HomeMy Public PortalAbout9526 LEMON AVE_Mechanical__ 78A384Fo CE816191-9/75 APPLICATION FOR PERMIT -
HEATING - VENTILATING - AIR- CONDITIONING
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN ADDRESS If
(PRINT OR TYPE ONLY). _
LOCALITY
NO TYPE OFAPPLIANCEOR EQUIPMENT FEE
- NEAREST -�
CROSS ST.
ABSORPTION UNIT, BTU
OWNER G
AIR HANDLING UNIT, CFM MAIL
ADDRESS
BOILER,.BTU CITY `� TEL. NO.f�
COMPRESSOR, BTU �d
CONTRACTOR1406/
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY / TEL. NO
FURNACE' FAU_GRAVITY STATE LIC
FLOOR BTU LICENSE NO. p CLASS
HEATER: SUSPENDED UNIT_ DISTRICT NO. GROUP ZONE PROLE D BY CD
WALL O
v O� 7
F-
INSPECTION REC w
o..
Cn
Plan check fee 25% of above. a� 20V1b(�Q
PERMIT ISSUING FEE $ (}
-TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS'
CITY TEL NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION en
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI-
LATING., AIR CONDITIONING
I HEREBY CERTIFY AT I AM NOT ACTING IN VIOLATION APPROVALS DA' r I ' INS EG��rS`SIAG NSA TU RE
OF CHAPTER 9, DIVIS N OF T E BUSINES ANDPROFE IONAL ROUGH
CODE OF THE STAT F C IFO IA I
SIGNATURE FINAL
OF PERMITTEE '
PERMIT VALIDATION cK. GM"0 CASH
PLAN CHEC VALIDATION M O CASH „
2 5 7l�AR.'2�.. _� _=e_. x.0.0.• "
WORKERS'COMPENSATION DECLARATION 76A364C p //,�� -y� f�� (� (� (�/�
1 hereby affirm,that,I have a certificate of consent to self CE-818 (2-80) : APP Los�C 6=1 tl ,0 O rl FOR P E R tlVl}�T
insure, or a certificate of Workers'Compensation Insurance,or a�(EATIN(s_V E RITIL.AT((V�s_A1a3• CC)Ri®IY,IOi�llNw
ya certified copy thereof(Sec 3800,Lab C.) ; - +'<Policy ivo 3107900779ipany Ca'._ Casualty I ndem _
COUNTY OF LOS ANGELES BUILDING ARlD SAFETY
7.
Certified copy is hereby furnished. !'
Certified copyisBled withthe county building inspection
FOR ALICI4NT TO FILL,I,N BUILDING
department .. PPADDRESS'
9526. E._Lemon
'. bate g=23=8-i- Applicant_E-,—L.—FAYNE* OMRAN1� (PRINT OiR TYPE'ONLY)� -
LOCALITY ° +
CERTIFICATE OF EXEMPTION FROM WORKERS' 's -No, TYPE OF,APPLLANCE OR EQUIPM`ENT_, ;".FEE T_empie=C_I,t_y p�
COMPENSATION INSURANCE NEAREST >
;(This'section need not'be if the°work.involved . ABSORPTIONfuNIT, BTU` CRoss ST -dem a l±l ty�B�_Vd. 0
by the permit is for one hundred dollars ($100),or less.)" DISTRICT NO . PRocessF BY
I'certtf that in the AIR-HANDLING UNIT,CFM _
y ; performance of the work for Which this
permit.is issued, I shall not employ any person in"any,manner 3 �� >�•' Or
so as to become'subject to the Workers' Compensation Laws BOILER, BTU - �' H,
APPROVALS 'DATE INSPECTOR'S SIGNATURE _0
r = - LU
Date Applicant COMPRESSOR, BTU00
�-
ROUGH
NOTICE TO APPLICANT- if,,-after making this-Certificate of• VE`NTILATION SYSTEM Z
Exemption, you 'should become subject to the Workers' . -FINAL —.
Compensation provisions'of the Labor Code, you must forth- ' EVAPORATIVE,COOLER V/�L�DAT�ON r
with comply with such provisions or `this permit shall be
deemed revoked. f- a FURNACE FAU x GRAVITY
LICENSED CONTRACTORS DECLARATION fst 00 R. BTU • „ 10 OO.
`I hereby affirm that I•amdicensedzunder-provi§ions of Chapter„•., = HEATER: SUSPENDED UNIT
9 (commencing with Section 7000)of Division 3 of the Busi- WALL.
ness and Professions Code, and my license is in full force and
effect,
License Numbers 20228 Lic-.Class C-20
Contractor E, L. `RAYNE Date-9-223M-8--
D
$ _D I,am•exempt from the,licensing requirements as I am a'- v ,
licensed'architect br a-.registered professional engineer Plan check fee 25%Of above. -
acting in my professional capacity (Section 7051, Bus- - - t.
mess,and Professions Code) PERMIT ISSUING FEE,$•` ] O�
Lic.orReg,No Date TOTALFEE� -i]n 00--
ROME
O:
HOME OWNER-BUILDP_R DECLARATION .fir ti
_ PLAN CHECK.APPLICANT ,
`I hereby affirm that 1 am exempt from- the Contractors -. NAME '•
,-License'Law for the following reason.(Sectioii 7031,.5, Busi-':, v R
r
ness and Professions'Code): ADDRESS_ -
0 I, as owner of the property,.will do the work.and the TEL. NO. z 3 k
.structure is not intended or offered for sale'(Section CITY ,$,
t-'
7044,Business and•Professions Code,). o.ao
OWNER' ',.
1, as owner-of the property, am exclusively contracting - MI'S �E. TaggetZ
with licensed contractors to'construct • the project- , MAIL` x. Z '1°.1-i7 Q Q a
-(Section 70A4,Business and Prd`fessions Code).' ADDRESS. `9526s�E.- LemOn,t Avenue ;; •. -
`
CITY TEL.NO. o lo°o d� e7;(} 0 5
CONSTRUCTION LENDING AGENCY ' . T efpp)_e'C_I ty r�F4�=6]84 '
I"hereby affirm that there is- a construction lending agency' -- _ 4 2�•-z$ ;
for the performance of the work fot which this•-permit is CONTRACTOR ,j r �, r• t'
-E:.� LPAYNE;'CO-MBA NY-
issued,(Sec. 3097,'Civ- C
Lender,'s Name ADDRES§ µ_
v L66_W:_L i ve�'Oak Avenue _
tender's Address CITY 44�j-�ji �$
s ,TEL NO: 4' �T
«A`rca d'i a'`
I certify that•I have read this application and'statethat the STATE ;'" - LIC'.
above information is correct.d agree to comply with all County LICENSE NO. 20228: CLASS.,,- C-20
ordinances and State laws regulating,Heating, Ventilating and
Air Conditioning, and her y authorize representdiives of=this � -SEE REVERSE'FOR EXPLANATORY,LANGUAGE
Coup to enter upo . he-;above-mentioned property.f_or
I s ct n purposes.
9=223-81
SI nature of Per tee• y Date