HomeMy Public PortalAbout6453 OAK AVE_Mechanical__ ^eAaBa—cealB-tiro APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES FNEAREST
DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION -77JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPERI.NTENDENT,OF BUILDING
FOR APPLICANT TO-FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OFAPPLIANCE•O-R EQUIPMENT FEE ADDRESS
CITY TEL. NO.
ABSORPTION SYSTEM, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, HORSEPOWER. CITY 1 .f TEL. NO. g
COMPRESSOR, HORSEPOWER STATE — LIC.
LICENSE NO. v 6�SCLASS
VENTILATION SYSTEM DISTRICT NO. CLASS GROUP ZONE P CESSED BY
EVAPORATIVE COOLER ��D y Ir
FURNACE: FAU—GRAVITY INSPECTION RECORD
FLOOR BTU
HEATER: SUSPEN EDUNIT_
WALL
c
c
• c
4-1
- c
c
NEW_ADDITION— PERMIT $ 3 00
ALTER_
REPAIR— TOTAL FEE $
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATEI?SPECIkR SIGNATURE
LATING,AIR CONDITIONING.
'ROUGH
I HEREBY CERTIFY THAT i AM T ACTINN IN VIOLATION `
OF CHAPTER 9p. DIVISION 3, OF THE S NESS AND PROFESSIONAL FINAL 5
CODE OF THE ST CALIFO
SIGNATURE JACK R. ALLEN,SUPE VISING MECHANICAL ENG'R.
OF PERMITTEE 7 '
ciggg PERMIT VALIDATION M.O. CASH
PLAN CHE VALIDATION ������
0 9 8 79 JUN 2,1 Q 1 D 7,00~
'SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE `•••�`
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT
"I ltereliyed'(fitm that I have a certificalp of consent to self '
insure, or a certificate of Workers'Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
or a certified copv thereof Sec. 3800, Lab. C.) 76A364C
W � t�Zcl L A CE-818(REV. 10/81)
Policy No.� �. Company S%. tDPr%�&.4 i 6,�
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 1
tion department. (PRINT OR TYPE ONLY) ADDRESS r 3 �. (Da 1-- 0 Q,=
Date —? 3' 6 Applicant 166 FJ C-Zl LOCALITY
NO. TYPE OF APPLIANCE OR•EQUIPMENT FEE NEAREST i
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS S7. I c5%,%tCOMPENSATION INSURANCE
(This section need not be completed If the work Involved by ABSORPTION UNIT, BTU DISTRICT NO. mlv�
the permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT;CFM �
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner BOILER,BTU
so as to become subject to the Workers'Compensation Laws. APPROVALS DATE IN ECTOR'S SIG ATUR
Date Applicant COMPRESSOR,BTU CPU d Q ROUGH
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL '
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION'
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU ll,GRAVI]:1'
LICENSED CONTRACTORS DECLARATION l FLOOR BTU '77'b �0
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
'(commencing with Section 7000)of Division 3 of the Business - WALL
and Professions Code,and.my license is in full force.and effect..
/ 2- O
License Number 142 6 450 Lic.Class �'— iI
Contractor Dili+v'e n .Y z `es 6. 7-23—d "
❑ I am exempt under Sec. v
Plan check fee a
B.&P.C. for this reason' N(] �+
Date: PERMIT ISSUING FEE$ ,
Signature TOTAL FEE
-
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor's License I ,
Law for the following reason (Section 7031.5, Business and NAME
Professions Code):
❑ I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,.will do the work and CITY TEL. NO.
the structure is not intended or offered for sale(Section
7044, Business and Professions Code).
OWNER
❑ I, as owner of the property,am exclusively contracting
with licensed contractors to construct the project (Sec- MAILgDDRESS �C( 5 Av R 5 4 8.7 A
tion'7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY CITY e. ' Lp •,� TEL. NO.e/ # 0 0 0 0 0
I hereby affirm that there is a construction lending agency for ,
t(Sec. 3097, Civ. C.). ��
he performance of the work for which this permit is issued CONTRACTOR o L c.cii' � e S � I ( o•° 5 ��3
ADDRESS { o 0 0 5 1.3 0 5
Lender's Name _ P'-%A N.a 0 9,2 3 1 8 6
CITY 7Q S G TEL. NO. �� Q f G
Lender's Address
STATE // LIC. '
I certify that I have read'.this application and state that the LICENSE NO. /5 7 t3 z 6 CLASS — Z
above information is coirect. 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
Signature of Applicant or Agent Date