HomeMy Public PortalAbout9077 OLIVE ST_Mechanical__ CZ7, _
76A364G 1�►r
GE-818(REV.6/78)
®5 APPLICATION fPERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
BUILDING
FOR APPLICANT TO FILL IN ADDRESS 0r G. Au AE 5r
(PRINT OR TYPE ONLY)
LOCALITY lC pi- C/
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST 50L-Z , fA
GROSS ST. /�
ABSORPTION UNIT,BTU
OWNER
AIR HANDLING UNIT,CFM Z.no MAIL
ADDRESS OT/ E. OL•%�� Sr
BOILER,BTU CITY •r� LE CJU TEL.NOAg V#D@j
COMPRESSOR,BTU CONTRACTOR
VENTILATION SYSTEM ADDRESS
arc
EVAPORATIVE COOLER CITY SAHE TEL.NO.
FURNACE: FAU GRAVITY STATE LIC.
FLOOR BTU ��►j 01' ( LICENSE NO. CLASS
HEATER: SUSPENDED UNIT APPROVALS DATE INSPECTOR'S SIGNATURE
WALL
ROUGH _
.F
•
FINAL 19-Z-8r,
INSPECTION RECORb
a
6�
Plan check fee 25%of above.
PERMIT ISSUING FEE$ -
TOTAL FEE
PLAN CHECK APPLICANT PLAN CHECK VALIDATION
NAME
ADDRESS
CITY ell, TEL.NO.
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 {{ 1 94, 1 A
I CERTIFYOF
CHAPTEREREBY 9. DIVISION 3, OFATHE BUSINESS ANDI AM NOTINPR FESSIIONALOCODE if 0 0 0 0 4 1
OF THE STATE OF Cot-LIFORNpk.SIGNATURE r�` L .L'.'O 2 7,0 0
OFPERMITTEE _
DISTRICT NO. PRO Y 0 — 27,005
/
1 . 1226-78
o r
WORKL'RS'COMYENSA i lON DECIL 'CE'19IS-2-Bo)• , A P P L ICAT I O Ill FOR PERMIT
I hereby affirm that•I have o' certiflcate of cbniAt to,sd
insure,or a certificate of Workers'CompensatirJeInsurance,or• HEATING-VENTILATING-AIR CONDITIONING
a certified copy thereof(Sec.3800,Lab.C.) LJ
,i
Policy No. Company COUNTY OF LOS ANGELES / �� BUILDING AND SAFETY
Certified copy is hereby furnished.
Certified copy is filed with the county building inspection I FOR APPLICANT TO FILL IN b -•�
department. ADDRESS /0 ! oz4a 5-r
Date Applicant (PRINT OR TYPE ONLY) �
NO. LOCALITY 9tl � L,.)
TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' C '
COMPENSATION INSURANCE CROSS STNEAREST., Svc-TR 1JA' - a
(This section need not be completed if the work involved ABSORPTION UNIT, BTU
by the permit is for one hundred dollars (S106) or less.) DISTRICT NO. PROCESS BY e U
I
1 certify that in the performance of the work for which this I AIR HANDLING UNIT,CFM
permit.is issued, I shall not employ any person in any manner �v tr
so as to become subject to the Workers'Compensation Laws. BOILER, BTU O
APPROVALS DATE INSPECTOR'S SIGNATURE V
LDate ApplicantI COMPRESSOR,BTU ROUGH A,_ -s d
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM ' N
Exemption, you should become subject to the Workers' FINAL z -
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER
with comply with such provisions or this permit shall be VALIDATION
deemed revoked.
LICENSED CONTRACTORS DECLARATION FURNACE: FAU GRAVITY
FLOOR: BTU I
I hereby.affirm thit I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT
9 (commencing with Section 7000) of Division 3 of the Busi- WALL 8
ness..and Professions Code, and my license is in full force and
effect.
License Number Lic.Class
Contractor Date
F1 I am exempt from the licensing requirements as I am a
licensed architect or a registered 'professional engineer Plan check fee 25%of above.
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). PERMIT ISSUING FEE$
Lic.or Reg.No. Date TOTAL FEE d U W
HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that-I am exempt from- the Contractor's NAME
License Law for the following reason (Section 7031.5, Busi-
ness and Professions Code): - ADDRESS < 0 9 7, 1 A
211111 is owner of the property, will do the work and the +
structure is not intended. or offered for sale (Section CITY TEL.NO. 0 0 0 0 0 8
7044,Business and Professions Code).
❑ OWNER � L Elf j2,1 1�'S %.� 2 0 5 0
I, as owner of the property, am exclusively contracting �
With licensed contractors to construct the project MAIL 07 oL,✓� � �0 0 0 2 0,J(}cz.
(Section 7044, Business and Professions Code). ADDRESS J
, I
CONSTRUCTION LENDING AGENCY CITi. t✓it * TEL.NO.256-WL C50 4-8 4
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is CONTRACTOR
issued(Sec.3097,Civ.C.).
Lender's Name ADDRESS
Lender's Address CITY E L.NO.
11�
I certify that I have read this application and state that the STATE LIC.
above information is correct.I agree to comply with all County LICENSE NO. CLASS
ordinances and State laws regulating Heating, Ventilating and
Air Conditioning,and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County to enter upon the above-mentioned properly for
in t)onpurposesl. / I
Signature mitten D�-�� j •