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HomeMy Public PortalAbout9224 LONGDEN AVE_Mechanical__ r 76A39C f o- CE-818(REV.11/78) Ss Pul N FOR PERMIT HEATING. - VENTI TING = AIR CON - TION COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO'FILL IN BUILDING ADDRESS (PRINT OR TYPE ONLY) NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY Teves NESOSS CROSS ST. ABSORPTION UNIT,BTU OWNER S AIR.HANDLING UNIT,CFM MAIL ADDRESS laid BOILER,BTU CITY TEL.NO. tp C alb�- COMPRESSOR.BTU CONTRACTOR C / VENTILATION SYSTEM ADDRESS EVAPORATIVE COOLER CITY TEL.N4 FURNACE: FAU GRAVITY STATE LIC. FLOOR BTU LICENSE NO. CLASS HEATER: SUSPENDED UNIT_ APPROVALS DTE INSPECTOR' S)CgNATURE WALL y ROUGH FINAL INSPECTION RECORD O Plan check fee 25%of above. us PERMIT ISSUING FEE$ TOTAL FEE PLAN CHECK APPLICANT PLAN CHECK VALIDATION NAME ADDRESS A CITY TEL.NO. i REBY ACKNOWLeIME THAT 1 HAVE READ THIS APPLICATION AND ar 0 4 7.6 A STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING, -VENTILATING, AIR #'D 0 0 0 4 1 CONDITIONING. PERMIT VALIDATION I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF 2 0 0 3 0 0 CHAPTER 9, DIV N 3, OF ,NES PROFESSIONAL CODE OF THE STAT FCA ORNI . SIGNATURE 0 0 0 1 O O L OF PERM ITT E _ 0.5.22-80. DISTRICT NO. PROCESSED Re, • �� J1. WORKERS'COMPENSATION DECLARATION I � A 1 818(2-80) APPLICATION FOR PERMIT I hereby affirm that I have a' certificate of e"onsent 'toi sett CE8 insure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONING a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is filed with the county building inspection BUILDING department. FOR APPLICANT TO FILL IN ADDRESS 2Z Date Applicant I (PRINT OR TYPE ONLY) LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ? • " COMPENSATION INSURANCE ! NEAREST CROSS ST. © a (This section need not be completed if the work involved ABSORPTION UNIT,BTU by the permit is for one hundred dollars ($100) or less.) . DISTRICT NO. PROCESSED BY 8 I certify that in the perform ce of the work for which this AIR HANDLING UNIT,CFM tr permit is issued, I shall emp y any person in any manner j 4� G so as to become subject to the rkers' pe Laws. BOILER,BTU t APPROVALS DATE• INSPECTOR'S SIGNATURE Date Applica I COMPRESSOR,BTU ROUGH y NOTICE TO APPLICANT: If, after making this Certificate of I Z i VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be j deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR: BTU a I hereby affirm that I am licensed under provisions of Chapter I HEATER: SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi- I WALL ness and Professions Code, and my license-is in full force and effect. I. License Number Lic.Class Contractor Date F_ I am exempt from the licensing requirements as I am a I' licensed architect or a' registered professional engineer Plan check fee 25%of above. , acting in my professional capacity (Section 7051, Bus- iness and Professions Code). PERMIT ISSUING FEE$ a Lic.or Reg.No. Date I - TOTAL FEE Q HOME OWNER-BUILDER DECLARATION I PLAN CHECK APPLICANT 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): I ADDRESS 0 I, as owner of the property, will do the work and the -95 1 0, 1 A structure is not intended or offered for sale (Section ` CITY TEL.NO. 7044, Business and Professions Code.). OWNER o o;o o o 8 F-1 i I, as owner of the property, am exclusively contracting with licensed contractors to construct the project MAIL 2'-,-. 2.3 5 0 (Section 7044,Business and Professions Code). ! ADDRESS CONSTRUCTION LENDING AGENCY I CITY TEL.NO. 0 0 0 2 3,5 0 I hereby affirm that there is a construction lending agency I CONTRACTOR 07,21 -82 for the performance of the work for which this permit is ! issued(Sec.3097,Civ.C.). Lender's Name ADDRESS Lender's Address CITY TEL.NO. I certify that I have read this application and state that the I STATE LIC. above information is correct.I agree to comply with all County I LICENSE NO. CLASS ces and State laws regulating Heating, Ventilating and Air Co ditionfng,and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to up e a ve-mentioned property for inspect' n urpos s. ature of Permi tee Date