HomeMy Public PortalAbout10034 LA ROSA DR_Mechanical__ ( 76�A i64CE 8I'8 -I/75 -
APPLICATION F PERMIT
HEATING, VENTILATING - AIR CONDIT'I NING
COUNTY OF LOS ANGELES BUILDI5NG
5 10034 L8 R088
DEPARTMENT OF COUNTY ENGINEER .
ADORE-BUILDING AND SAFETY DIVISION
LOCALITY
NEAREST
CROSS ST. RaldWin
FOR APPLICANT TO FILL IN OWNER ,- - R.N. -Cons trucaia_en `
- - - (PRINT-OR'TYPE ONLY) - -
MAIL
No•. T.YPE&SIZEOF EQUIPMENT - - ADDRESS_, .i 1271 N '. -
^ SEE BACK OF APPLICATION FEE O• Normandie Ave.
p� CITY . L.A. ' TEL. NO.
FORCE AIR FURNACE, BTU - 'V
CONTRACTOR Gibson's i{emiort Air, Inc.
COMPRESSOR;*BTU -
ADDRESS 7032. Darby AVE• "
VENTILATIONFAN -
clrY Reseda TEL. No:', ; 996-4314. _
LIST.ALL.OTHERS BELOW STATE 303400 ' LIC.. C 20 .
LICENSE NO, l CLASS
DISTRICT NO. GRDUP - ZONE PX ESSED By '
08 -) 21
' ,INSPECT]ON(RECO R -
a
o
r U
F
U
.,Plan check fee. Seer verse:
- .' . I'F.R\IIT IS�IiISG k-li li 3' h� -
- TO 111. V I:IP -
PLAN CHECK APPLICANT
NAME
ADDRESS . - -
CITY TEL.NO:" -
I HEREBY ACKNOWLEDGE THAT HAVE REAO,TNIS APPLICATIONrFINAL
AND STATE THAT THE ABOVE I5 CORRECT AN0AGREE TO COMPLY'WITHALL ORDINANCES 'AND LAWS REGULA ANG HE ING. VENTI- APPROVALS 'DATE INSPECTOR'S SIG TURE
LATING, AIR CONDITIONING. lieAHEREBY CERTIFY AT AM AC GIN VIOLATION -
[41177 1
01`CHAPTER 9. DIVI51 E '..INES NO PROFESSIONAL[ODE'OF THE STATE L' RHIA-SIGNATURE IT VALIDATION'(::::1 M.O. 1, CASH
OF PERMITTEE_
PLAN CHECK VALIDATION
.9 0 z4 Al IG 26'41
WORKERS'COMPENSATION DECLARATION 76A364C -
1 hereby affirm that I have a certificate of consent to self CE -SIB Iz-Bol APPLICATION FOR PERMIT
insure, or a.certificate of Workers'Compensation Insurance,or - HEATING-VENTILATING-AIR CONDITIONING
u certi'f"J, i r^ f(Sec. 3800, Labb C)
Polic''1.o. Company_]r_r� - --
❑
Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified ropy is filed with.the county building inspection. BUILDING
depa tm t ' ffss (� FOR APPLICANT TO FILL IN gDORESS bSftf�'
Date AAm k_ Applicant_14 •"'�+^ti--'---�� - (PRINT OR TYPE ONLY) �QO�� /( �� '
LOCALITY T>f_=%N&;)�r� C-1
CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OREQUIPMENT FEE
COMPENSATION INSURANCE NEAREST � 1c� 1 y
CROSS�ST. WIU C
(This section need not be completed if thework involved ABSORPTION UNIT, BTU O
Py the permit is for one hundred dollars ($IB$) or legs.). DISTRICT NO. PROCESSED BY U
I certify that in the performance of life work for which this AIR HANDLING UNIT,CFM Ti D f� cc
permit Is issued, I Shall not employ any person in any mariner
so as to become subject to the Workers' Compensation Laws. BOILER, BTU—`QC/-%Q! ~
J APPROVALS DATE INSPECTOR'S SIGNATURE W
Date Applicant COMPRESSOR, BTU ROUGH _ N
NOTICE TO APPLICANT: Iff,.after making this Certificate of VENTILATION SYSTEMZ
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 (evoked: 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- WALL
ness and Professions Code, and my license'is in full'force'and } /]-
effect. - - -
LicenseNamberLia Class ,`
Contractor-e-Al Pools Date_3-2-Y-02 .
❑ b am exempt .from the licensing reuuiiements as T am a -
licensed architect or a registered professional engineer Plan check fee 25%of above.
acting in my professional capacity (Section 7051-. Bus
iness and Professions Code). PERMIT ISSUING FEE $ �6
Lic.or Reg.No. Date TOTAL FEE '33 .,SC
HOME OWNER-BUILDER DECLARATION
PLAN CHECK APPLICANT -
1 hereby affirm that 1 am exempt from- the Contractor's hADDRES$
Cryo 7QO`S _
License Law for the following reason-(Section 703.1.5, Busi-
nessand Professions Code);I, as owner of the property, wilfdo:the work and the 20Sstructure is not intended or offered for sale (Section p•�_r � b_(-1TEL.NO.7044, Businessand-Professions Code). w
OWNER •Q;�� � IC � hs . 33.7:7A
❑'I. as owner of the property, am exclusively contracting - 1 ,
with licensed contractors to construct the project MAIL
1Q73 h.�A ROsn?� #ja�e le • e 8
(Section.7044, Business and Professions Code). ,
CITYT l�(�
CONSTRUCTION LENDING AGENCY g IF.m�,e�1 TEL. NO.L' , 1=5V - 2!-!'- 3,3.5,0
I hereby affirm that there is a construction lending agency �r 4t ` roO) A 000/ 5 .j 3,5 O
for the performance of•the work for which this permit is CONTRACTOR (�!Y A / •e e.e = '
issued Sec.309'7.Civ.C.)
Lender s Name %J If% ADDRESS"08(X0 _JC.�s (V s 03'2'4I_8-2
-
Lender's Address CITY L'n � br1`J� TEL. NO. �dc_Z Z6 - -
1 certify that i have read this application and state that the STATE•Je•TT1 ((�/�rr�� LIC. OJ
above information is correct.I agree to comply with all County• LICENSE NO. 1 tVCi CLASS
ordinances and State laws regulating Heating. Ventilating and -
Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE '
County, to enter up-ri the above-mentioned property, for
S coon purDase.. 1 '
Sc. _ _ 3 2 1�s2
1`�-
Signature of Permittee Date