HomeMy Public PortalAbout9815 LONGDEN AVE_Mechanical__ G�'B,16lREV.B/781..- d:Y' ::; • •r. :; '... +, •"„ + '.: .., - - •I ,
®s 'APPL.B'C•A'.T9' •FOR' PERMIT
: .'WEA.TBNdv VEIdYOU I'f�,G ASR :CONDITIONING
COIJNTYI®F:L®S'.ANGEcES• `: ; "BUILDING lAND SAFETY,
FOR APPLICANt TO FILL IN
(PRINT Oft TYPE.
y , ADDRESS
,.
ONLY);
.
'NO.. .TYPE.OF"APPL IANCE OR,E�UIPMENT' F.E:
Z. LOCALITY, �
NEARESTT."�
• C055�:S
R '
ABSORFTION,UNIT;:BTU '?
i, OWNER` may:
AIR HANDLING UfVIT.,-CFM MAIL. •'-
t' ADDRESS,` 17.e'mn-
BOILER,.BTU._-`:` '
CITY;. f TEL.N'
COMPRESSOR,BTU 66NTRX6
IWA
VENTILA'fION SYST EM _
G
ADDRESS (�D.C� • .•
is
EVAPORATIVE`COOLER C'ITYTEL.NO'
v.
'FURNACE: FAU GRAVITY' STATE '/ LIC.
FLOOR ' BTU : f ;.LICENSE.NO'. !. CLASS .fr7
HEATER: SU.SOEND.ED UNIT_ •"� '
..APPROVAL'S DATE INSPECTOR'S SIGNATURE
WALL•
-ROUGH
EINAL
INSPE TIO REC. FRD �.
1... 10
Plan"Oeck fee 2.5'/o-of above....
uv
o'EIfMIT.ISSU9I�IG FEE'S' 'p.0
TOTAL*FEE ®p.
PLAN'CHECK APPLIC/{NT
�.
PLAN CHECK VALIDATION
NAME
�09CI A.
ADDRESS. 1
#.yoa oo
:.CITY T.EL.NO:' _ °•
2:A � 1a00
FHEREBY'ACKNOWLEDGE THAT'I HAVEAEAD THIS AP,P,LICAT.ION!AND
STATE;THAT THE ABOVE'IS.CORRECT AND AGREE TO COMPLY WITFI'ALL ' '' O a o 1. 5 O O U_
ORDINANCES AND LAWS"REGULATING'HEATING;:VENTILATING.,,'AIR,
CONDITIONING:.
.. PERMIT-VALIDATION:.• a�.-O-. 7, 7 8
HEREBY CERT.IFY�' T, •1 AM NOT 'ACTING VIOLATION`-OF-.-
I
t HAPTER:'9, DIVISION OF E B INESS AND ESS)OI�"L'CODE\" 5 x\
OF-THIE'STATE C CA •ORW V�
.SIGNATURE
OF PERMITTEE '.e
DISTRICT NO:, ..,f PROCESSE Y. :U -\
..�''{.rte •�a,i �'_ .. 4 .. •. , '
:WORKER'S COMPENSATION DECLARATION 720-0 6A,36a DPW 9189 APPLICATION FOR PERMIT
7 �° IME GREEN
I her affirm�th�U have a certificate of consent to self.insure, ;
or a oNrtificefe�oT'Wdrker;s Compensation Insurance,or•a certified HEATING-VENTILATING-AIF CONDITIONING
Copy.theroof(Sec.3800 Lab.C.)
PolicyNo. .Company, i!COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING.AND SAFETY DIV.. "
Certified copy is hereby furnished. i
❑ Certified copy is filed•With the county building.inspectibn' ( FOR APPLICANT TO FILL IN ADDRESS ( �' LGN '�/�/� ✓G'
department: y (PRINT OR TYPE ONLY)'
LOCALITY [/_�
Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE. P� v r��
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSSS ST.
L":ZMAJ LU�s'7-
COMPENSATION INSURANCE ff '
ABSORPTION UNIT,BTUASSESSOR
(This section need not be completed If the work involved by the MAP BOOK PAGE.. PARCEL
permit,is for one hundred dollars($100)or less.). �. -AIR HANDLING UNIT,CFM ' DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit !
is issued; I shall'nbt employ any person In any manner ad as to' i BOILER BTU
become subjectAo the Workers'Compensation Laws.
COMPRESSOR,BTU
I APPROVALS . DATE INSPECTOR'S SIGNATURE'
Date Applicant I!� VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making•this Certificate of ROUGH'
Exemption,you should become subject to the Workers'Compensation• +
EVAPORATIVE COOLER
provisicns,.of the l:abor.Cbde,you must forthwith comply with such
provisions,orthis permit shall be deemed revoked. 1' FURNACE: 'FAU GRAVITY'
LICENSED CONTRACTORS DECLARATION, I FLOOR. . BTU [� ' VALIDATION -
I hereby affirm that am licensed'under•provisions of.Chapter 9SUSPENDED• UNIT
HEATER:
(commencing with Section 7000)of Division 3 of the Business and j WALL
Professions Code,and my license kin full force and effect." q
Jo
License Number Lic.Class
Contractor Date C
❑ i am exempt under Sec. R.Ian check fee C:
I, Q
B.&P.O.for this'reason PERMIT ISSUING FEE$. �' C
.DateC
: ;l. TOTAL FEE C.'
'� ', LL
Signature OWNER-BUILDER DECLARATION PLAN,CAECK APPLICANT
1 hereby aifirm'that.l am exempt from the Contractor's License Law NAME ^i
for the following.reason (Section 7031.5;Business and Professions i. 8
ADDRESS '. Yftr!•a Y
as owner of the property, or my employees with wages t"
as their sole:compensation, will d6-the work and the CITY TEL.NO. 3307. .49x,
structure is not'Intended of offered for sale(Section 7044,
Business and Professions-Code). OWNER: 0 ►� 'Co o Pj 1 I t E S}
❑ •'I, as owner of the'property, am exclusively contracting TOTAL. .49-o.00
with lioonsed,'contractoFs to construct the protect (Sec- ADDRESS t�'r uECr� .-
Von 7044,"Business and Professions Cbde). I C<
• ' "'CONSTRUCTION L'ENDING.AGENCY CITY. C t f TEL.NO. �(r �•i
I hereby'affl4i that there"'is a construction Isnding.aggency for I CHANCE AUL
the performance of the work for which this permit.Is Issued CONTRACTOR
(SeC.3097,Civ:C.).
ADDRESS
Lender's Name 0I3610' 00.1 ,5/31.;f.+S.1.,
CITY TEL:NO.• =.- '
Lender's Address .lop- I c 72V''7r,,, AM •7•e'S�
r v
ddreas STATE
I Corti that I have read,this aptil cation and state that the above LICENSE NO. CLASS ,
info IN-ti n is correct. I'agree to comply with all County ordinances
an Sta laws relating to building construction',and hereby authorize '
re 's tat!ves o this County to enter upon-the above-mentioned
p ty for in. Cr rposes. f SEE REVERSE FOR EXPLANATORY LANGUAGE
3v
IS RE GF APPLICANT AGENT' D E ^ •,r