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Home My Public Portal About5948 MUSCATEL AVE_Mechanical__ of s�ewv.e/su m, APPL7TJl ION FOR PERMIT HEATING - VEITING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING (PRINT OR TYPE ONLY) ADDRESS LOCALITY 1t 4L • NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST t r CROSS ST. Q.S ABSORPTION UNIT.BTU OWNER -� ir r 44 LY AIR HANDLING UNIT.CFM MAIL ADDRESS BOILER.BTU CMYr`,. t t kd TEL NO. COMPRESSOR.BTU CONTRACTOR v wt VENTILATION SYSTEM ADDRESS 1 EVAPORATIVE COOLER CRY N TEL NO. LI-'t(j' FURNACE: FAU GRAVITY STATE LIC. FLOOR BTU LICENSE NO. Z 7 CLASS HEATER: SUSPEN U APpppyA� DAM imsfwro •sSWRATURE W I ROUGH .. , 0 C0. r FINAL /w 7, INSPECTION RECORD Plan check fee 25%of above. f .— PERMIT ISSUING FEE$ TOTAL FEE PLAN CHECK APPLICANT PLAN CHECK VALIDATION NAME N %A r ds ADDRESS 10 11 W - y CRY Pt IA-1TEL 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 1 HEREB�IWR , AM OT SNC IN VIOLATION OF CHAPTER B. VL BUS A PROFESSIONAL CODE G 2 fl OF THE STATE SIGNATURI Do D O O 4 ' OFPERMITTE +/1/V �/ DRRRKTNO. P ED BY 2 - 2100 - 27.005 r I "0/ff � 4- /J S 1 WORKERS'COMPENSATION DECLARATION APPUCATION FOR PERMIT I hereby affirm that I have a certificate of consent to self I insure, or a certificate of\Norkers'Compensation Insurance, ��QI�G = VENTILATING . AW CONDITIONING or a certified copythereof (Sec. 3800, Lab. C.) 76A364C 20-0046 DPW 9/88 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 tion department. ADDRESS (PRINT OR TYPE ONLY) nn Date Applicant LOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST � �� . COMPENSATION INSURANCECROSS ST. (This section need not be completed if the work Involved by ABSORPTION UNIT, BTU -+� DISTRICT NO. PR ED BY the permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT, CFM 3 -:TOW I certify that in the performance of the work for which this g permit is issued, I shall not employ any person in any manner BOILER, BTU A10so as to become subject to the Workers'Compensation Laws. APPROVALS DATE IN ECTOR'S SIGNATURE Date Applicant COMPRESSOR, BTU ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER LID Idpr with comply with such provisions or this permit shall be deem- ed revoked. FURNAT FURNACE: FAU GRAVITY Q� LICENSED CONTRACTORS DECLARATION �f 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 WALL. and Professions Code,and my license is in full force and effect. License Number Lic. Class O Contractor Date ❑ I am exempt under Sec. Plan check fee U B.&P.C, for this reason H Date:. PERMIT ISSUING FEE $ � Signature TOTAL FEE Q� 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 C� Professions Code): t I, as owner of the property, or my employees with ADDRESS ��04 wages as their sole compensation,will do the work and CITY TEL. NO. F' the structure is not intended or offered for sale(Section c`ola 7044, Business and Professions Code). I, as owner of the property, am exclusively contracting OWNER 1 ITEM with licensed contractors to construct the project (Sec- MAIL i tion 7044, Business and Professions Code). ADDRESS TOTAL 53.ti[0 CONSTRUCTION LENDING AGENCY CITY TEL.NO. CHECK 53.00I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTOR -0HANG5E ells (Sec. 3097, Civ. C. . ADDRESS Lender's Name '� 00 i ,r � CITY TEL. NO. UVt)J'QClLI� C�i�I�Ft Lender's Address S�yf Af�sGAT�� -1 is o;r 1 certifythat I have read this application and state that the STATE LIC. ��'t.} dif t �l�-t}r PP LICENSE NO. CLASS above information is correct. I agree to comply with all County ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE iwp ,7— Signature of Applicant or Agent Date @