The URL can be used to link to this page

Home My Public Portal About9514 LAS TUNAS DR_Mechanical__ :76A364 = CEB,B - 3-69- APPLICATION FOR PER T HEATING - VENTILATING - AIR CONDITIONING a COUNTY OF LOS ANGELES BUILDING f � DEPARTMENT OF COUNTY ENGINEER ADDRESS / BUILDING AND SAFETY DIVISION JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY COLEMAN W JENKINS,SUPERINTENDENT OF.BUILDING NEAREST CROSS ST. FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) MAIL NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS ABSORPTION SYSTEM, BTU CITY TELL. NO. AIR HANDLING UNIT, CFM CONTRACTOR ADDRESS tv j BOILER, HORSEPOWER CITYN0. COMPRESSOR, HORSEPOWER STATEp a� LIC. LICENSE NO . / CLASS VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED Y EVAPORATIVE COOLER ( Of F� FURNACE: FAU GRAVITY FLOOR BTU INSPE TIO R ORD HEATER: SUSPENDED IT WALL J r CL 0 V Od 0 U Li CL V) NEW—ADDITION— PERMIT $ 3 00 Z ALTER_REPAIR_ TOTAL FEE PLAN CHECK APPLICANT ` NAME ADDRESS CITY TEL. NO. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING,VENTI- LATING, AIR CONDITIONING. APPROVALS DATE IN TOR'S SIGNATURE I HEREBY CERTIFY THAT I AM NO ACTING IN VIOLATION OF ROUGH CHAPTER 9, DIVISION 3, OF THE SINES AND PR FE SSIONAL FINAL C/ CODE OF THE STATE OF CALIFOR SIGNATURE '/ JACK R. ALLEN, SUPERVICK. MECHANICAL ENG'R. OF PERMITTEE > 1 PERMIT VALIDATION M.O. CASH PLAN CHECK VALIDATI a' ] (' tom} O c ' J 9 4 1 D 7.0 0` SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE `- WORKER'S COMPENSATION DECLARATION 20-0046 DPW 969 APPLICATION FOR PERMIT 76A364C' �I . .E GREEN I hereby affirm that I have a certificate of consent to self insure, 'or-a certificate of Worker's.Compensation Insurance, or a certified HEATING -VENTILATING-AIR CONDITIONING- copy thereof(Sec.3800 Lab.C.) Policy No. CompanyCOUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY,DIV. ❑ .Certified copy is hereby furnished: ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING department. (PRINT OR TYPE ONLY) ADDRESS Date Applicant LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST ,CERTIFICATE.OF EXEMPTION FROM WORKERS' CROSS ST. COMPENSATION INSURANCE . ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed if the work involved by the MAP BOOK PAGE PARCEL permit is.for one hundred dollars($100).or less.) AIR HANDLING UNIT,CFM ' DISTRICT NO: PROCESSED BY ,. I certify that in the performance of the work for which this permit is issued,4 shall not employ any person in any manner so as to BOILER,BTU become subject to the Workers' Compensation Law COMPRESSOR,BTU 6� - APPROVALS DATE INSPECTOR'S SIGNATURE Date ApplicantVENTILATION SYSTEM NOTIC O C PL ANT: If, after making 't 's Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER 2�1�f provisions,of the Labor Code, you must forthwith comply with such FINAL !ll provisions or this permit shall be deemed revoked. 'FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED—UNIT— (commencing USPENDED UNIT(commencing with Section 7000) of Division 3 of the Business and HEATER: WALL Professions Code,and my license is in full force and effect. ® � - o License Number Lic.Class L1,00 pop-Contractor _,4�4 Date O ElI am exempt un r Sec. Plan Check fee BAP.C.:for this reason PERMIT ISSUING FEE.$ w O F- Date: TOTAL FEE Q G W Signature PLAN CHECK APPLICANT CD OWNER-BUILDER DECLARATION Z I hereby affirm that I am exempt from the Contractor's License Law NAME , for the following reason.(Section 7031.5, Business and Professions 4 Code): .. r ADDRESS,- .- t I °it - i, as owner of the property, or my employees.with wages .y I_p- as their sole compensation, will do the work and the CITY TEL.NO. o stip_=, ° structure is not intended or offered for sale (Section 7044, —Business and Professions Code). OWNER R. EJ 1, as owner of the property, am exclusively contracting MAIL IHf 4 3;-= 00. with licensed contractors to construct the project (Sec- ADDRESS.;Iq �i4yl - tion 7044, Business and Professions Code), hi- F� ' ;CITY TEL.,NO. - CONSTRUCTION LENDING AGENCY ✓L z.Hf=NGE I hereby:,affirm.that there is a construction lending agency for CONTRACTOR /( ► the performance of the work for which this permit Is issued �i (Sec.3097,Civ.C.). ADDRESS !I il.i�.1`(_ R,1 SES 3 1-t ,.t.. 1 -' Lender's Name CITY . TEL.NO. - .. ~j i•it 1iz tea:=1.19- . Lender's Address STATE LIC. 1 certify that I have read this application and state that the above LICENSE NO. CLASS information is correct. I agree.to comply with all County ordinances and State laws relating to building construction,and hereby'authorize representatives of this CqunW to enter upon the above-mentioned property for insp tion u oses. SEE REVERSE FOR EXPLANATORY LANGUAGE'. SIGNATURE OF APPLIC OR-AGENT DATE