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HomeMy Public PortalAbout9123, 9123 1/2, 9125, 9125 1/2 LAS TUNAS DR_Mechanical__ 76A364C - - CE-818(REV.6/78) ©� APPLICATION FOR PERMIT HEATING VENTILATING AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO'FILL IN: BUILDING (PRINT OR TYPE ONLY) ADDRESS LOCALITY yC /Y r NO. TYPE OF APPLIANCE OR EQUIPMENT FEE l•- NEAREST CROSS ST. ' ABSORPTION UNIT,BTU OWNER AIR HANDLING UNIT,CFM MAIL. -� G A ADDRESS ! !gym !v BOILER•.BTU - 'CITY �` TEL.NO.��1S COMPRESSOR,BTU CONTRACTOR vC VENTILATION SYSTEM /`�� ` ^ / L�•V��s, ADDRESS d i-�T'- EVAPORATIVE COOLER CITY ' 'L_C. TEL.NO. FURNACE: FAU GRAVITY STATEQ� LIC. FLOOR BTU Q a LICENSE NO.� Q CLASS HEATER: SUSPENDED UNIT_ APPROVALS DATE INSPECTOR'S SIGNATURE WALL ROUGH FINAL i -O0 ®' INSPECTION RECORD In Plan check fee 25% of above. ta � PERMIT ISSUING FEE$ 7 — TOTAL FEE / 7 PLAN CHECK APPLICANT PLAN CHECK VALIDATION NAME ADDRESS - 3 79 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 _ p n A ORDINANCES AND LAWS REGULATING HEATING, VENTILATING. AIR /277 1.1.'8 CONDITIONING. PERMIT VALIDATION 1 HEREBY CERTIFY THAT I AM NOT ACTING •IN VIOLATION OF # O o 0 0 (� � CHAPTER'9, DIVISION 3, OF THE BUSINES99.AND PROFESSIONAL CODE - OF THE STATE OF CALIF IA. _ G O O O,1 7 O 0 SIGNATURE /�) OF PERMITTEE ` Y\� 'ZO O O 1 1,00-r U DISTRICT NO. ,r� - PROCESSED BY O 0 ;-.7 WORKER'S COMPENSATION DECLARATION A46DPW 9,69 76364C APPLICATION FOR PERMIT LIME GREEN 76A I hereby affirm that 1 have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified . HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec.3800 Lab.C.) Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. . Certified copy is,hereby furnished. ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING y � 9-- _7 y1 department. (PRINT OR TYPE ONLY) ADDRESS / L� LOCALITY Date ApplicantNO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEARESTCROSS /✓C")v 1, /�/9 . COMPENSATION INSURANCE ABSORPTION UNIT,BTU 'ASSESSOR ' (This section need not be completed if the work involved by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less:) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY - - I certify that in the performance of the work for which this permit is issued, I shalt not employ any person in any manner so as to BOILER,BTUO D become subject to the Workers' Compensation Laws. O COMPRESSOR,BTU -3b 000 �f APPROVALS DATE INSPECTOR'S SIGNATURE - Date �` Applicant.- pplicant VENTILATION SYSTEM NOTA E TO PLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER _ provisions of the Labor Code, you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU 70 Off— / VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED-UNIT- (commencing USPENDED UNIT(commencing with Section 7000) of Division 3 of the Business and HEATER: WALL Professions Code,and my license'is in full force and effect. /^1 License Number Lic.Class _,tit /xr., 0 f-Ie j¢Ti If/6 , } Contractor coo'Z r Ny Date R0 i/ O ❑ I am exempt under Sec. .J'�1"yj Plan Check fee 60 B.&P.C.for this reason PERMIT ISSUING FEE$ 3 O H Date: TOTAL FEE 7 4 O W 0- Signat, , PLAN CHECK APPLICANT OWNER-BUILDER DECLARATION Z I hereby affirm that I am exempt from the Contractor's License Law NAME ' for-the following reason (Section 7031.5, Business and Professions Code): ADDRESS Ertt.i•I nA9' ❑. I, as owner of the property, or my employees with wages as.their sole compensation, will do the work and the CITY TEL.NO. x•_;11 re(I structure is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER - 1° 1 Il ET 1, as owner of the property, am exclusively contracting MAIL TO I AL 3 d ( with-licensed contractors to construct the project (Sec- ADDRESS t {• ',til tion 7044, Business and Professions Code). CHECK CITY TEL.NO: CONSTRUCTION LENDING AGENCY CHANGE I hereby affirm that there is a construction lending agency for tl'f�t the performance of the work for which this permit Is issued CONTRACTOR l���,e�_S r/�AT'.U� �OO/t tN ► (Sec.3097,Civ.C.). ADDRESS ��Sf� /9,L 11-,e Lender's Name 1 CITY t7 s 2./L�/P rind TEL.NO. '�/�33 1 r c7��r r#�i =��r Lender's Address STATE LIC. I certify that I have read this application and state that the above LICENSE NO. ���I CLASS G c ,V information is correct. I agree to comply with all County ordinances and State laws relating to building construction,'and hereby authorize representatives of this my to enter upon the above-mentioned property for i specti p poses. SEE REVERSE FOR EXPLANATORY LANGUAGE �° old 9J RE OF APPLICANT OR AG DATE WORKER'S COMPENSATION DECLARATION " 2"046 DPW 9/89 APPLICATION FOR PERMITUMEti I hereby affirm that I have a certificate of consent to self insure, 76A364 or a,cerfificate•of worker's Compensation Insurance, or a certified 4 HEATING-VENTILATING AIR CONDITIONING copy thereof(Sec.3900 Lab. C.) Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished. ❑ Certified copy is filed BUILDING with the county building inspection FOR APPLICANT'TO FILL IN ADDRESS department. (PRINT OR TYPE ONLY) LOCALITY f "• Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. COMPENSATION INSURANCE ABSORPTION UNIT,BTU (This section need not be completed if the work involvedby the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU become subject to the Workers'Compensation Laws. COMPRESSOR,BTU ��'�� v APPROVALS DATE NSP OR'S SIGNATURE Date Applicant - x—'�� VENTILATION SYSTEM . NOTICE TO APPLICANT: If, after making, is Certificate of ROUGH Exemption,you.should become subject to the Workers' Compensation EVAPORATIVE COOLER provisions of'the Labor Code, you must forthwith comply with such FINAL 17owmil TY— provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY d LICENSED CONTRACTORS DECLARATION FLOOR BTU * -,& VALIDATION I hereby affirm that I amlicensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and HEATER: WALL Professions Code,and my license is in full force and effect. z-nxi'/ r 97■30 License Number �_ � Lia Class i ITEMS- EM Contractor - t Date Zt O ❑ I am exempi un s Plan check fee cc B.&P.C.for this reason PERMIT ISSUING FEE$ TOTAL a37 o Date: TOTAL FEE LU Signature PLAN CHECK APPLICANTGECK 97■ OWNER-BUILDER DECLARATION _ I hereby affirm that I am exempt from the Contractor's License Law NAME . fordhe following reason (Section 7031.5, Business and Professions f� r1n Cade): ADDRESS CKPIKE ■OU ❑ I, as owner of the property, or my employees with wages /Z� �� as their sole compensation, will, do the work and the CITY TEL:10. structure is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER �� �y �r�y�y ❑ I, as owner of the property, am exclusively contracting 0000—mol .$f��9� MAIL f � with licensed contractors to construct the project (Sec- ADDRESS l /LJ 1910 1 wpt pm 16 tion 7044, Business and Professions Code). 7V A t 7 7 CITY TEL.NO. CONSTRUCTION LENDING AGENCY I hereby.affirm that there is a construction lending agency for CONTRACTOR- the performance of the work for which this permit Is issued (Sec. 3097,Civ.C.). ADDRESS 2 G0 Lender's Name If CITY TEL.NO.�7J �4 Lender's Address STATE / LIC. I certify that I have read this application and state that the above LICENSE NO. CLASS C 'O information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR-EXPLANATORY LANGUAGE r SIG PLI NT r AGENT DATE