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Home My Public Portal About5910 MUSCATEL AVE_Mechanical__ '6n3e4. -,CEB'B - 3-69 APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING Iul • COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS /D BUILDING AND SAFETY DIVISION T JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY I- STATE .:OLEMAN W.JENKINS,SUPERINTENDENT OFBUILDING NEARESTCROSS ST. FOR APPLICANT TO FILL IN • (PRINT OR TYPE ONLY) OWNER MAIL NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS ABSORPTION SYSTEM, BTUCITY TEL. N0. CONTRACTOR AIR HANDLING UNIT, CFM ADORESBOILER, HORSEPOWERLzCITY . TEL. NOOWA'�-1 7,3COMPRESSOR, HORSEPOWER �7//�� LICENSE NO. CLASS G.;ZO VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED BY EVAPORATIVE COOLER ` FURNACE: FAU GRA YjTY FLOOR-___ BTU INSPECTION RECORD " HEATER: SUSPENDED UNIT r r IO WALL �I Com- V I. F • F ( l t r NEW—ADDITION– PERMIT $ 3 00 ALTEREPAIR_ TOTAL FEE $ 7 db PLAN CHECK APPLICANT NAME LADDRESS TEL.N0. REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ATE TNAT THE ABOVE IS CORRECT AND AGREETOCOMPLYLL ORDINANCES AND LAWS REGULATING HEATING,VENTI- pppROVALS DATE INSPECTOR'S SIGNATURE , AIR CONDITIONING.REBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH R 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONALF THE STATE OF IFORN[A. FINALURE JACK R. ALLEN, SUPERVISING MECHANICAL ENG'R. MITTE PERMIT VALIDATION c . M.O. CASH PLAN CHECK VALIDATION SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 76•A36i -fCE816 - 3-69 II . _ APPLICATION FOR PERMI ll HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES FB / DEPARTMENT OF COUNTY ENGINEER ' 7/ C BUILDING AND SAFETY DIVISION JOHN A. LAMBIE, COUNTY ENGINEER rl COLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING ir . FOR APPLICANT TO FILL-IN (PRINT OR TYPE ONLY) MAIL NO. TYPE.OF APPLIANCE OR EQUIPMENT FEE ADDRESS s ABSORPTION SYSTEM, BTU CITY � TEL. r. CONTRACTOR AIR HANDLING UNIT, CFM � BOILER, HORSEPOWER ADDRESS CITY TEL. NO. COMPRESSOR, HORSEPOWER STATEo3 rS / LICENSE NO.- �a CLASS T VENTILATION SYSTEM a DISTRICT NO./�� GROUP ZONE PROCESSED BY EVAPORATIVE COOLER l FURNACE: FAU GRAVITY CJ y L FLOOR BTU INSPECTION RECORD HEATER: SUSPENDEDUNIT WALL • o - F 0 u NEW—ADDITION— PERMIT $ • .3 00 L ALTER_REPAIR_ TOTAL FEE $ PLAN CHECK APPLICANT NAME ADDRESS L TEL.N0. EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION TE THAT THE ABOVE IS C RECT AND AGREE TO COMPLY ' LL ORDINANCES AND LA REGULATING• HEATING,VENTI- APPROVALSDATE INSPECTOR'SSIGNATURE AIR CONDITIONING.EBY CERTIFY THAT , M NOT ACTING IN VIOLATION OF ROUGH 9, DIVISION 3, THE BUSINESS ND PROFESSIONAL THE S F C IFORNIA. FINAL / id �1 RE JACK R. ALLEN., SUPERVISING MECHANICAL ENG'R. ITTEE PERMIT VALIDATION k. M.O. CASH PLAN CHECK VALIDA " �-1 7-9 .G% .sEP11 41 D 5.00 y - 'EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE WORKERS'COMPENSATION DECLARATION CEA 6818 4C(2-80) A P P LL=IC H ®6�1 ®� �� I her affirm that I have a' certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,of I-IIEATII�IG-V E NTIL.ATI�NG-AIR CONDITIONING a certified copy thereof(Sec.3800,Lab.C..) � Policy No. Company 4 ❑ Certified copy is hereby furnished. COUNTY OF LOS ANGELES II BUILDING AND SAFETY ❑ Certified copy is filed with the county building inspection BUILDING �. department. FOR APPLICANT TO FILL IN Date Applicant (PRINT OR TYPE ONLY) ADDRESS Q Q. as e-A T CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY AJ lc L 66 o oeS+ COMPENSATION'INSURANCE NEARESTA��CROSS ST-. O}. (This section need not be completed if the work. involved ABSORPTION UNIT,BTU � O by the permit is for• one hundred dollars ($100) or less.) t " , DISTRICT NO. PROCESS D BY 0 I certify that in the performance of the work for which this i AIR HANDLING UNIT,CFM permit is issued, I shill not employ any person in any manner ' O so as to become subject to the Workers'Compensation Laws. 1 BOILER,BTU 17— APPROVALS DATE INSPECTOR'S SIGNATURE W Date Applicant COMPRESSOR,BTU - CL � ROUGH N NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM VLZ Exemption, you should become subject to the Workers' I FINAL Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such p,rovisidns or this permit shall be deemed revoked. FURNACE: • FAUAVITY LICENSED CONTRACTORS DECLARATION i FLOOR: TU I herebyaffirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi- WALL ness and Professions Code, and my license is in full force and effect. License Number Lic.Class Contractor Date i ❑ I am exempt. from the licensing requirements as I am a I licensed architect ,or a registered professional engineer .� Plan Check fee 25%of'above. acting•in my professional capacity (Section 7051, Bus- I iness and Professions Code). PERMIT ISSUING FEE$ Lic.or Reg.No. Date I TOTALFEE HOME OWNER-BUILDER DECLARATION 1 PLAN CHEC APPLICANT 31 kG. A I hereby affirm that I am exempt from-the.. Contractor's I NAME t License Law for the following reason'(Section 7031.5, Busi-'�' ;I{ ° a o ° ° ness and Professions Code): ADDRESS 12 I, as owner of the property, will do the'work and the I ° °( 3 0.5 0 CITY TEL. NO R— , structure is not intended or offered for sale Section �' O v S�.Z.3 ° ° e 3:Q 5 0 c 7044,Business and Professions Code). ❑ I, as owner of the proper'ty, am exclusively contracting OWNER p 1,627-83 with licensed contractors to construct the project MAIL (Section 7044,.:Business and Professions Code). ADDRESS 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 CONTRACTOR issued SSec.3097,Civ.C.). i Lender.s Name i ADDRESS Lender's Address CITY O• I certify that I have read this application and state that the STATE LIC. above information is correct.I agree to comply with all County LICENSE NO. CLASS ordinances d State laws regulating Heating, Ventilating and I Air Condi oning,and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County 0 enter. upon the above-mentioned properly for i sp i purposes: i�� ! , Signature of Permittee Date