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HomeMy Public PortalAbout5314 LOMA AVE_Mechanical__ I• 76A364C` �- CE-818 (REV 11 /78) ®s `- APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS % . (PRINT OR TYPE ONLY) LOCALITY NO TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST ' CROSS ST ABSORPTION UNIT,BTU OWNER fRo AIR HANDLING UNIT,CFMMAIL. v ADDRESS I / BOILER,BTU �� CITY1 TEL NO COMPRESSOR,BTU ' G CONTRACTOR VENTILATION SYSTEM ADDRESS; J � EVAPORATIVE COOLER CITY =; TEL NO FURNACE FAU GRAVITY STATE LIC FLOOR BTU LICENSE NO 3� 0` CLASS HEATER SUSPENDED UNIT_ APPROVALS DATE INSPECTOR S SIGNATURE WALL ROUGH f FINAL / eD�'=' O V INSPEC ION RECORD GS O Plan check fee 25% of above r�l J — PERMIT ISSUING FEE$ TOTAL FEE PLAN CHECK APPLICANT PLAN CH��••..E_�CK VALIDATION - NAME ADDRESS CITY TEL NO 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 VENTILATING, AIR 2 67 0.5 A CONDITIONING PERMIT VALIDATION I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF o o o o 4 1 CHAPTER 9, DIVISION 3, OF THE BUSINESS AND OFESSIONAL CODE , OF THE STATE OF )RNIA ( _ - - 2 0 0 27,00 SIGNATURE OF PERMITTEE !" i- 270050 0 27. 0050 DISTRICT NO PROCESSED BY O8 09, 1 4'-79 364C WORMERS'COMPENSATION DECLARATION CEA SIB(2-80) A P P UC A T�®N rl FOR If-E R MT I hereby,affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONINGa certif" d cop t C f( ec.3800,Lab. ) -To h^rz M Policy No Company COUNTY OF LOS ANGEL'ES� BUILDING ARID SAFETY Certified copy is hereby furnished /O Certified copy is filed with 11!6, t ingt$I1 MDrM BUILDING de arty t FOR APPLICANT TO FILL IN gDDREbS ur�lq- Iv Lt;Jl1A Date l5 "� Applicant �' (PRINT OR TYPE ONLY) --- LOCALITY'TJn-Jr- IF C-4CERTIFICATE,OF EXEMPTION FROM WORKERS' NO, ITYPE OF APPLIANCE OR EQUIPMENT. FEE COMPENSATION INSURANCE NEAREST } (This section need not be completed if the work involved ABSORPTION UNIT, BTU CROSS ST a0 by the permit is for one hundred;dollars ($100)•Or, less.) DISTRICT NO PROC� P U I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM 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 S .NATURE 0 W Date Applicant = COMPRESSOR, BTU 0 ROUGH 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 VALIDATION with comply with such provisions'or this permit shall be 11 1 deemed revoked. FURNACE. FAU GRAVITY LICENSED,CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter P 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 , • - ' License.Number 2tq�s� Lie.Class ItA Irl la ow i3v I L,Drri­:5 7 is l°i I Contractor Date 1-.am-exempt from the licensing requirements as I am"a licensed architect or a registered professional engineei Plan check fee 25%of above. n f�" acting in my professional capacity(Section 7051, Bus- iness and Professions,Code). Lic.orReg No. Date TOTAL FEE HOMEOWNER BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt frdm- the Contractor's NAME • 4F--^ iQL4ZD%JJ . I3V L.)Wl%-S� ` License Law'for the following reason (Section 7031.5, Busi- ness and Professions Code): ADDRESS 57—BQ' 1;1 as owner of the property, will do the work and the CITY ��tiE�7P�/a TEL NO structure is not intended or offered for sale (Section 3 9 A ' 7044, Business and'Professions Code). OWNER t I, as owner of the property, am exclusively contracting #10:0'0'0 0 8 with licensed contractors to construct the project MAIL ,�, ' • (Section 7044, Business and Professions Code). ADDRESS 2,-'-'27..o O CITY (�,Ic G`(`jTEL.NO. � i CONSTRUCTION LENDING AGENCY `0 0'0,2 7,0 0 v I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is CONTRACTOR /1S issued(Sec 3097,Civ.