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Home My Public Portal About6009 OAK AVE_Mechanical__ 76A36 - CEB1fa-9/7� ,f APPLICATION FOR PERMIT HEATING - NTILATING - AIR CONDITIONING (::7BUI G AND SAFET kISION FOR APPLICANT TO FILL IN [NEAREST LDING (PRINT OR TYPE ONLY) RESS AITY 1 NO. TYPE OF APPLIANCE OR EQUIPMENT FEE SS ST. ABSORPTION UNIT, BTU OWNER AIR HANDLING UNIT, CFM MAIL ADDRESS Q BOILER, BTU -- CITY TEL. NO, COMPRESSOR, BTU i CONTRAC OR VENTILATION SYSTEM ADDRESS --'OEVAPORATIVE COOLER CITY FURNACE: FAL}"""~GRAVITY STATE LLIC�`. nn //�� FLOOR BTU LICENSE NO. CLASS( -- 0 HEATER: SUSPENDED UNIT_ DISTRICT N0. GROUP ZONE PRO SSED By y WALL CD INSPECTION RECORD F- FJ W N Z Plan check fee 25% of above. PERMIT ISSUING FEE $ TOTAL FEE PLAN CHECK APPLICANT NAME ADDRESS 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, VENTI- LATING, AIR CONDITIONING. I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION APPROVALS DATE INSPECTOR'S SIGNATURE OF CHAPTER 9, DIVISION 3, OF THEBUSIN S AND PROFESSIONAL CODE OF THE STATE O ALIFOR IA. ROUGH , SIGNATURE d4mLa� FINALfx OF PERMITTEE. PLAN CHECK LI DA ON PERMIT VALIDATION �� M.o. cnsH CK, M.O. CASH Co _fF a.n, POLICY HOLDER_ e�;- 9 4 rzt; c.1 4 i 0 1 iZ j j A, POLICY NI. MBER- 6;� -�� - - WORKERS COMPENSATION DECLARATION APPLICATION FOR PERMIT 1 hereby affirm that I have a certificate of consent to self insure or*certificate of Workers Compensation Insurance HEATING - VENTILATING - AIR CONDITIONING or a certified copy thereof(Sec 3900 Lab C) 2D4)M 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 budding inspec FOR APPLICANT TO FILL IN BUILDING tion department ADDRESS Q 41,4Z (PRINT OR TYPE ONLY) Date Applicant NO TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY CERTIFICATE EXEMPTION SU�WORKERS NEAREST �ST CSV Y a, (This section need not be completed 8 the work Involved by CE ABSORPTION UNIT BTU DISTRICT NO BY the permit is for one hundred dollars($100)or less) AIR HANDLING UNIT CFM 5 Off do - I certify that in the performance of the work for which this f/ l permit is issued I shall not employ any person in any manner BOILER BTU so as to become subject to the Workers Compensation Laws /1 APPROVALS DATE INSPECTOR S SIGNATURE Date Applicant COMPRESSOR BTU V 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 V L TIO with comp) with such provisions or this permit shall be deem ed revoked FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED.149Z1LP— NIT 10.00 (commencing with Section 7000)of Division 3 of the Business WALL and Professions Code and my license is in full force and effect VLicense Number Lic Class e 10o, d Contractor Date C ❑ I am exempt under Sec G Plan check fee B&P C for this reason y Date PERMIT ISSUING FEE $ Z Signature TOTAL FEE OWNER BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that Iam exempt from the Contractor s License N1111.Law for the following reason (Section 7031 5 Business and NAME C' P f-S L re Professions Code) !, © I as owner of the property or my employees with ADDRESS O V�! wages as their sole compensation will do the work and CITY TEL NO AMAT the structure is not intended or offered for sale(Section 7044 Business and Professions Code) 3M7 39.25 I as owner of the property am exclusively contracting OWNER �'� S t-t (�� 1 ITM with licensed contractors to construct the project (Sec CRESS TOTS 3 25 tion 7044 Business and Professions Core) CONSTRUCTION LENDING AGENCY CITY TEL NO tIECK 39.25 1 hereby affirm that there is a construction lending agency for , the performance of the work for which this permit is issued CONTRACTOR ( •00 (Sec 3097 Civ C) ADDRESSyn�nn LenderCITY TEL No s Name OU-Ml 12/11/$9 79 1 AN e M Lender's Address have read this application and state that the �A� CL Gr�VI certify le nformation is correct I agree to comply with all County LICENSE NO CLASS ordinances and State laws relating to building construction and hereby horize repro ntatives of this County to enter vis"the ci v mentioned spperty for inspection purposes _� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date ®