HomeMy Public PortalAbout6135 OAK AVE_Mechanical__ 76A364�C � s r •w
CE-tjIP1REV.11/78)
e: APPLICATION FOR PERMIT -
HEATING - VENTILATING - 'PIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
AAND SAFETYUILDING
'(J
FOR APPLICANT TO FILL IN ADDRESS Cv% � • �� '
(PRINT OR TYPE ONLY)
LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST. G�•��
ABSORPTION UNIT,BTU �/ —
OWNER Y,/ je V�• ��,(JC/V
AIR HANDLING UNIT,CFM MAIL
ADDRESS SSU"�
BOILER,BTU JCITY TEL.NO.Gi�eb _3�'
COMPRESSOR,BTU / {� CONTRACTOR
VENTILATION SYSTEM ADDRESS &l3J''!l,•Lla, -- �UL,
EVAPORATIVE COOLER CITY TEL.NO. `;'?j3�(�
FURNACE: FAU MIT
r+�� STATE LIC.
FLOOR BTU L ,0L, LICENSE NO. CLASS
HEATER: SUSPENDED UNIT_ APPROVALS DATE INSPECTOR'S SIGNATURE
WALL
ROUGH
FINAL
INSPECTION RECORD I%
IlYmPlan check fee 25%of above. in.
PERMIT ISSUING FEE$ 7 b - - )° z
TOTAL FEE U(
w
PLAN CHECK APPLICANT PLAN CHECK VALIDATION
NAME
ADDRESS
I •-
CITY TEL NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
f STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR
CONDITIONING. PERMIT VALIDATION 6 7,U '.
I HEREBY CERTIFY THAT I AM 'NOT ACTING IN VIOLATION OF
CHAPTER 9, DIVISIPK3. OF E BUSINES ND PR
OF PERMITTEE ESSIONAL CODE
OF THE STATE OFC LI O74
7
SIGNATURE 2 0 0 27.U C.
�
DISTRICT NO. RO SSED BY f0 0 0 2 7 r1
�� ) GrL:�_r i•' 9 2 5 7
WORKERS'COMPENSATION DECLARATION P - APPLICATION FOR PERMIT
I hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers'Compensation Insurance, 76A3b4c HEATING - VENTILATING - AIR CONDITIONING
or a certified coppy thereof(Sec. 3800, Lab. C.) CE-818(REV. 10/81)
�Y3�0 S� C> l: /�
Policy No. Company G_ct, a-
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
p (PRINT OR TYPE ONLY)
Date U� APPlican LOCALITS ;Tr r�
. TYPE OF APPLIANCE OR EQUIPMENT FEE '
CERTIFICATE OF EXEMPTION FROM WOR ERS' NEAREST � Z
COMPENSATION INSURANCE CROSS ST.
(This section need not be completed if the work involved by ABSORPTION UNIT,BTU DISTRICT NO. PROCESSE BY
the permit Is for one hundred dollars($100)or less.)
AIR HANDLING UNIT,CFM
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner BOILERBTU
so as to become subject to the Workers ,Compensation Laws. APPROVALS DATE INSPECTOR'S SIGNATURE
COMPRESSOR,BTU ROUGH
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL �----
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR 2a—BTU --�
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED—UNIT—
'(commencing
USPENDED UNIT'(commencing with Section 7000)of Division 3 of the Business WALL
and Professions Code,and my license is in full force and effect.
License Number -��l 7J Lic. Class /�' , V
Contractor R Ld-n Date :1—D S S2 V
❑ I am exempt under Sec.
Plan check fee to
t/t
BAP.C. for this reason'
PERMIT ISSUING FEE$
Date:
�t
SignatuTOTAL FEE a
re/
OWN - UILDER DE RATION 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 Pn /�
Professions Code): (, 4A
El 1, as owner of the property, or my employees with ADDRESS
sc—
wa es as their sole compensation,will do the work and
g p CITY 6' TEL.
the structure is not intended or offered for sole(Section �✓ ,
7044, Business and Professions Code). OWNER 2 J 0.5 C
❑ I, as owner of the property, am exclusively contracting r- z
with licensed contractors to construct the project (Sec- MAIL
tion 7044, Business and Professions Code). ADDRESS
CONSTRUCTION LENDING AGENCYCITY s TEL. NO —. 25 R
I hereby affirm that there is a construction lending agency for �`�
the performance of the work for which this permit is issued CONTRACTOR -
(Sec. 3097, Civ. C.).
ADDRESS
Lender's Name
CITY TEL. NO.
Lender's Address
STATE LIC.
I certify that I have read this application and state that the LICENSE NO. ,3s� %� 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
ftWg afore oft or Agent Date