HomeMy Public PortalAbout4939 MCCLINTOCK AVE_Mechanical__ . I
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JISA384C
CE-8IS IREV.6/78)
85 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING ND SAFETY
FOR APPLICANT TO FILL IN BUILDING ADDRESS 4939 NbClintock
(PRINT OR TYPE ONLY)
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY Tem le Cit
NEAREST 94
CROSS ST.
1 ABSORPTION UNIT,BTU 10.00
OWNER Shackelfort
AIR HANDLING UNIT,CFM MAIL
ADDRESS Same
BOILER,BTU CITY Temple City TEL.NO. lel.p 1,108
COMPRESSOR,BTU 36,000 10.00CONTRACTOR Dart Air Systems
VENTILATION SYSTEM ADDRESS 3.340 D amics Unit J
EVAPORATIVE COOLER CITY Anaheim TEL.NO. 24— 6 0
FURNAFLOORCE: FAU BTU GRAVITY STATE LIC LICENSE NO. 3l 0-599 CLASS Q-20
HEATER: SUSPENDED UNIT_ APPROVALS DATE INSPECTOR'S SIGNATURE
WALL
ROUGH �
6
FINAL
INSPECTION RECORD u
Plan check fee 25% of above.
PERMIT ISSUING FEE$ 7poo
TOTAL FEE 2 00
PLAN CHECK APPLICANT PLAN CHECK VALIDATION
NAME ��JJ
ADDRESS /
�S_
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 .`_'[! 5 S.4 n
CONDITIONING. PERMIT VALIDATION
1 HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF # 0 0 0 0 [a
CHAPTER 9, DIVISION 3. OF THE BUSINESS AND PROFESSIONAL CODE
OF THE STATE OF CALIFORNIy/7 y� � 2 0 - 27.00
SIGNATURE
OFPERMITTEE
0 0 0 2 7 0 Ol u
DISTRICT NO. PR SSED BY
�.-, �o 05.25-79
N
WORKERS'COMPENSATION DECLARATION
J, herpby"affirm that I Have a certificate of consent to self f
APPLICATION FOR PERMIT
insure, or a certificate of Workers'Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
or a certified copy thereof (Sec. 3800, Lab. C.) 76A364C
CE-818(REV. 10/81) J J
Policy No. Company
Certified 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 BUILDING /i
tion department. (PRINT OR TYPE ONLY)
ADDRESS "'�
Date Applicant LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF'EXEMPTION 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($100)or less.)
I certify that in The performance of the work for which this AIR HANDLING UNIT,CFM ,
permit is issued, I shall not employ any person in any man BOILER,BTU
so as to become subject to the Worker ' om Untio n L APPROVALS DATE INSPECTOR'S SIGNATURE
COMPRESSOR,BTU ROUGH
Date r " pplicant • '
NOTICE TO APPLICANT: If, after making this Certificdte of VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED-UNIT-
'(commencing
USPENDED UNIT'(commencing with Section 7000)of Division 3 of the Business WALL
and Professions Code,and my license is in full force and effect.
License Number Lic. Classpop- U
m9
Contractor Date �
❑ I am exempt under-Sec. 11,d
Plan check fee H
B.&P.C. for this reason PERMIT ISSUING FEE$ S •
Date: TOTAL FEE (� 0
Signature I
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): 0388
ICh I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and CITYTEL. NO.
the structure is not intended or offered for sale(Section 1A,N1
7044, Business and Professions Code). I OWNER21n ' 2 0.5 0
❑ I, as owner of the property, am exclusively contractingMAIL 2 0 5 0'J
with licensed contractors to construct the project (Sec- I ADDRESSF. �c
tion 7044, Business and Professions Code). O a 1 1 -83
CONSTRUCTION LENDING AGENCY CITY TEL. NO.
I hereby affirm that there is a construction lending agency for ,
the performance of the work for which this permit is issued CONTRACTOR
(Sec. 3097, Civ. C.). "
ADDRESS
Lender's Name
CITY TEL. NO.
Lender's Address
STATE LIC.
I certify that I have read this application and state that the LICENSE NO. CLASS
above information is correct. I agree to comply with all County
ordinancrelating to building construction,
and heresentatives of this County to enter
U
t
;eEmproperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign ure of Applicant or Agent Date