HomeMy Public PortalAbout9202 LEMON AVE_Mechanical__ F
76-A364- •,CE 818 - 9-71 App TION FOR RMIT
HEATING - VENTILATING - A CONDITIONING
COUNTY OF LOS ANGELES BUILDING -
DEPARTMENT OF COUNTY ENGINEER ADDRESS C! . ✓fir
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO 'TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
CITY TEL. NO. /
ABSORPTION UNIT, BTU
CONTRACT R 7L�
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU
CITY TEL. NO.
COMPRESSOR, BTU STATE LIC
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO.. GROUP ZONE(__2SEO BY
EVAPORATIVE COOLER O yr _ '
FURNACE FAUG LTY c�
FLOOR BTU 00 0 INSPECTION RECORD �
HEATER. SUSPENDED-UNIT O
WALL v
Lu
Q_
Cn
Z
Plan check fee 257o of above. See reverse.
PERMIT ISSUING FEE 8 3 00
TOTAL FEE L}�
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-ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS D TE SPECTOR'S SIGNATURE
LATING, AIR CONDITIONING
RO UG H
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
19 —
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE STATE OF IFOR NIA
SIGNATURE PERMIT VALIDATI N cK. 0 CASH
OF PERMITTEE r -
PLAN CHECK VALIDATION CK M O CASH
1 " 3 3 3 3/ OCT 10 4 1 D .0,0 4 r
j .
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT
I here§y(•affirm that I have a certificate of consent to self •
insure , or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
or a certified copy there?-of,(S�c 3800, Lab C ) 76A364C ;
CE-818(REV 10/81)
Policy No Company
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 BUILDING0 1117rj .�
tion department (PRINT OR TYPE ONLY) ADDRESS/,K
Date Applicant LOCALITY znz
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST
ABSORPTION UNIT, BTU DISTRICT NO PROCESSED BY
(This section need not be completed if the work involved by-
the permit is for one hundred dollars ($100)or less.) ;
AIR HANDLING UNIT,CFM J((�
C-V
(,certify that In the performance of the work for, which this -
permitis issued, I shall not employ any person in any manner
so as t I o the;;Wkers' ompensatl Laws BOILER, BTU APPROVALS DATE IN CT R'S SIGN TURE
COMPRESSOR, BTU ROUGH
Dat Applica -
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 N
with comply-with such provisions or this permit shall be
deemed revoked FURNACE FAU AV
LICENSED CONTRACTORS DECLARATION -IP 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 75000 f
and Professions Code,and my license
is in full force and effect /^ d
License Numbe. �?w Llc Clas v V
Contra- r Date — O
❑ - t—
I am exempt under Sec U
Plan check fee 0.
W
_ y
B &P C for this reason Z
Date
PERMIT ISSUING FEE $ O
' - '
TOTAL FEE
Signature i
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT ,
I hereby affirm that I am exempt from the Contractor's License 8 3 b A'
Law for the following reason (Section 7031 5, Business and NAME
# 0 0 0 0,0
Professions Code) -
❑ j, as owner of the property, on my employees with 'ADDRESS
- 2(150
wages as their sole compensation,will do the work and e
the structure Is not intended or offered for sale(Section CITY TEL NO - 20,505:
7044, Business and Professions Code) 1
TOWNER �, 1 6-87-
El
—SI-
❑ I, as owner of the property, am exclusively contracting
ctors to construct the project (SecAIL
- M
with licensed contraC
tion lice Business and Code) ADDRESS D G�♦ ��/1'�
CONSTRUCTION LENDING AGENCY CITY �� G��- T L NO
I hereby affirm that there Is a construction lending agency for 40,
the performance of the work for which this permit is issued ' CON '
(Sec 3097, Civ C )
Lender's Name
CIT
^-�'i�Lt� .� Tv� \
Lender's Address
STATE '7 ? � 6 'CLASSC� 3 oZ O
I certify that I have read this application and state that the LICENSE NO / - --- - - -
above Information is correct I agree to comply with all County
ordinances and State jaws relating to building construction, G�>y • X,(� A'6, a 6.
and h uthonze r s tatives of this County to enter
up ov -m on roperty for.innspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE _
Signature of Applicant or Agent Date '