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Home My Public Portal About9441 LONGDEN AVE_Mechanical__ s 76A364C CE-818(REV.6/78) ®s APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING FOR APPLICANT TO FILL IN (PRINT OR TYPE ONLY) ADDRESS C'/& U �uy NO. TYPE OF APPLIANCE OR EQUIPMENT FEELOCALITY NEAREST GROSS ST. ABSORPTION UNIT,BTU OWNER J AIR HANDLING UNIT,CFM MAIL L+ ADDRESS BOILER,BTU CITY TEL.NO. COMPRESSOR,BTU CONTRACTOR a � VENTILATION SYSTEM ADDRESS 12_2 W 7LIAISSy EVAPORATIVE COOLER i TEL.NO. a FURNACE: FAU GRAVITY STATE �f LIC. ,p FLOOR BTU LICENSE NO.�.?y CLASS `S4 HEATER: SUSPENDED UNIT_ APPROVALS DATE INSPECTOR'SSIGNATURE WALL ROUGH 0.r FINAL INSPECTION RECORD D- h Plan check fee 25% of above. w PERMIT ISSUING FEE$ -7 — TOTAL FEE PLAN CHECK APPLICANT PLAN CHECK VALIDATION NAMEvFJ ;-77ADDRESS • `� �� ( CITY TEL.NO. IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR CONDITIONING. PERMIT VALIDATION • 4 �. F I HEREBY CERTIFY THAT IAM NOT ACTING IN VIOLATION OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL CODE 0 0 0 0 (G OF THE STATE OF CALIF NIA. SIGNATURE OFPERMITTEE 2 0 - 27. 00 DISTRICT NO. PROCESSED BY O O 2-1,` .i 08, 0607-' �� 76A364C CE-8119(REV.6/781 ®9 APPLICATION'FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING (PRINT OR TYPE ONLY) ADDRESS LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST CROSS ST. ABSORPTION UNIT,BTU OWNER AIR HANDLING UNIT,CFM MAIL ADDRESS Y/ �• �D/7 BOILER,BTU CIT e_,, /�, �! TEL NO COMPRESSOR,BTU CONTRALTO cam' VENTILATION SYSTEM ADDRESS17 ap- 1. EVAPORATIVE.COOLER CITY / TEL.Nr FURNACE: FAU V TY STATE LIC. FLOOR BTU Q '� LICENSE NO CLASS HEATER: SUSPENDED UNIT_ APPROVALS DATE INSPECTOR'S SIGNATURE WALL ROUGH p /yam FINAL INSPECTION RECORD @s a Plan check fee 25%of above. PERMIT ISSUING FEE$ '? — TOTAL FEE /"7 PLAN CHECK APPLICANT PLA/NQ CHECK VALI ATION NAME C,2�iJ v . C-eS a44 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, VENTILATING, AIR CONDITIONING. PERMIT VALIDATION I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF -5 2 1.6 A CHAPTER 9, (31 N 3, OF THE BUSINESS AND PROFESSION L CODE OF THE STA CA IFO NIA. # o 0 o o 4 1 SIGNATURE OFPERMITTE 2 D D 1 7,0 0 DISTRICT NO. PpOG ED BY O o O 1 7,Q C L 0g 062 -79 ON I hereby afowt I haveMa cerrttificiate of consentOto self insure, 76A320-0046 DPW PW9l89 , LIME GREEN APPLICATION P®R PERMIT or.t cei ftcate ot'Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec.388000 abb...C..) �— e 'C Company/5Z ��/t' _ COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. LJ Certified copy is hereby furnished. ❑ Certified copy is filed with the county building in ction FOR APPLICANT TO FILL IN BUILDING de artm nett. c ` (PRINT OR TYPE ONLY) ADDRESS .� Date a Applicant r NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. COMPENSATION INSURANCE ABSORPTION UNIT,BTU (This section need not be completed if the work involved by the MAP B OK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER.BTU become subject to the Workers'Compensation Laws. Q O Q-e COMPRESSOR.BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL �z provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU fp O VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business and WALL Professions Code,and my license is In full force and effect. C 041 License Number 7 V LID.Class Contract e"L6Date ACCT.a L ❑ 1 am exempt under Sec. Plan Check fee �� oa �� C B.&P.C.for this reason PERMIT ISSUING FEE$ )- C' Date: TOTAL FEE Q Signature PLAN CHECK APPLICANT V OWNER-BUILDER DECLARATION G I hereby affirm that I am exempt from the Contractor's License Law NAME for the following reason (Section 7031.5, Business and Professions _ 69�e `- Code): ADDRESS 3�t�/ �� a✓ ME p I ITEI'SO �50 F1 1, as owner of the property, or my employees with wages 80e rn as their sole compensation, will do the work and the CITY a,2 `,,vl(�� TEL.N J7'��Z structure is not intended or offered for sale (Section 7044, v ` Business and Professions Code). * OWNER F1 I, as owner of the property, am exclusively contracting MAIL nnn with licensed contractors to construct the project (Sec- ADDRESS OQI Ot.101 7/20/95 tion 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY TEL.NO. 1476 1 AMiiu-28 Ihereby affirm that there is a construction lending agency for CONTRACTOR , the performance of the work for which this permit is Issued (Sec.3097,Civ.C.). nn ADDRESS Lender's Name CITY TEL.NO. Lender's Address STATE LIC. 1 certify that I have read this application and state that the above LICENSE NO. CLASS information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize representativesof this County nter upon the above-mentioned pro er ` of inspect' pur s SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANT OR AGENT