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HomeMy Public PortalAbout5664 LOMA AVE_Mechanical__ X76 A364'- CE 818 - 9-71 �AP LIC=ON A II'ON FOR II' :VIII HEATING - VENTIlLATNG - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER A D D R E (G� BUILDING AND SAFETY DIVISION LOCALIT NEAREST 2_ CROSS ST. L' FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) t MAIL r NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS n r CIT JTEL. NO. ABSORPTION UNIT, BTU CONTRACTOR AIR HANDLING UNIT, CFM ADDRESS BOILER, BTU CITY. L. NO. 9,7, 16 COMPRESSOR, BTU STATE LIC. c LICENSE NO. / CLASS VENTILATION SYSTEM D _. ISTRICT NO. [GROUP JCZONE( PR SS ED BY EVAPORATIVE COOLER } FURNACE: FAU 7!GR jI�T�Y C✓ v ( FLOOR BTU — Op INSPECTION RECORD I= HEATER: SUSPENDED UNIT_ OI.— WALL Lu Z Plan check fee 25% of above. See reverse. PERMIT ISSUING FEE 8 3 00 TOTAL FEE 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 'y' PECTOR' IGNATURE LATING, AIR CONDITIONING. ROUGH I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL �`-- CODE OF THE STATE OF IFOR IA. ' SIGNATURE Q/� PERMIT VALID T QN CK. M.O. CASH OF PERMITTEE PLAN CHECK VALIDATION CK. M.O. CASH I An SEE BACK OF APPLICATION FOR COMPLETE_FEE SCHEDULE 2S'COMPENSA'ION DECLARATION - e nt i have a certificate of consent to self t APPLIC.�TION FOR PERMIT iIn IcaSe of Workers' Com_ ensation Insurance, erlifie thereof (Sec. 3800, b. C.) 7aAse4c HEATING - VINTfLATING - AIRS CONDITIONING n CE-818(REV. 1 Y81) P t�0.;`d.0 r 72 i 4&mpany StapPr].O_r N ±_, F1 Certified co toy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified cq.oy is filed with the county buildi inspec- FOR APPLICANT TO FILL IN BUILDING tion depart.nent. ADDRESS ��- a% (PRINT OR TYPE ONLY) Date�:i-21—G'p ApplicantAe� LOCALITY /���L� F TIF' 0 NO. TYOE OF APPLIANCE OR EQUIPMENT FEE NEAREST ��/ / ATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE CROSS ST. ,rj ABSORPTION UNIT, BTU DISTRICT NO. PRO Y (This section need not be completed if the work involved by the permit is for one hundred dollars ($100)or less.) 1r t AlR HANDLING UNIT,CFM 6 "O I certify that in the performance of the work for which this � (J 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 INS ECTOR'S SIG ATURE Date Applicant COMPRESSOR, BTU ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' 0 Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER A AIO ^ with comply with such provisions or this permit shall be t deemed revoked. FURt4ACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED—UNIT— (commencing USPENDED UNIT(commencing with Section 7000) of Division 3 of the Business WALL and Professions Code,and my license is in full force and effect. License Number /�© Lic. Class L, V Contractoe—�P142ey e— $(L^-- Date S-Z14 I am exempt under Sec. � Plan check fee B.&P.C. for this reason PERMIT ISSUING FEE $ Date: e T 17 5VOTAL OTAL FEE OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and NAME ZISL5 Professions Code): ❑ I, as owner of the property, or my employees with ADDRESS �O _ wages as their sole compensation, will do the work and / CITY . . the structure is not intended or offered for sale(Section 9 d� TELNO ?L7 7044, Business and Professions Code). 5 4 2.2,A OWNER ❑ I, as owner of the property, am exclusively contracting # 0 0 0.0 0 8 with licensed contractors to construct the project (Sec- MAIL tion 7044, Business and Professions Code). ADDRESS o 01 7.5 0 CONSTRUCTION LENDING AGENCY CITY TEL. NO. I hereby affirm that there is a construction lending agency for o o 0 1 7.5 0 70: the performance of the work for which this permit is issued CONTRACTORrG�® (Sec. 3097, Civ. C.). N11111. 0 9.1 146 8 6 ADDRESS Lender's Name CITY /"� TEL. NO. �l�esZ Lender's Address /� .i STATE LIC. e 'A I certify that I have read this application and state that the LICENSE NO.� CLASS GGA" 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 upo�ove-me oned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date