�j��� {.5 8 1, Lender's Name ADDRESS Lender's Address CITY TEL NO 1 certify that I have read this application and state that the STATE 12,t�-J 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, and hereby authorize representatives of this SEE REVERSE,FOR EXPLANATORY LANGUAGE County to enter Lupo t doped open_} uis npt�sess 1I !!4 L. 1.3� s ture of Permittee Date WORKERS'COMPENSATION DECLARA.TIDN CEA381L(2-80) If— I� ��,o�� ®Y�1 ®� I� H�%U 0T I hereby affirrr.that I have a certificate'of consent to self insure, or a certificate of Workers'Compensation Insurance,o"r .HEATING-VENTILATING-AIR CONDITIONING a cel i tcopy thereof(Sec 3800,Lab C.)' u Policy N60� Company ST lf4. Corti 'ed copy is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified cdpy is filed with-the county building inspection BUILDING CJ dPoartr�7ent L�A �L FOR APPLICANT TO FILL' IN ADDRESS l % LO Date^` Applicant (PRINT OR TYPE ONLY) LOCALITY CERTIFICATE OF EXEMPTION FROM'WORKERS'- NO TYPE'OF APPLIANCE OR EQUIPMENT FEE ✓ `�— j COMPENSATION INSURANCE NEAREST } (This section need not be completed if the work involved. ABSORPTION UNIT,-BTU CROSS ST © ( CJI O by the permit is for one-hundred dollars ($100) or less.) ; DISTRICT NO PROCESSED BY O I certify that in the performance of'the work for which this AIR HANDLING UNIT,CFM Y - permit is issued, I shall not employ any-person in any manner V O so as to become subject to the Workers' Compensation Laws BOILER, BTU H APPROVALS DATE INSPECTOR'S SIGNATURE U ' W` Date Applicant COMPRESSOR, BTU ROUGH 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 • VALIDATION r with comply with such provisions or` this permit shall be deemed revoked FURNACE* FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU Q I hereby affirm that I am licensed under provisions of Chapter HEATER. SUSPENDED UNIT iry !► z 0 6 9.'3'A 9 (commencing with Section 7000)of,Division 3 of the Busi- WALL qJ qBCQC7 G� ness and Professions Code, and my license is in full force and ' # 6,o o o-o 8 effect License Number Lic.Class_/ 2 ° 01-7.0 0 Contractor&57-0-^' '� r 7 ° 17, 0 0 0 I am exempt from the licensing require dots as I am a O 0.7-'8 _ licensed architect or a registered professional engineer Plan check fee 25%of above.. ""x•n acting in'rny professional capacity (Section 7051, Bus' A mess and Professions Code) PERMIT ISSUING FEE $ Lic.or Reg LNo DateTOTAL FEE HOME OWNER-BU ILDEk'DECLk-RATION PLAN CHECK APPLICANT I hereby affirm that I' am exempt from- the Contractor's NAME License Law for_the following reason (Section 7031.5,_Busi- �,0 6 ness and Professions Code). ADDRESS YY I, as owner of the property, will do.the=work and the #,o'®� ;0 8 structure is not intended or offered for sale (Section CITY TEL NO. o 7044, Business and Professions-Code). 2 O.'1 7' OWNER I, as owner of the property, am exclusively contracting o io 4e 0.'l ]v with licensed contractors to construct the project MAIL - (Section 7044, Business and Professions Code) ADDRESS -�3I 7 / O OtT—8•1 CONSTRUCTION LENDING AGENCY CITY C�j TEL.NO.Zg 7a55� I hereby affirm that there is' a construction lending agency .� for the performance of the work for which this permit is CONTRACTOR _ b �� issued(Sec. 3097,Civ.C.). N1. Lender's Name ADDRESS Lender's Address CITY TEL NO I certify that I have read this application and state that the STATE LIC. above information is correct.I agree to comply with all County LICENSE NO CLASS ordinances and State laws regulating Heaiing, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter upon Ihte above-mentioned property for inspection pu es o R'.,e of P •e Date