HomeMy Public PortalAbout9812 LIVE OAK AVE_Mechanical__ 76A364 - CES18 -"3-69 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING /
DEPARTMENT OF COUNTY ENGINEER ADDRESS L�
BUILDING AND SAFETY DIVISION
JOHN A LAMBIE, COUNTY ENGINEER LOCALITY
COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING NEAREST
CROSS ST. �Q
FOR APPLICANT TO FILL IN OWNER ,GG��
(PRINT OR TYPE ONLY)
MAIL /
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
ABSORPTION SYSTEM, BTU CITY L. NO
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, HORSEPOWER
CITY TEL NO 2
COMPRESSOR, HORSEPOWER STATELIC ,y
LICENSE N0. 'T�f CLA.SS (_
VENTILATION SYSTEM, DISTRICT NO. GROUP
GROUP ZONE PROCESSED BY,
i
EVAPORATIVE COOLER 5 Oe
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FURNACE FAU GRAVITY `J JJJ���
FLOOR BTU INSPECTION RECORD
HEATER SUSPENDED UNIT
WALL }
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NEW—ADDITION— PERMIT $ 3 00 Z
ALTER_REPAIR_ TOTAL FEE $
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL. N0.
IHEREBY 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-,
LATING, AIR CONDITIONING. APPROVALS DAT SPECTOR'S SIGNATURE
IHEREBY CERTIFY THAT I AJA NOT ACTING IN VIOLATION OF ROUGH 4��
CHAPTER 9,.DIVISION , OF BUSINE S AND P SSIONAL FINAL - f
CODE OF THE STATE ALI NIA.
SIGNATURE JACK R. ALLEN, SUPER V S'IN�ECHANICAL ENG'R,
OF PERMITTEE
PERMIT VALIDATION CK. M.O. CASH
PLAN CHE VALIDATION
i.j1 '3 83 ? JAW 4 4 1 D l�W8.0 0 �1
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
1 WORKERS' COMPENSATION DECLARATION APPLICATION PPL ICATION FOR PERMIT*
A I hereby affirm that I have a certificate of consent to self /` If�J �u
+i Insure, or a certificate of,Workers' Compensation Insurance, - HEATIWG - VENTILATING - AIR CONDITIONING
,a tifled copy they f (Sec 3800, Lab C ) 76A364C
t t! CE-818(REV 10/81)
Po o Company tida-/y
❑ Certified copy is hereby furnishel COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy is filed with the county buildmZ Ins ec- FOR APPLICANT TO FILL IN - BUILDING
tion department ADDRESS / /(�� aRll
(PRINT OR TYPE ONLY)
Date 9--211
12 Applicant LOCALITY �{
• NO TYPE OF APPLIANCE OR EQUIPMENT FEE �i
_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 PROCESSED BY
the permit is for one hundred dollars ($100)or;less.)
I certify that in the performance of the work for which this AIR HANDLING UNIT, CFM IY,
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 INSPECTOR'S NATURE
'
Date Applicant COMPRESSOR, BTU yZ 000 1666 ROUGH
MNOTICE TO APPLICANT If, after making this Certificate of VENTILATION SYSTEM '• FINAL V
Exemption, you should become subject to the Workers' �—
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER �, ALIDATIO "
with comply with such provisions or-this permit shall be
deemed revoked FURNACE FAU GE[g:Y
LICENSED CONTRACTORS DECLARATION I FLOOR BTU ODD
I hereby affirm that I am li2ensed under provisions of Chapter 9 HEATER SUSPENDED UNIT(commenting with Section 7000) of Division 3 of the Business ,
and Professions Code,and my license is in full force and effect
O.
License Number �(0 3 73 S Lic Class C 3�? _ - D V
v �
Contractor �O�N�2 Date 0
t—
❑ I am exempt under Sec , L&A
Plan check fee H
B&P C for this reason PERMIT ISSUING FEE $ Z
Date i
Signature TOTAL FEE ;2 7 0 a 6 A
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT — #,o'o • o o 8
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031 5, Business and NAME D (( ° ° 30,50
Professions Code)
❑ j, as owner of the property, or my employees with ADDRESS ° *to 3 Q 5 0 6
wages as their sole compensation,will do the work and - -
thestructure Is not Intended or offered for sale(Section CITY TEL NO 0 Q O O
7044, Business and Professions Code) �J`
OWNER �[ 0ON't12 go
❑ I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec- MAIL �)
tion 7044, Business and Professions Code) ADDRESS �� i U V
CONSTRUCTION LENDING AGENCY CITY 'TEL NO"
I hereby affirm that there is a construction lending agency fo"r D
the performance of the work for which this permit Is issued CONTRACTOR %L NrK Q
(Sec 3097, Civ C ) Q2
ADDRESSNr��r��
Lender's Name
CITY •�_ TEL NO-
Lender's Address
STATE LIC
I certify that I have read this application and state that the LICENSE NO V 3?J S - CLASS
above 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
7UP the above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE "
Signature of Applicant or Agent Date _