HomeMy Public PortalAbout9141 LONGDEN AVE_Mechanical__ 's"SGaE,, C198168 9/75. APPLICATION FOR PERMIT
' A HEATING - VENTILATING - AIR CONDITIONING °
BUILD AND SAFETY IS10N
FOR APPLICANT TO FILL IN BUILDING
(PRINT OR TYPE ONLY)' ADDRESS
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY
NEAREST
CROSS ST.
ABSORPTION UNIT, BTU
OWNER
AIR HANDLING UNIT, CFM' MAIL
ADDRESS
BOILER, BTU CITY TEL. NO.
COMPRESSOR, BTU CONTRACTOR
VENTILATION SYSTEM ADDRESS 2� �/ ►� �
EVAPORATIVE COOLER CITY C� TEL. NO.," Z�r�
FURNACE:
FLOOR LOORBTU
FAU AVITY STATE LIC.
� LICENSE NO. 2� Z72 C ASS
HEATER: SUSPENDED. UNIT_ DISTRICT NO. GROUP I ZONE CEBBED BY y
WALL
Im
i 2.Z�
INSPECTION RECORD
. W
o.
y
' Z
Plan check fee 25%b of above.
PERMIT ISSUING FEE $
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 ORDINANCESAND LAWS REGULATING 'HEATING, VENTI-
LATING,AIR CONDITIONING.
I HEREBY CERTIFY THAT I A O ACTING IN VIOLATION APPROVALS DATE INSPECTOR'S SIGNATURE
OF CHAPTER 9, DIVISION 3 FH BU NESS AND PROFESSIONAL ROUGH
CODE OF THE STATE OF IF NIA.
SIGNATURE FINAL
OF P E R M I T T
PLAN CHECK VA. DATION PERMIT VALIDATION CK. M.O. CASH
CK, M.O. CASH
09_0'r`_'N0V* 24.1 12.00A
.WORKF,)? ,COMP,ENSATION DECLARATION APPLICATION FOR PERMIT
�If lbereby.'y(firm that 1,-have a certificate of consent to self
insure, or'-a certificate of Workers'Compensation Insurance, 76A364C HEATING - VENTILATING - AIR CONDITIONING
or p ce4tif' 'o thereof(Sec. 3800, b.C.) t
c CE-818(REV. 10/81)
PoliCertifiedny
copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY
❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDI j�
tion department. (PRINT OR TYPE ONLY) ADDRE / c -
LOCAUT
Da-14a-44Appit TYPE OF APPLIANCE OR EQUIPMENT FEE
ION L
CERTIFICATE OF EXEM FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST.
(This section need not be completed If the work involved by ABSORPTION UNIT,BTU DISTRICT NO. PROCESSED
the permit is for one hundred dollars(;100)or less.) ,r �}
AIR HANDLING UNITCFM
I certify that in the performance of the work for which this , s� _®]i'
permit is issued,I shall not employ any person in any manner C./ C./
A.-
so as,to become subject to the Workers'Compensation Laws. I BOILER,BTU APPROVALS DATE INSPECTOR' NATURE
COMPRESSOR,BTU ROUGH
Date Applicant
NOTICE TO APPLICANT: If, after making-this Certificate'of VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Workers' ��11
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER ' ALIDATWN
with comply with -such provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU
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 i WALLe �3 9 Q 3 A >.
and Professions Code,and my license is in full force and effect. g,
License Numbe°rALic. Class ► # 0 0 0 0 0 $ �
Contract 1�'� t�''� ��f � �-�7 1,o o20,50
❑ I am exempt under Sec. i o,o o 2 Q 5 0.55 IL
Plan,checkfee •
-
B.BP.C. for this reason-
q PERMIT ISSUING FEE$ b 61.2 3 . 86
Dat
TOTAL FEE 00 L570 f
Signawi%94me .4,g
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor's License ►
Law for the following reason (Section 7031.5, Business and NAME
Professions Code):
❑ I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and
the structure is not intended or offered for sale(Section CIN TEL.NO.
7044, Business and Professions Code).
OWNER o
❑• I, as owner of the property,am exclusively contracting
with licensed contractors to construct the project (Sec- MAIL
tion 7044, Business and Professions Code).
ADDRE (�
CONSTRUCTION LENDING AGENCY CITY 'TEL.
1 hereby affirm that there is a construction lending agency for ,
the performance of the work for which this permit is issued CONTRACTOR s .r
(Sec. 3097, Civ. C.).
ADDRE
Lender's Name ` Q
CITY TEL. N
Lender's Address STAfE LIC.
I certify that I have read this application and state that the LICENSE CLASS
above 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
upol above-men' ne property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Dote
Signature of Applicant or Agent ' ,