HomeMy Public PortalAbout6454 OAK AVE_Mechanical__ 76A364 - CE818 - 3-69 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES FBUILDING:tDEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION
JOHN A. LAMBIE, COUNTY ENGINEER P� qPCOLEMAN W.JENKINS,SUPERINTENDENT OF BUILDING
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE A D D R E4Q
ABSORPTION SYSTEM, BTU CIT ' TEL. N0, tf
AIR HANDLING UNIT, CFM CONTRACTO %2
_.8DDRE,%S
BOILER, HORSEPOWER
CIT Cj, TEL. NO 0-
COMPRESSOR, HORSEPOWER STATE LIC.
LICENSE NO. D CLASS L/
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER
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FURNACE: FAU GRAVITY
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED UNIT
WALL >
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NEW—ADDITION— PERMIT $ 3 00 L
ALTER_REPAIR_ TOTAL FEE $ (iC/
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL. N0.
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- APPROVALS DATE PECTOR'S SIGNATURE
LATING,AIR CONDITIONING.
I HEREBY CERTIFY THAT 1 AM NOT ACTING I VIO ATION OF ROUGH
CHAPTER 9, DIV1510 3, OF THE BUSIN SS A P FESSIONAL FINAL �'
DE OF THE TAT F CALIFORNIA. .
SIGNATURE JACK R. ALLEN, SUPERVIS MECHANICAL ENG'R.
.1 OF PERMITTEE
PERMIT VALIDATION CK. M.O. CASH_
PLAN CHECK VALIDATION
cq
Lko.a. Q 5- ��; JAN 2 0 4 1 D 8. 0
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORKERS'COMPENSATION DECLARATION �P P L I CB' VON FOR P E RM I T
I hereby affirm that I have certificate of consent to self i �
insure,'or a cejtificatd`of Wo"rk'brs' CJmpensatidn Insurance, 76 +�EAQING dlEPITIdATING AIR CONDITIONING
or a d4rtifi6cl copy thereof (Sec. 3800, Lab. C.) , A364C
8905182 "' Fremont
20-0046DPW9/88
Policy No.8905182 I i �
Certified copy is hereby furnished. I COUNTY OF LOS ANGELES I BUILDING AND SAFETY
A
Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING
tion department. (PRINT OR TYPE ONLY) ADDRESS 6454 N. Oak Ave.
Date 4-30-90 Applicant KamOr A- j LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE i CROSS ST.
(This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. 1 PROCESSED BY
the permit is for one hundred dollars(;100)or less.) i -5, ��
I certify that in the performance of the work for which this 1 AIR HANDLING UNIT, CFM , ,
permit is issued, I shall not employ any person in any manner,
so as to become subject to the Workers'Compensation Laws. BOILER, BTU APPROVALS DATE INS OR'S SIGNATURE
Date Applicant COMPRESSOR, BTU ROUGH
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL h
Exemption, you should become subject to the Workers' le
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATI
kk
with comp)y 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 UNIT—
(commencing with Section 7000)of Division 3 of the Business WALL.
and Professions Code,and my license is in full force and effect.
4 New Inlet ai�a Outlet . 00 �
License Number 165064 Lic. Class C-2 0 ® O
Kamor A.C. 4- 30-91 V
Contractor Date EX
E:1 , I am exempt under Sec. O
Plan check fee ~
• V
B.BP.C. for this reason 1 H
Date: PERMIT ISSUING FEE $ Z
• Signature TOTAL FEE
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
Professions Code):
❑ I, as owner of the property, or my employees with ADDRESS z il:l
. .s� . .. - .45o�_
wages as their sole compensation,will do the work and CITY TEL. NO. *r
the structure is not intended or offered for sale(Section 1 ITEMS
EMS
7044, Business and Professions Code). OTOTAL
O T AL -45-00
❑ I, as owner of the property, am exclusively contracting WNER Mr. George Forrester CHECK
_
with licensed contractors to construct the project (Sec- DDRESS 6 4 5 4 N. Oak Ave. I Ei !s f}_E,Ii
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY CITY
TEL. NO. CHANGE
I hereby affirm that there is a construction lending agency for —698 1
,
theperformance of the work for which this permit is issued CONTRACTOR Kamor Air Conditioniilq_
(Sec. 3097, Civ. C.). ® 01;010-00101 1t 9/010
Lenders Name [LICENSE
11 DDRESS 60 N. San Gabriel Blvd. ,156 1 Ai'11iRCIL1
TY TEL. NO. 795-7523
Lender's Address
I certifythat I have read this application and state that the IATE LIC.
PP 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 a ve-mentioned property for inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE
. 12-29-89
Signature f Applicant or nt Date
I ,
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