HomeMy Public PortalAbout9100 LAS TUNAS DR_Mechanical__ 76A364—Ct818—1/70 dA m FOR PEW
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COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS OD
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. . COUNTY ENGINEER NEAREST -
COLEMANW. JENKINSNKINS, B
SUPERINTENDENT OF BUILDING NEAREST
ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO TYPE OF APPLIANCE-OR EQUIPMENT FEE ADDRE OQ r Lam/
CITY
ABSORPTION SYSTEM, BTU TEL. NOVI !/
CONTRACT R
AIR HANDLING UNIT, CFM
ADDRES
BOILER, HORSEPOWER CITY STATEf /J TEL. NO
/ COMPRESSOR, HORSEPOWER LICENSE N lQO}I CLASS D
VENTILATION SYSTEM DISTRI C�TaNO CLASS GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER (/ p�
FURNACE: FA VITY j, INSPECTION RECORD
FLOOR BTU
HEATER. SUSPENDED UNIT_ 1110-717
2. Y
WALL
a
c;
LL
CL
PERMIT $ 3 00 ?
NEW—ADDITION—
ALTER—REPAIR— TOTAL FEE $ �/5 lz)o
PLAN CHECK APPLICANT ✓
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 ALL ORDINANCESAND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING. 7
RO UG H
1 HEREBY ER Y THAT I AM N ACT G N VIOLATION
OF CHAPTER D I N 3, OF THE B ESS ND ROFESSIONAL FINAL s�7
CODE OF THE AT 0 CAIIFOR NIA / "'
SIGNATURE JACK R. ALLEN,SUP R ISI ANICAL ENG'R.
OF PERMITT
PERMIT VALIDATIO CKM O. CASH
PLAN CHECK VALIDATION
LAI,,o 5 R 1 5 MAY 3 .a 1 1 3.0 0 N
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
76A364C
WORKERS'COMPENSATION DECLARATION CE-818 (2-80) A PPp l� C Q u 0 O N FOR If—ERUVU T
ay affirm that I have a certificate of consent to self
' L nsurereb, or a certificate of Workers'Compensation Insurance,or HEATING-VENTIL_ATIRIG-AllR CONDITIOk�19bZG
"fl
a certified copy thereof(Sec. 3800,Lb}ya�JC.) A 'n
Policy
V'fled copy is hereby furnished COUNTY OF LOS ANGELES BUILDING ARID SAFETY
ified copy Is filed with the county building inspection ( 1 C
BUILDING ADDRESS
department a FOR APPLICANT TO FILL IN
Date.( -ea Applicant-MLA, (PRINT OR TYPE ONLY)
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY C
CERTIFICATE OF EXEMPTION FROM WORKERS' — -- _
COMPENSATION INSURANCE NEAREST }
(This section need not be completed if the work involved ABSORPTION UNIT, BTU CROSS ST '�pC�/T O
by the permit is for one hundred dollars ($100) or less.) DISTRICT NO PROCESSED BY V
I certify that in the performance of the work for which this AIR HANDLING UNIT,CFMcc
permit is issued, I shall not employ any person in any manner ohe-7, O
so as to become subject to the Workers' Compensation Laws BOILER,BTU H
APPROVALS DATE INSPECTOR'S SIGNATURE lU
Date Applicant COMPRESSOR, BTU )lJC/d / ROUGH sq l- N
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL '°�'� Z
Exemption, you should become subject to the Workers' —
ith comply provisions of the Labor Code, you must forth- EVAPORATIVE COOLER ` VALIDATION
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 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. � a a"C�
License Number � � Lic Class
MOW W- �,Z`7
v� /tel 2s
Contractor JOik Date
F11 I am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer Plan check fee 25%of above.
acting in my professional capacity (Section 7051, Bus- z'624,3A'
iness and Professions Code). PERMIT ISSUING FEE $ /0570 b ,
Lac.or Reg No. Date TOTAL FEE �'t7 210,0 39.75
HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT t
I hereby affirm that I am exempt from-the Contractor's NAME 10 0'.0,3 9 7 5 c=�
License Law for the following reason (Section 7031.5, Busi-
ness
Q,2 4-'8 3
and Professions Code): ADDRESS r
I, as owner of the property, will do the work and the
structure is not Intended or offered for sale (Section CITY TEL NO.
7044, Business and Professions Code).
QOWNER
I, as owner of the property, am exclusively contracting
with licensed contractors to construct the ,project MAIL j
(Section 7044, Business and Professions Code). ADDRESS l�-'���0
CONSTRUCTION LENDING AGENCY CITY TEL.NO
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is CONTRACTOR 11 1u C�
issued(Sec 3 Cry C). L 02,2>
Lender's Name
- ADDRESS
Lender's Address CITY ��\1}�—� TEL NO.443-�'l�
—1-11J Art IC 6
I certify t a 1 have read this application and state that the STATE /� Q LIC. C_zo
above m �r at
is corre(tbly
.. I agree to comply with all County LICENSE NO. ZCop8� CLASS
ordina s nd State lax egulating Heating, Ventilating and
Air C it onin and , authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
Coun the above-mentio 'd property for
uispr ti a s
,G' �3
Signature of Permittee Date