The URL can be used to link to this page

Home My Public Portal About9843 MILOANN ST_Mechanical__ 76 A364 �mcE 818 9-71 APPL CATION FOkARMIT HEATING - VENTILATING'- AIR CONDITIONING COUNTY OF LOS ANGELES FEA G DEPARTMENT OF COUNTY ENGINEER S Sf.c7 BUILDING AND SAFETY DIVISION Y ` TT.FOR APPLICANT TO FILL IN 74(PRINT OR•TYPE ONLY)NO. .TYPEOFAPPLIANCEOR EQUIPMENT FEE S CITY TEL. NO. ABSORPTION UNITi BTU CONTRACTOR AIR HANDLING UNIT, CFM. ADDRESS BOILER, BTUil.�C1s�' CITY NO COMPRESSOR, BTU STATE / ��' LIC. /�•� LICENSE NO J CLASS G �/ 31, VENTILATION SYSTEM DISTRICT NO. �GROUP0ONECESSED BY EVAPORATIVE COOLER UQ FURNACE: FAU_GRAVITY FLOOR BTU INSPECTION RECORDCD C) HEATER: SUSPENDED-UNIT- WALL USPENDED UNIT_WALL W CL N • Z Plan check fee 25% of above. See reverse. PERMIT ISSUING FEE $ a 00 TOTAL FEE PLAN CHECK APPLICA NAM ADDRESS ✓ CITY roe EL.NO LBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION E THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS D TE PECTOR'S SIGNATURE IR CONDITIONING. ROUGH 'j IPP771 EBY CERTI THAT 1 AM NOT ACTING IN VIOLATION ER 9, DIVISIjHE BUSINESS AND PROFESSIONAL FINAL THE STATE FORNIA. URE PERMIT VALI AT1Q ' K. M.o. CASH MITT E PLAN CHECK VALID TION CK. M.O. CASH � . 0865i3 F 1 41 D 10.50 SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE V1fORKER'S�OMPENSATIONDECLARATION 766AA3084CPW9169 APPLICATION FOR PERMIT LIME GREEN I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec.3800 Lab.C.) Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished. ❑ Certified copy is filed with the county g inspection FOR APPLICANT TO FILL IN BUILDING pection INT OR TYPE ONLY) ADDRESS department. (PR LOCALITY ��0— Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. COMPENSATION INSURANCE ABSORPTION UNIT,BTU SOR (This section need not be completed if the work Involved by the MAPEBOOK PAGE [PARCEL permit Is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER.BTU become subject to the Workers'Compensation Laws. COMPRESSOR,BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL + provisions or this permit shall be deemed revoked. FURNACE: FAU At GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU Z f_&15`C 4X VALI A ION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business and HEATER: WALL Professions Code,and my license is in full force and effect. License Number. Lic.Class G �f, ® CL Contractor �` •Date '`Z ! C ❑ I am exempt under Sec. Plan check fee 17 BAP.C.for this reason PERMIT ISSUING FEE$ C C Date: TOTAL FEE �� U Signature f U OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT 1 hereby affirm that I am exempt from the Contractor's License Law NAME for the following reason (Section 7031.5, Business and Professions Code): ADDRESS ❑ 1, as owner of the property, or my employees with wages -- a as their sole compensation, will do the work and the CITY TEL.NO. �{Z. 04 structure is not intended or offered for sale (Section 7044, Business and Professions Code). OWNER ❑ �. I, as owner of the property, am exclusively contracting MAIL with licensed contractors to construct the project (Sec- ADDRESS T--j y^ tion 7044,Business and Professions Code). r)L. •."P d, o 00 CONSTRUCTION LENDING AGENCY CITY TEL.NO. I hereby affirm that there is a construction lending agency for CONTRACTOR the performance of the work for which this permit Is issued popi(IF�t�r (Sec.3097,Civ.C.). ADDRESS �� — Lender's Name n �/ _ CITY 6Zf TEL.NO.9 �- / '% .I I.j_--lJj. %�I7t Lender's Address STATE y LIC. —� �, I certify that I have read this application and state that the above LICENSE NO._7f�,r�� CLASS C 2-ti 313 1 A i13:.:, information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize rep esentatives of this County to enter upon the above-mentioned pr arty for ins action purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE /1.0/5RE PPLICANT OR AGENT DATE