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Home My Public Portal About9570 KENNERLY ST_Mechanical__ 76A364E(rE-61SA)-9/77 , r t APPLICATION FOR PERMIT HEATING - VEN JLATING, - AIR CONDITIONING COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN BUILDING (PRINT OR TYPE ONLY) ADDRESS LOCALITY -F ' NO TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST �� /� /,•�/ " CROSS ST ABSORPTION UNIT,BTU - OWNER el,ai L� AIR HANDLING UNIT.CFM MAIL ADDRESS BOILER,BTU CITY TEL NO COMPRESSOR,BTU CONTRACTOR VENTILATION SYSTEM ADDRESS EVAPORATIVE COOLER CITYTEL NO r FURNACE FAU GRAVITY STATE LIC FLOOR BTU LICENSE NO CLASS HEATER SUSPENDED UNIT- DISTRICT NO GROUP E ESSED BY WALL /� � - "V INSPECTION RECORD d O U c O Plan check fee 25% of above- PERMIT ISSUING FEE$ TOTAL FEE -PLAN CHECKLVPLICANT NAME r � ADDRESS CITY TEL NO IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING VENTILATING, AIR . CONDITIONING I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF APPROVALS DATE, INSPECTOR S SIGNAfIURE CHAPTER 9, DIVISION 3 F THE BUSINESS AND PROFES NAL CODE - OF THE STATE OF CALIF IA r ROUGH SIGNATURE � FINAL, OFPERMITTEE PLAN CHECK,VALIDATI CK M CASH PERMIT VALIDATION CK MO CASH OD (' fal Stl�_• co J O O 4- .O Cb O & 7ro CH ©S WORKERS'COMPENSATION DECLARATION CEA3818(2-80) ��d=i��®0�! �®� ��del}�� I hereby affirm that I have.a certify.ate of consent to self Insure, or a certificate of Wo&ers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDIYIONIMG Ga'cert�iffiied copy.thereof(See 3800,Lab PC)) �y a4'ol�A,(3 7fP_CJn1Nany—s/=/-✓-�s�T Cn i opy is hereby furnished COUNTY OF LOS ANGELES �� BUILDING ARID SAFETY Certified copy is filed with the county building inspection FOR,APPLICANT TO FILL IN BUILDING department_ Date, pplicanL�i�✓ QQ�-ef (PRINT OR TYPE,ONLY) ADDRESS LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO TYPE OF APPLIANCE OR EQUIPMENT FEE COMPENSATION INSURANCE NEAREST Jrr (This section need not be completed if the work involved ABSORPTION UNIT, BTU CROSS ST by the permit is 'for one hundred dollars ($100)'or less.) DISTRICT NO PROCESS J BY Q I certify that in the performance of the work for which this I AIR HANDLING UNIT,CFM D 15-1I/ y O permit is issued, I shall not employ any peison in any manner /�� O so as to become subject to the Workers' Compensation Laws BOILER, BTU__1 APPROVALS DATE INSPECTOR S SIGNATURE V Date Applicant COMPRESSOR,BTUa ROUGH NOTICE TO APPLICANT If, after making this Certificate of VENTILATION SYSTEMa" N Exemption, you should become subject to the Workers' FINAL Z Compensation provisions of the Labor Code,you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be 7 deemed revoked '0 (7 FURNACE FAU GRAVITY - LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that i am licensed under provisions of Chapter HEATER SUSPENDED UNIT 9 (commencing wifh Section 7000) of Division 3 of the Busi- WALL - ness and Professions Code, and my license is in full force and effeet. 7 License Numbber_/ ,�./r�lLic ClasC Contractoii'jJ�"y J/5/�Ga✓ Date—1-7::: 6 I am exempt from'the licensing requirements as I am a licensed architect or a registered professional engmeer Plan check fee 25%of above, acting irr my professional capacity (Section 7051, Bus- iness and Professions Code) PERMIT ISSUING FEE $ Lic or Reg No Date TOTAL FEE, HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICA 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 Of' 1, as owner of the property, will do the work and the CITY TEL NO #,o'o jo o,0 8 structure is not intended or offered for sale (Section 7044, Business and Professions Code) OWNER 2 o,o°2 7,0 0 I, as owner of the property, am exclusively contracting � with licensed contractors to construct the project MAIL } o o e 2'7,0 0 z (Section 7044, Business and Professions Code) . ADDRESS J_ i f i U CONSTRUCTION LENDING AGENCY CITY TE _N �L��may``! / X,02-8;1 I hereby affirm that there is.a construction lending agency �� for the performance of the work for which this permit is CONTRACTOR issued(Sec 3097,Civ C) - Lender's Name ADDRESS/ ^/A Lender's Address C� CITY - �/��s - TEL NC�gr/ _ f •� I certify that I have --d this application and state that•the S Alt LIC above information is orre•t I agree to comply with all County LICENSE NO ��e CLASS ordmanc- ind State laws regulating Heating,Ventilating and Air C, ..itio'ing no here.y authorize representatives of this SEE`REV ERSE FOR EXPLANATORY LANGUAGE moi ,ity to t nt, up• n ie above-mentioned property for ' u .pectin 001 s Signdta e c Permittee