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HomeMy Public PortalAbout9552 LIVE OAK AVE_Mechanical__ %6A364 - CE818 - 3-69 APPLICATIO FOR PERMIT ,i HEATI G - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION ` JOHN A. LAMBIE, COUNTY ENGINEER LOCALI COLEMAN W JENKINS,SUPERINTENDENT OF BUILDING NEAREST �. CROSS FOR APPLICANT TO FILL IN (PRINT OR TYPE ONLY) OWNER MAIL NO, TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRE S ABSORPTION SYSTEM, BTU CIT TEL. CONTRACT AIR HANDLING UNIT, CFM BOILER, HORSEPOWER ADD TEL NO. COMPRESSOR, HORSEPOWE STATE LIC LICENSE Q1 ASS VENTILATION SYSTEM DISTRICT NO. GROUP ZONE/ PROCESSED BY EVAPORATIVE COOLER �� �/ FURNACE FAU GRAVITY FLOOR BTU INSPECTION RECORD HEATER SUSPENDED UNIT WALL >- t a 0 V 0 v W LoLo NEW—ADDITION— PERMIT $ 3 00 c ALTER_REPAIR_ TOTAL FEE $ PLAN CHECK APPLICANT NAME ADDRESS CITY TEL. N0. 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. , I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH CHAPTER 9, DIVISION 3, OF TH USINESS AND PROFESSIONAL CODE OF THE STAT OF IFO A. FINAL SIGNATURE JACK R. ALLEN, SUPER ISI MECHANICAL ENG'R. OF PERMITTE , PERMIT VALIDATION CK. M.O. CASH �57 PLAN CHECK VALIDATION _s I ant's, 6,0 4 6'--' JUL 24. 4 1 D •t 7.0 0 ;EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE WOR%EhS'COMPENSATION DECLARATION 76A364Co [ hereby affirm,that 1 have a certificate of consent to self CE -818 (2-80) If" I� l� C AT U O tl FOR IT"E R IIVU T insure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONING a certified copy thereof(Sec.3800,Cab C.) T Policy rt ified copy is heiebY furnishCd:Compan Certy COUNTY OF LOS ANGELES, / BUILDING ARID SAFETY 0 Certified copy is filed with the cdunty building inspection BUILDING department FOR APPLICANT TO FILL IN S�Ja L1�� iJL.1� Date Applicant (PRINT OR TYPE ONLY) ADDRESS �y LOCALITY �p M n\� CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF•APPLIANCE OR EQUIPMENT FEE W_` need NSATIONpNSUAQNCE NEAREST CROSS ST \�� (This SeCdori need ri0i be completed.if the work involved ABSORPTION UNIT, BTU d by the permit is for One hundred dollars ($100) Or less.) DISTRICT NO - -PROCE F BYr. 0 I certify that in the performance-of the work for which this AIR HANDLING UNIT,CFM 'Q permit is issued, I shall not employ any person in any manner VY so as to become sublect'to the Workers' Comperisatiom Laws. BOILER, BTU- Old Q 0 APPROVALS DATE INSPECTOR'S SIGNATURE V Date.Applicant COMPRESSOR,BTU ROUGH a NOTICE TO APPLICANT: ff, after waking this Certificate of VENTILATION SYSTEM FINAL Z Exemption, you should become subject to the Workers' _ Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER with comply with•Such provisions or this permit shall be VALIDATION deemed revoked. FURNACE FAU GRAVITY- LICENSE RAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions 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 Number Lic.Class Contractor Date QI am exempt froro the licensing requirements as I am a licensed-architect or a registered professional engineer Pfan check fee 25%of above. acting in my professional capacity (Section 7051, Bus- iness and Professions Code).. PERMIT ISSUING FEE $ SCS Lye.or Reg_No. - Date TOTAL FEE HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICAN I hereby affirm that I am exempt from--the Contractor's NAME - License Law for the following-reason (Section 7031.5, Busi- ness and Professions Code). ADDRESS EJI, as owner of the property, will do the work and the TEL NO structure is not intended or offered for sale (Section` CITY 7044, Busyness and Professions Code): �•�. r� X13 5 Q'8 A �f ^OWNER �11^ e -! S1�J��_V� � I, as owner of the property, am exclusively contracting l�MAIL 11Y h y i t J�with licensed contractors to construct .file• project /II MAI L #'O�° 0.0 ° 8 p J - (Section 7044, Business and Professions Code) I ADDRESS- CITYTi d0 T'�/_ 3,3.'50 CONSTRUCTION LENDING AGENCY G TEL.NO b_ (/T I hereby affirm that there is a construction lending agency �1_� for the performance of the work for which this permit is ' CONTRACTOR © � :3,3,,5, c'), issued(Sec. 3091,Clv C.). Q''0'Sr 8 2 Lender's Name ADDRESS - si Lender's Address_ CITY TEL NO I certify that 1 have read this application and state that the STATE LIC. above information is correct I agree to comply with all County LICENSE NO. CLASS ordinances and,State laws regulating Heating. Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE Countv to enter upon "ie above-mentioned property for in r ,,(ion parposes JSignature of Permittee Date