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Home My Public Portal About9425 LAS TUNAS DR_Mechanical__ 76 A364 - CE! 818 - 9-71 APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING / �y DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITYNEAREST // CROSS ST. a /` FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) 'I�`/AJ �j MAIL !�(/ s ®G�ij/J f�� , No. TYPE OFAPPLIANCE OR EQUIPMENT FEE ADDRESS CITY L�7 TEL. NO..C7j g-s / ABSORPTION UNIT, BTU CONTRACTORf� AIR HANDLING UNIT, CFM ADDRESS BOILER, BTU CITY0-tT ®/! J4C; TEL. NO. COMPRESSOR, BTU STATEf LIC. 2 LICENSE NO. ! �'�!p` CLASS / VENTILATION SYSTEM DISTRICT NO. GROUP ZONEPROCESSED BY EVAPORATIVE COOLER r FURNACE: FAU_GRAVITY INSPECTION RECORD C-3 FLOOR BTU HEATER: SUSPENDED-UNIT- WALL USPENDED UNIT_WALL V C-> ii z Plan check fee 25% of above. See reverse. PERINUT ISSUING FEE 9 a 00 TOTAL FEE (}�+ PLAN CHECK APPLICANT NAME ADDRESS CITY TEL.NO. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION I AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY jo WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENT[- APPROVALS D1 'JASPECTOR'S SIGNATURE LATING, AIR CONDITIONING. ROUGH n I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF CHAPTER 9, DIVISION 3, OF THE BUSINE AND PROFESSIONALI IV CODE OF THE STATE CALIFORNIA. FINAL / / A, SIGNATURE PERMIT VALI ATI N cK.wM-O- .20!2�OF PERMITTE PLAN CHECK VALIDATION CK. M.O. CASH / SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE t 76 A364- CE 818- 5-73 APPLICATION OR PERMIT . HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELESBUILDING .Q DEPARTMENT OF COUNTY ENGINEER •ADDRESS BUILDING AND SAFETY DIVISION LOCALITY NEAREST CROSS ST. FOR APPLICANT TO FILL IN OWNER J (PRINT OR TYPE ONLY) - ,A MAIL NO.'TYPEOFAPPLIANCE OR EQUIPMENT FEE ADDRESS LlArl�3S CITY z� �' L. NO. /OO ABSORPTION UNIT, BTU CONTRACTOR _ AIR HANDLING UNIT, CFM ADDRESS 4 BOILER, BTU CITY �� r TEL. f COMPRESSOR, BTU O OSTATE LTC d LICENSE NO. (� �� CLASS VENTILATION SYSTEM DISTRICT NO. GROUP ZONE ESS ED BY EVAPORATIVE COOLER , O CSL Qd�`7V d FURNACE: FAUGRAVITY INSPECTION RECORD FLOOR BTU HEATER: SUSPENDED UNIT_ WALL O U O r w d Plan check fee 25% of above. See reverse, z PERN11'[ISSUING FEE S 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 DATE INSPECTOR'S SIGNATURE LATING, AIR CONDITIONING. _ p. ROUGH I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF CHAPTER 9, DIVISION F THE BUSINESS AND PROFESSION FINAL / CODE OF THE STATE OF ALI ORN 1 SIGNATURE PERMIT VALIDATION CK. M.O. CASH OF PERMITTEE - PLAN.CHECK VALIDATION CK, NK0. CASH . 7 9r- 1AY 2 4 1'0 8.0 0 ,&&8 SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE - WORKER'S,COMPENSATION DECLARATION 20-0046 DPW 9/8976A364C APPLICATION 'FOR PERMIT' LIME:- GREEN,, I hereliq affirm that I have a certificate'of.consent to self insure, ., or a certificate:of Worker's Compensation.Insurance, r rFrfi ; {� copy thereof(sec.3800 Lab'.C.) (Z �✓L�G �t�l��"{l�I HEATING VENTILATING- AIR CONDITIONING ILJI 3 0 1 A'. � � COUNTY.OF.LOS ANGELES DEP..T-OF PUBLIC:WORKS BUILDING AND SAFETY DIV. Policy No. Compa y ❑ Certified copy is,hereby furnis'6d.: BUILDING 1 Certified copy is filed with the county bulldmg'inspection FOR APPLICANT TYPE ONLY) IN ADDRESS d partme t. " (PRINT OR TYPE ONLY)' lJr,`' TY'rGt�fL� UT� Date Applicant LOCALITY NO... TYPE OF APPLIANCE OR, FEE , CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS ST • COMPENSATION INSURANCE ABSORPTION UNIT,BTU This.section need not be completed if the work involved b ASSESSOR . ( Y the p 'MAP BOOK .'�2 PAGE 4- ARCEL permit is for one hundred dollars($100)or less.) AIR HANDLINGUNIT,CFM' DISTRICT NO. PROCESSED BY I certify that in the-perforrriance.of the work for.which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU become subject to-the Workers' Compensation Laws. D I COMPRESSOR,BTU -. APPROVALS - DATE INSPECTOR'S SIGNATURE - Date Applicant =IL X2MM=M01MSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH t" Exemption,you should become subject to'the.Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code,-you must.forthwith comply with such. FINAL `Z provisions or this perrnirishall be deemed revoked. FURNACE: FAU - GRAVITY ` LICENSED CONTRACTORS DECLARATION / FLOOR BTU VAI-IDATI -N I hereby affirm that I.am licensed under provisions of Chapter 9: SUSPENDED UNIT (commencing with Section 7000) of Division 3'of the Business and HEATER"` WALL Professions Code,and my license is in full force and effect: �i�4Zl I r1A Got Lr License Number Lic. ass • Cl ,, trr •�v a a Contractor 0 I am exempt under Sec. •Plan Check fee'' r r + t F V B.BP:C.for this reason " PERMIT ISSU.ING.FEE$ 'CJT41 �ki 0 Date: TOTAL FEE, 9S Sighature / ^r W OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT f/) I hereby affirm that I am exempt from the Contractor's.License Law NAME M tIVl; C� f Z for the followirig reason (Section 7031.5, Business and Professions - V , tela f_ _I_4 IU ,•._• ;4 Code): ADDRESS;?*3 I, as'owner of the property,or my employees with wages U I as their sole compensation, will do the work and the CITY �7ps!—� ct`1�k TEL.NO.gj0� =structure is not intended or offered for sale (Section•7044„ t`�✓ Business and Professions Code). OWNER CJ47PVPQt,�- kA( F-1. I, as owner of the property, am exclusively contracting-. MAIL. with licensed contractors.to construct,the project (Sec- ADDRESS S �,,G� '. V� - tion 7044, Business and Professions Code). TEL.NO. CONSTRUCTION LENDING AGENCY �� I hereby p eby affirm that there is a construction lenn ding agecy for CONTRACTOR �I the performance of the work for-which.this ermlt Is Issued 1V.•. ( �1V (Sec.3097,Civ.C.). ADDRESS V 1 Q v f'r A\1 1: Lender's Name . O:CITY V / N7A1" A le � Lender's Address STATELIC I certify that I have read this applicationand state.that the above LICENSE NO. Z'�$' C_LASS 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 upon the above-mentioned property for ins action purposes. SEE REVERSE FO.R'EXPLAN ATORY LANGUAGE SItNAtURE OFPPLI VOR AGENT DATE