HomeMy Public PortalAbout5312 LOMA AVE_Mechanical__ ' y 76 A364- CE 818-1/75
APICATION FOR PERMIT "
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING /a
DEPARTMENT OF COUNTY ENGINEER ADDRESS �/ `t
BUILDING AND SAFETY DIVISION LOCALITY'-� :
AJ A 1-71
NEAREST_
CROSS ST (�/46//
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) MAIL
No TYPE&SIZE OF EQUIPMENT FEE ADDRESS
SEE BACK OF AP_PLICATION n TEL. NO. -
FORCE AIR FURNACE, B,TU CITY� 01
. CONTRACT.OR
COMPRESSOR, BTU -
ADDRESS
VENTILATION FAN
CITY TEL. NO
LIST ALL OTHERS BELOW STATE LIC
LICENSE NO. CLASS
/ - DI T ICT NO GROUP ZONE PROCESSED BY
51082:Z::
INSPECTION RECORD
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Plan check fee. See reverse. z
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PLAN CHECK kPPLICANT
NAME
ADDRESS
'CITY TEL NO
I HEREBY AC KNO W,LEDGE THAT 1 HAVE READ'T HIS APPLICATION t
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -
WITHALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING /
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACT G IN CATION
OF'CHAPTER 9, DI
VISIO OF THE BUSINESS NO PR ESSIO L FINAL -� -7
CODE OF THE STATE 0 C LIFORNtA_ '
SIGNATURE PERMIT VALIDATION M 0 CASH
OF PERMITTEE �-- -
PLAN CHECK ffALIDATION M O CASH
6 2 7"'App 30 41 U 7.50 e136
V \ �Y
WORKERS'COMPENSATION DECLARATION %76A364C' pp ^ y� N a R Pp R n�
I hereby affirm that I have.a certificate'of consent to self CE -818(2-80) l4. 0�{"J� ®1 YI ®Ifs If Ifni 11�7U ��
ipsure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONIM6
a certtcopy thereof(Sec. 3800,Lab C.)
PolicyNo � 3! 1-kompany_ C � COUNTY OF LOS ANGELES ✓ BUILDING ARID SAFETY
CCertified
rtified copy is hereby furnished.
copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING
/p_rt—! A It �S O /fes/¢ ADDRESS �✓�Z LQA��'� �v
Date pp cant (PRINT OR TYPE ONLY)
LOCALITY
FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NO TYPE OF APPLIANCE OR EQUIPMENT
NEAREST
.COMPENSATION INSURANCE. CROSS ST
(This section need not be completed if the'work*involved ABSORPTION UNIT, BTU p
by the permit is 4or one hundred dollars ($100) or less.) DISTRICT NO PROCESSE By (�
- I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM �^ V� �
permit is issued, I shall not employ any person in any manner / O.
so as to become subject to the Workers' Compensation Laws BOILER, BTU
- APPROVALS DATE< INSPECTOR'S SIGNATURE tU
Date Applicant COMPRESSOR, BTUROUGH N
NOTICE TO APPLICANT' If, after making this Certificate of VENTILATION SYSTEM FINAL Z
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER
with comply with such provisions or this permit shall be VALIDATION
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 /
effectQT� �tJ
License Number/MZ-C Lyiicc.Class ( p
Contractor W�76^7 r"" � ate
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-
iness and Professions Code). PERMIT ISSUING FEE $
Lic.or Reg.No Date TOTAL FEE .3
HOME OWNER-BUILDER DECLARATION CHECK APPLICANT
I hereby affirm that I -am exempt from- the Contractor's NAME
License Law for the following reason (Section 7031.5, Busi-
ness and Professions Code): ADDRESS
F I; as owner of the property will do the work and the CITY TEL. NO. ��;7
L
structure is not intended or offered for sale (Section (/ � B 0 11 CA 1 A
7044, Business and Professions Code). It
OWNER, # 0 0 0 0 4❑
I, as owner of the property,'am exclusively contracting _�
with licensed`contractors to construct the project MAIL T-3/2 Zm� �� 2 010 O O
(Section 7044, Business and Professions Code) ADDRESS
CONSTRUCTION LENDING AGENCY CITY �J�� ��l l /�tL.NO G Zf– aJ0 0 1006
I hereby affirm that there is 'a construction lending agency r
for the performance of the wCONTRACTOR
work for which this permit is jo/�j �jt.9�� Q 1 r�8,1
issued (Sec 3097,Civ.C.)
Lender's Name ADDRESS ? SQ �✓ �je,¢w„Q
Lender's Address CITYTEL.NO
Cpv��
I certify that I have read this application and state that the ' STATE ^� Zt LIC.
above information is correct.I agree to comply with all County LICENSE NO.� / CLASS
ordinances and State laws regulating Heating, Ventilating and
Air Conditioning,andP by authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County to a upon t1 a above-mentioned property for
11' Pectic, r rposes
eture of Perm Date C r