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HomeMy Public PortalAbout10125 LANDSEER ST_Mechanical__ I6A364_CE81 B_B�BB APPLICATION FOR PERMIT . HEATING - VENTILATING -. AIR CONDITIONING COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING ^ BUILDING AND SAFETY DIVISION ADDRESS r^ JOHN A. LAMBIE, COUNTY ENGINEER © /9 4" COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY T7y&->— 'FOR APPLICANT TO FILL IN CROs EST. (Print or type only) _ OWNER ��'. No.. TYPEJOF'APPLIANCE OR EQUIPMENT FEE MAIL ADDRESS /O�p7 J'� ��-/✓Q ����ABSORPTION SYSTEM, BTU CITY TEL. NO.-- Pl - CX5'3AIR HANDLING UNIT, CFM CONTRACTORj BOILER, HORSEPOWER ADO&ESS 0 � L y N� G�,< � �Ier COMPRESSOR, HORSEPOWER CITY ��C �/ /TEL. NO. 41Lll1, STATE VENTILATION SYSTEM LCE SE NO. CLASS J DISTRICT NO. GROUP ZONE PROCESSED BY EVAPORATIVE COO ZR (i / FURNACE: FAU RAVI TFLOOR—BT ► d l INSPECTION RECORD HEATER: SUSPENDED UNIT WALL Q y, a O V O U • W 0_ N Z NEW- ADDITION— PERMIT $ 3 00 ALTER—REPAIR— TOTAL FEE $ Plan check applicant Name Address City Tel. No. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES A S REGULATING HEATING,'VENTI- APPROVALS DATE I PECTOR'S IG TURE LATING, AIR CO NDITIO G. ROUGH I HEREBY C TIFY THAT I M T AC-TING IN VIOLATION FINAL OF CHAPTER 9, 1VISION'3, OF E B SI ES AND PROFESSIONAL CODE OF THE S ATE O CALIF0 NIA. - - JACK R. ALLEN,SUPERVIS HANICAL ENG'R. SIGNATURE OF PERMITTEE PERMIT VALIDATIO CK. .O. CASH PLAN CHECK VALID. ON 8,.1 5..0DEC 28 4-1 D 8.00— SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 76A364C CE--818 (2-80) nJ n C AT gy '®R .n E R VT �as Or v _RKERS'COMPENSATION DECLARATION I' etjffirm that I have -a certificate of consent to self i-isure, or a certificate of Workers'Compensation.Insurance,or H EATINIG_VENtILATIWG-AIR CONDITIONING a certified copy thereof(Sec. 3800,Lab.C..)�.�• Policy N(�-���Compaik_ E%S/P.J_l—`��•_C�tl El Certified copy is•hereby furnished. COUNTY OF LOS ANGELES BUILDING ARID SAFETY �ertified copy is filed with the county building inspection BUILDING de artment. FOR APPLICANT TO FILL IN ADDRESS JC)J_ '�.. Date —�Z�pplicar...D_ S (PRINT OR TYPE ONLY) — LOCALITY CA— — CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE. '` COMPENSATION INSURANCE NEAREST (This section need not be Completed if the work'involved ABSORPTION UNIT, BTU CROSS ST. 00 by the permit is for one hundred dollars'(5100) or less.) DISTRICT NO _ PROCES D v' 0 I certify,that in the performance of�the work for which this AIR HANDLING UNIT,CFM `u, /� cc permit•is issued, I shall not employ any person in any manner 0 so 'as to become subject"to the Workers' Compensation Laws. - BOILER, BTU APPROVALS DATE SPECTO ',s ATURE �8 L _ w Date Applicant ` COMPRESSOR, BTU— ROUGH ✓_ _ co NOTICE TO,APPLICANT: If, after making this Certificate of VENTILATION SYSTEM 21 FINAL Exemption, you should become subject to the Workers' — Compensation provisions of-the Labor Code, you must forth- EVAPORATIVE COOLER VALID TION with comply with such provisions or this permit 'shall be .deemed revoked. ✓ ,PAVITY FURNACE: FAU— LICENSED CONTRACTORS DECLARATION FLOOR• B-f —_ I hereby affirm that I ain 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. License NumbeLic.-Class 20 Contrac�, Date 4 b 2 9 A I am exempt from the licensing requirements as I am a tigensed architect or a registered professional engineer Plan check fee 25%of•above. acting in my professional' capacity (Section 7051, Bus- /1 rl #;� e e • •`$ iness and Prbfessibns Code). PERMIT ISSUING FEE $ r J,9;• 30,50 Lic.or Reg.No.' Date- TOTAL FEE �. HOME OWNER-BUILDER-DECLARATION PLAN CHECK APPLICANT e'� e `3 Q 5 0 05 I hereby affirm that I.,am exempt from- the Contractor's NAME S 2-8 6 License-Law for the following reason (Section 7031.5, Busi- ness and Professions Code): ADDRESS ' El I, as owner of the-pr operty, will'do the work and the TEL. NO. structure is not intended or offered for sale (Section CITY 7044, Business and Professions Code). �/� - ❑ O W N E R GL „'�pf-+-7 I, as owner of the property, am exclusively contracting ) with licensed contractors to construct the project MAIL (Section 7044, Business and Professions Code). ADD R ESA012,�j_' TEL.Nr` CONSTRUCTION LENDING AGENCY 1;" iE R^R'E`L'I I hereby affirm that there' is a construction lending Agency for, the performance of the work -for which this permit: CONTRACTO is j issued(Sec. 3097,Civ.C.). Lender's Mame ADDRESS J�ifY� Lender's AddressCIT' 1�� TEL.NOp I•certify that I have read this application and state that 'the STATE LIC. / above information is correct.I agree to comply with alLCounty - H LICENSE NO. ' 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 u on the above-mentioned prbperty for bion purposes — - - - Signature of Perm,.tee Date J �