HomeMy Public PortalAbout9468 LA ROSA DR_Mechanical__ 76 A364 - CE 818- 5-73 �� '
APPLIC ION FOR PERMI
HEATING -'VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
(od i�.Sl K'o
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY 7'�jf(J
NEAREST / 1
CROSS ST.Lol, U&/_C
FOR APPLICANT TO FILL IN. OWNER '4`��
77-
(PRINT OR TYPE ONLY) T
MAIL `6�
No TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS �j/ ZA A '
CITY22t� /� i� TEL. NO.��i�
ABSORPTION UNIT, BTU' R
CONTRACTOR01
AIR HANDLING UNIT, CFM
ADDRESS
ABOILER, BTU CITY TEL. NO.
COMPRESSOR, BTU 17 STATE' LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP z PRO SSED BY
EVAPORATIVE COOLER
FURNACE: FAII GRA ITY 'INSPECTION RECORD
FLOOR • BTU d
HEATER: SUSPENDED • UNIT_
WALL
O
U
O
W
\ a.
Plan check fee 2Wbf above. See reverse.
PERMIT ISSUING FEF, S 3 00
TOTAL FEE Q
PLAN CHECK PPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALLORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS- DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING.
• ROUGH '
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSINE NO PROFESSIONAL FINAL � � %-7
CODE OF THE STATE OF CALIFORNIA.
SIGNATURE " PER T VALIDATION CK. M.O. CASH
OF PERMITTEE '
PLAN CHECK VALIDATI'O'N CK. M.O. CASH
2'9 0 MAR 28 4.1 0 1 3.0'0 e53
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT
•I hereby affrrm that I have a certificate of consent to self
Insure, or a certificate of Workers' Compensation Insurance,
or a HEATING - VENTILATING - AIR CONDITIONING V •
c Citi i c /@re ri�S ,` bdC. 76A364C
7F'611c 'No �Q th f800LaNCOm� 17'fti[�� 40 CE-818(REV 10/81)
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 f D��
ADDRESS /
tion department. y (PRINT OR TYPE ONLY) /[
Date D � `f�Applicant /�' LOCALITY
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE'OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST
(This section need not be completed if the work Involved by ABSORPTION UNIT, BTU DISTRICT NO PROCESS BY
the permit is for.one hundred dollars ($100)or less.),
AIR HANDLING UNIT, CFM L (�
I certify that in the'performbnce of th'e'work for which this _ o _
permit is Issued, I shall not employ any person in any manner.
so as to become subject to the Workers'-Compensation Laws BOILER, BTU - APPROVALS DATE S CTOR'S SIGNATURE
- r '
COMPRESSOR, BTU ROUGH
DateApplicant
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 VALIDAT ON ,
with comply with such -provisions-or this permit shall be
deemed revoked FURNACE FAU GRAVITY
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 gp2ol /- 6 7!2Lic Class .6!:-joilU
/� �� 8i/gs Date iLl O
Contractor '
❑ I am exempt under Sec. ' _ d
Plan-check fee # 6 0 N
B BP.0 for this reason
Date"
PERMIT ISSUING FEE $ + e
- 2 Q 50
•
Signature �`� TOTAL FEE
OWNER-BUILD D CLARATION PLAN CHECK APPLICANT c a o 2 Q 5 0 25
I hereby affirm that I am exempt from the Contractor's License f] '/ O a08- 8 5
Law for the following reason (Section 7031 5, Business and NAME !/�/✓�/y q�0 /�� ,
Professions Code). -
El I, as owner of the property, or my employees with ADDRESS 119? ASO 6 dam, Ate
wages as their sole compensation,will do the work and - `
the structure is not intended or offered for sale(Section CITY TEL NO
7044, Business and Professions Code).
OWNER
❑ ' I, as owner of theproperty, am exclusively contracting /��/�
with licensed contractors to construct the project (Sec- MAIL
ADDRESS �`T p /<!H
tion 7044, Business and Professions Code)-
CONSTRUCTION LENDING AGENCY CITY . TEL NO 2$
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued CONTRACTOR ��LD
(Sec 3097, Civ C )
-ADDRESS
' p,
Lenders Name
LJ
//II�
Lender's Address CITY - f✓�r r!� TEL NO 3, 77 46 _
I certifythat I have read this application.and'state that the. STATE n LIC.
pp LICENSE NO a"• CLASS -
above information Is correct j agree to comply with all County
ordinances'and State jaws relating to building construction,
and hereby authorize representatives,of this County to enter =
upon he above-mention perry for inspectionpurposesSEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Ap net Ag Date 1 - .