HomeMy Public PortalAbout9075 LONGDEN AVE_Mechanical__ F.
76A36AC O ,
t CE-8181REV 6/78)
APPLICATION FOR PERRAIT
HEATING - V,ENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING
ADDRESS 9075 E. LOV=
• - (PRINT OR TYPE ONLY), �*G��If�7� �.T�7�C7
LOCALITY 1J.:�1'lC'''•. calf ,
,,,NO TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST '
ABSORPTION UNIT,BTU - � 7�77Vr,T
OWNEF�{- 1�-�, KTM, j'11VG
AIR HANDLING UNIT,CFM - MAIL -
ADDRESS
` •F' BOILER,BTU - '
CITY SAi�E , r�.��� L7�y-� TEL N028L0368
COMPRESSOR,BTU 3 hp-- - 1 .OO CONTRACTOR 11�LyE HIM - U
r, VENTILATION SYSTEM ', 2034 q. FECK
ADDRESS 1
EVAPORATIVE COOLER CIrJOUICH M MEM TEL N05797982
FURNACE . FAU - GRAVITY r STATE 265094 LIC
1 FLOOR BTU LICENSE NO CLA55 ('-
HEATER SUSPENDED UNIT_ APPROVALS DATE INSPECTOR S SIGNATURE
WALL
' ROUGH .� f,��}
FINAL '�J ��--~ O
w INSPE(aTION RECORD ccV
O
Plan check fee 25% of above
m
PERMIT ISSUING FEE$ 7.00 Z
TOTAL FEE 27.00
PLAN CHECK APPLICANT ' PLAN CHECKVALIDATION ,
NAME _ �•` YyV(,,,C.iLfi[CL t-
ADDRESS �co U n `7 69 OZV• - (/
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, 4�/ 4A
ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR ,
CONDITIONING PERMIT.VALIDATION •# O 0"0'014 1
HEREBY CERTIFY THAT I AM NOT AC ING IN VIOLATION OF -
CHAPTER 9 DIVISION 3, OF THE BUSINESS D PROFESSIONAL CODE
OF THE STATE OF CA=LIF , ^ '2 o O 2-7.0.0
SIGNATURE 6'0
/YJ ,
OF PERMITTEE _ 10 10 O 217,O O U
DISTRICT NO PROCESSED B
•M;7RKERS' COMPENSATION DECLARATION - ,
apPUC QM
sol hereby atfmm that I.have a certificate of consent to self �O� PERM57
Insure, or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
or a certified copy thereof (Sec 3800, Lab C ) 76A364C
CE-818(REV 10/81)
Policy No Company, f COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy Is hereby furnished
❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING
tion department (PRINT OR TYPE ONLY) ADDRESS
Date Applicant LOCALITY -
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
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 B
the permit is for one hundred dollars ($100)or less.) AIR HANDLING UNITCFM /"d
I certify that in the performance of the work for which this ,
permit is Issued, I shall not employ any person In any manner BOILER, BTU
so as to become subject to the Workers'-Compensation Laws APPROVALS DATE INSPECT— SIGNATURE
Date a pphcant COMPRESSOR, BTU ROUGH ^7Q
NOTICE O APPLICANT If, after Waking Kis ertificote of VENTILATION SYSTEM FINAL / y
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDA ON
with comply with-such provisions or this permit shall be
deemed revoked FURNACE FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT
HEATER WALL t�
(commencing with Section 7000) of Division 3 of the Business (/
and Professions Code,and my license is in full force and effect -4.0 7 A
License Number - Lic Class _ # 0 0 0 0,0 $ V
D
Contractor Date '
I - F2Q50 O
❑ I am exempt under Sec 2 Q 5 0" 2
Plan check fee d
B 8P C for this reasonPERMIT ISSUING-FEE $ �j 0 2 2 0-8 6 Z
Date
Signature TOTAL FEE
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor's License D
Law for the following reason (Section 7031 5, Business and NAME
Pr essions Code)
j, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and CITY TEL NO
the structure Is not intended or offered for sale(Section
7044, Business and Professions Code)
OWNER 1 -IA-AJ
ETI, as owner of the property, am exclusively contracting /
with licensed contractors to construct the project (Sec- MAIL
tion 7044, Business and Professions Code) ADDRESS 90 mfr at-C
CONSTRUCTION LENDING AGENCY CITY J i TEL NO _o
I hereby affirm that there Is a construction lending agency for D
the performance of the work for which this permit Is issued CONTRACTOR
(Sec 3097, Civ C )
Lender's Name k//� �Tl �i9 ADDRESS =i ,
Lender's Address 90� r c-i�r�YCL �'t/� CITY TEL NO
STATE LIC
I certify that I have read this applicat on and state that the LICENSE NO - 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
n the above-m boned ro Irt for inspection purposes P P Y P P P
SEE REVERSE FOR EXPLANATORY LANGUAGE
_ - <ot, �r,-ri- �—/•yam/y+� -
ignature o Applicant or Agent Date / �/• !d
C ■