HomeMy Public PortalAbout9569 LAS TUNAS DR_Mechanical__ 76 A364 - CE 818 -1 75
APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
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COUNTY OF LOS ANGELES ADDREUILDING
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DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN 'OWNER
(PRINT OR TYPE ONLY) H -+C �/�(!�� w �✓ f
MAIL
N0. TYPE&SIZE OF EQUIPMENT FEE ADDRESS 7 57
SEE BACK OF APPLICATION
NO
CITY TEL. .
/ FORCE AIR FURNACE, BTU l�UN� - i
CONTRACTOR fJ
COMPRESSOR, BTU •Z S -
ADDRESS
VENTILATION FAN
CITY C TEL. NO.
LIST ALL OTHERS BELOW STATE / LIC.
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LICENSE NO. /S7- Q CLASS
VCL CC..�� �, DI T ICT NO. GROUP ZONE PROCE SEC BY
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S� INSPECTION RECORD
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Plan check fee. See reverse.
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PLAN CHECK APPLICANT aa. J
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, VENT I- APPROVALS DATE INSPECTOR'S SIGNATURE
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 2--Z
CODE OF THE STATE OF CALIFORNIA.
SIGNATURE , PERMIT VALIDATION CK. 'M.O. CASH
OF PERMITTEE E✓,.yd---ji L
PLAN CHECK VALIDATION CK. M.O. CASH
0 0 6,L rFR X 4 1
WORKER'S COMPENSATION DECLARATION 76A346DPW9/89 APPLICATION FOR PERMIT .IME GREEN
}y' 76A364C
o harceilfwate of Worker's Compensation(Insurance, or alfcert fled
HEATING-VENTILATING -AIR CONDITIONING
copy thereof(Sec 3800 Lab C) �Z / u
Policy No Company - �a�/ COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
Certified copy Is hereby furnished
❑ Certified co Is filed with the count buildingIns a FOR APPLICANT TO FILL IN BUILDING
department py y ADDRESS
(PRINT OR TYPE ONLY)
LOCALITY '� G
Date �� Applicant NO TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
CROSS ST .cry
COMPENSATION INSURANCE ABSORPTION UNIT,BTU
This section need not be completed if the work involved ASSESSOR
( b p Y 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, I shall not employ any person in any manner so as to BOILER,BTU
become subject to the Workers'Compensation Laws ,
-Z COMPRESSOR,BTU ,I�W.
APPROVALS DATE INSPECTOR S SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT If, after making this Certificate of ROUGH
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Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL -- _ 2
provisions or this permit shall be deemed revoked FURNACE FAU GRAVITY���
LICENSED CONTRACTORS DECLARATION FLOOR BTU 12�d y®'�/ / VALIDATION
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED UNIT
(commencing with Section 7000) of Division 3 of the Business and WALL
Professions Code,and my license Is In full force and effect
License Number yS�3�Z LIc Class r ZC� �Q , }
CL
Contractor Date 6 U
❑ I am exempt under Sec Plan check fee �O
B&P C for this reason PERMIT ISSUING FEE 0 U
Date TOTAL FEE 80 d
Signature CO
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT 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 L d//l -
Code) ADDRESS �7 � �✓ -t '_i eIr
1, as owner of the property, or my employees with wages 1
as their sole compensation, will do the work and the CITY �� TEL NO37 ~S_{7 li` =`-
structure Is not Intended or offered for saleSection 7044,
Business and Professions Code) ( OWNER
❑ I, as owner of the property, am exclusively contracting ' 07AL 1 -19 ,r 1
MAIL �/ / '�-^� ,,., ` - r'i '` —
with licensed contractors to'construct the project (Sec- ADDRESS G7 > � (� G1j-� a3��CCi_��
_
tion 7044, Business and Professions Code) !:f Gf.
CONSTRUCTION LENDING AGENCY CITY TEL NO 3�-��' CHA41 E
I hereby affirm that there Is a construction lending agency for CONTRACTOR ,
the
cCiv performance)of the work for which this permit is Issued
ADDRESS
Lender's Name //'^
CITY
�_- G6(, TEL N0
Lender's Address _
I certify that I have read this application and state that the above LICENSE NO % /�� Z CLCASS
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 I o rposes SEE REVERSE FOR EXPLANATORY LANGUAGE
APPLICANT OR AGENT
DATE