNIT WALL >- CL. O U K O H U W d N Plan check fee 255 of above. See reverse. Z PER\417' ISSUING FEE 8 00 TOTAL FEE PLAN CHECK APPLICANT NAME ADDRESS CITY TEL.NO. e I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 2 1 9 6 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE LATING, AIR CONDITIONING. ROUGH I HEREBY CERTIFY THAT I AM NOT ACTIN IN VI ATION OF CHAPTER 9, DIVISI 3, OF THE BUSINESS PROFE NAL FINAL CODE OF THE STATE O ALIFORNIA. SIGNATURE66tif MIT VALIDATION CK. NroOp O 1 C`fTSo O U OF PERMITTEE , 78 PLAN CHECK VALIDATION CK. M.0. CASH I O_ SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate,of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING or a certified copy thereof (Sec. 3800, Lab. C.) 76A364C 20-0046 DPW 9/88 Policy No. Company ❑ 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 q� tion department. (PRINT OR TYPE ONLY) ADDRESS Date Applicant LOCALITY s NO. TYPE OF APPLIANCE OR EQUIPMENT FEE G CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST l COMPENSATION INSURANCE CROSS ST.�E,y /� ��- v /v 0 (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. PR ED 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 1 so as to-become subject to the Workers' Compensation Laws. BOILER, BTU APPROVALS D TE INSPECTOR'S SIGNATURE Date Applicant COMPRESSOR, BTU ROUGH ^ 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 ALI ATIO with comply with such provisions or this permit shall be deem- ed revoked. FURNACE: FAU ATY rn LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business WALL. and Professions Code,and my license is in full force and effect. License Number Lic. Class , O V Contractor Date ❑ O I am exempt under,Sec. Plan check fee V LU B.&P.C. for this reason 9L Date: PERMIT ISSUING FEE $ 60 Signature TOTAL FEE a OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and NAME Professions Code): gyp(' - - ,JGX` I, as owner of the property, or my employees with ADDRESS f^if'i'_..• eIlLr wages as their sole compensation, will do the work and CITY TEL. NO. ;37;077*7 the structure is not intended or offered for sale(Section �:ilf Lai='LI=� 7044, Business and Professions Code). OWNER I, as owner of the property, am exclusively contracting t �-` ❑ with licensed contractors to construct the project (Sec- MAIL s I� [t3 tion 7044, Business and Professions Code). ADDRESS L 37 . 01D CONSTRUCTION LENDING AGENCY CITY TEL. NO. L-H=,Ho( (: I hereby affirm that there is a construction lending agency for 01111. 1 the performance of the work for which this p rmit is issued CONTRACTOR CHAM=� °`i1' (Sec. 3097, Civ. C.). ADDRESS Lender's Name r; 1 / CITY TEL. NO. 0 5•� Lender's Address ��D �� 1� I certifythat I have read this application and state that the STATE LIC. PP LICENSE NO. CLASS above information is car�cs t. I agree to comply with all County ordinanc and State I relating to building construction, and h9.', yauth rizeresentatives of this County to enter upon above menti re property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE -.-3 Sig e of App icant WAgent Date ©s