HomeMy Public PortalAbout5308 NOEL DR_Mechanical_4/14/1977_ 76 A364- CE 818-1/75
APPLICATION FOR PERMIT
• HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES fEBUILDING a
DEPARTMENT OF COUNTY ENGINEER RESS o !.4,BUILDING AND SAFETY DIVISION ALITYRESTSS ST
FOR APPLICANT TO FILL IN OWNER 1
(PRINT OR TYPE ONLY)
MAIL
NO TYPE&SIZE OF EQUIPMENT FEE ADDRESS-mo o` / -
SEE BACK OF APPLICATION
CITY ' L NO
FORCE AIR FURNACE BTU
CONT RACTO d Y/• G ��l11
COMPRESSOR BTU
ADDRESS 6
VENTILATION FAN CITY �.
/1' ITA EL NO at0 - �
LIST ALL OTHERS BELOW STA E LIC D
U LICENSE NO CLASSa
DISTRICT NO GROUP ZONE PROLES D BY
S' o i3 Z �2 /
INSPECTION RECO
a
O
U
O
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V
W
Plan check fee See reverse
PI II\II I I\( h I I c
In111 III 0
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY oiP TEL NO 0o
1 HEREBY ACK40WLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING VEN71 APPROVALS DATE INSPECTOR S SIGNATURE
LATING AIR CONDITIONING
ROJGH w
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9 DIVISION 3 OF THE BUSI ESS AND PROFESSIONAL FINAL
CODE OF THE STATE DFIFOR,NIA
SIGNATURE PERMIT VALIDATIN CASH
OF PERMITTE
PLAN CHECK VALIDATION CK CASH
6 8 7 i-APR 1 14 41 0 9.5 0 Abd
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76A 3464C
CE 6IS(REV 6/76)
®S APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING ANDSAFETY
FOR APPLICANT TO FILL IN BUILDING ADDRESS d '5777 .
-6 = O 0 O
(PRINT OR TYPE ONLY)
NO TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY & /i
NEAREST oz;
CROSS ST
ABSORPTION UNIT BTU
OWNER
AIR HANDLING UNIT CFM MAIL
ADDRESS
BOILER BTU CITY TEL NO
COMPRESSOR BTU CONTRACTOR
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY TEL NO
FURNACE FAU GRAVITY STATE LIG
FLOOR BTU LICENSE NO CLASS
HEATER SUSPENDED UNIT_ APPROVALS DATE INSP3VOR S SIGNATURE
WALL /
ROUGH -27 l!-� ``-C �
FINAL rl -1&--10
O
INSP CTION RE ORD V
®C
O
Plan check fee 25%of above 9
PERMIT ISSUING FEE$ a
TOTAL FEE
PLAN CHECK LICANT PLAN CHECK VALIDATION
NAME
ADDRESS
CITY TEL O
IHEREBY 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 L
I HEREBY IFY THA I AM NOT ACTING IN VIOLATION OF 3 7 q 7 A
CHAPTER 9 DI ION 3 OF E SINESS D PROFESSIONAL CODE
OF THE STAT ALIFO A
SIGNATURE # • • 6 • 4 1
OF PERMITT E
DISTRICT NO ESSED
2 • • 1700
-^ U • • • 170Cul
0416-79
1
S
ORKERCOMPENSATION DECLARATION ,4 '
I hohg� offlrm APPLICATION FOR PERMIT that I have a certificate of consent to self '
'Insure or a certificate of Workers Compensation Insurance HEATING - VENTILATING - AIR CONDITIONING
CE 81
or a certified copy thereof (Sec 3800 Lab C ) C
CE 818(REV 10/81)
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 d
tion department
(PRINT OR TYPE ONLY) ADDRESS Q
Date Applicant LOCALITY f
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST
COMPENSATION INSURANCE CROSS ST �G✓a,
(This section need not be completed if the work Involved by ABSORPTION UNIT BTU DISTRICT NO PROCESSED BY
�Z
the permit Is for one hundred dollars($100)or less)
I certify that in the performance of the work for which this AIR HANDLING UNIT CFM
permit is issued I shall not employ any person in any manner BOILER BTU
so as to become subject to the Workers Compensation Laws �) APPROVALS DATE I s R 5 SIGNATU E
Date v Applicant COMPRESSOR BTU D0� a V ROUGH �Z
NOTICE TO APPLICANT If er ing th s ertificate of VENTILATION SYSTEM FINAL (� i fpn1 \ I ��
Exemption you should be o ubject to the Workers �IC
;
Compensation provisions of t e Labor Code you must forth EVAPORATIVE COOLER with comply with such provisions or this permit shall be
deemed revoked FURNACE FAUGR ITY /D Jl
LICENSED CONTRACTORS DECLARATION FLOOR BTU ( V
I herebyaffirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT
p p HEATER �
(commencing with Section 7000)of Division 3 of the Business WALL
and Professions Code and my license is in full force and effect
�` a IL
��S 7'^^
License NumberxLic Class 6-.14 2 �ll , oC
b V
_ (J i
Contractor �te v 0
❑ I am exempt under Sec Plan check fee —47721 A IL
B 8P C for this reason PERMIT ISSUING FEE$ Z
Date # • e • • • $
Signature TOTAL FEE
g I • • 58,50
OWNER BUILDER DECLARATION PLAN CHECK APPLICANT f
I hereby affirm that I am exempt from the Contractor s Licenseloe , e • e 5 a 5 0 5
Law for the following reason (Section 7031 5 Business and NAME
Professions Code) V 8 7
Elas owner of the property or my employees with ADDRESS / W L 1 -. 87
wages as their sole compensation will do the work and TEL NO
0
the structure is not intended or offered for sale(Section CITY
7044 Business and Professions Code)
ElOWNER U
I as owner of the property am exclusively contracting
with licensed contractors to construct the project (Sec MAIL
tion 7044 Business and Professions Code) ADDRESS Q�
CONSTRUCTION LENDING AGENCY CIT YTEL NO ,0�
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued CONTRACTORG ' ,
(Sec 3097 Civ C )
ADDRESS
Lender s Name
CITY - C TEL NO11t 2 7
Lender s Address
I certifythat I have read this application and state that the STA UC
pp LICENSE NO � � CLASS 0
above information is correct I agree to comply with all County
ordinances and State jaws 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
I-JV4 -
Si a re fAppliconft or Agent Date