HomeMy Public PortalAbout9238 OLIVE ST_Mechanical__ 76 A364 - CE BIB - 9-71 APPLICATION FOR PERMIT
HEATING - VENTILATING'- AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS �� L�/✓�
BUILDING AND SAFETY DIVISION LOCALITtj,- 2,.0Zd-
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER /J
(PRINT OR TYPE ONLY) /
MAIL `l OL/✓�
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS d
CITY 7ra.�►PG� ep-y/ TEL. NO.
ABSORPTION UNIT, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS Ale -P®/
BOILER, BTU CITY
S Dgd,9 G TEL. NO.rp
COMPRESSOR, BTU LICENSE NO. CL
VENTILATION SYSTEM DISTRICT NO. GROUP aB.Y.
EVAPORATIVE COOLER a
CD
FURNACE: FAU_GRAVITY INSPECTION RECORD
FLOOR BTU U
HEATER: SUSPENDED UNIT_ J+ C)
WALL v
Lu
CL
N
' Z
Plan check fee 25% of-above. See reverse.
PERMIT ISSUING FEE 8
s TOTAL FEE �Q
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
LBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
E THAT THE.ABOVE IS CORRECT AND AGREE TO COMPLY
ORDINANCES ANO LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
IR CONDITIONING.
ROUGH
EBY CERTIFY AT I AM NOT ACTING IN VIOLATION ER 9, DIVISIO 3, OF HE B NESS AN PROFESSIONAL FINALTHE STATE OF C 0 NIA
URE PERMIT VALIDATION CK.MITTEE
PLAN CHECK V#LIDATION CK. M.O. CASH rpt
8.9.9 NRov 19 41 ".D V 96c) 0 A98
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
i J,
WORKERS'�OMPENS4TION DECLARATION APPLICATION FOR PERMIT
^' 4-preby affirm that re-ve a'e4LIificate of co nt to self
S!n3tire�a,certificate of4Workers'Compens n Insurance,
or a certified copy thereof(Sqc�3800, La .) 76A364c HEATING - VENTILATING - AIR CONDITIONING
t I CE-818(REV. 10/81)
Policy�No. i Compan
❑ COUNTY OF LOS ANGELES BUILDING AND SAFETY ,
Certified copy�h.rebished.Certified copye county building inspec- FOR APPLICANT TO FILL IN BUILDING
tion depart (PRINT OR TYPE ONLY) ADDRESS 9.Z 3 8 ® f e,
Date Applicant LOCALITY —'1--M
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ll _
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST IF
COMPENSATION INSURANCE CROSS ST. ra lwS
(This section need not be completed if the work Involved by ABSORPTION UNIT,BTU DISTRICT NO. PROCESSED
the permit is for one hundred dollars($100)or less.)
I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers'Compensation Laws. BOILER;BTU APPROVALS DATE CTOR'S SIGN URE
COMPRESSOR,BTU __LOD ROUGH
DateApplicant-
NOTICE TO APPLICANT: If, after making 'this Certificate of VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATI
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAY Y 101,10
/I a �)
LICENSED CONTRACTORS DECLARATION FLOOR BTU 1 l/
I hereby affirm that I am licensed under provisions of Chapter 9SUSPENDED UNIT
'(commencing with Section 7000) of Division 3.of the Business HEATER: WALL
and Professions Code,and my license is in full force and effect.
License Number y 6G Z� Lic. Class 3,f G-� t U
Contractor •A Date 7 r
I am exempt under Sec.
2786,3A
B.&P.C. forthis reason
Plan check fee # e o o'o o 8
PERMIT ISSUING FEE$ U ') o 0 4 9.5 0
Date:
Signature TOTAL FEE qts o 0 0 4 9.5 0 5
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor's License ► O 9 0 8"8 7
Law for the following reason (Section 7031.5, Business and NAME
Professions Code):
❑ I, as owner of the property, or y employees with ADDRESS
wages as-their sole compens ' n,will do the work and
the structure is not ince or offered for sale(Section CITY TEL. NO.
7044, Business and fessions Code).
OWNER
❑ I,as owner a property,am exclusively contracting -
with licensed contractors to construct the project (Sec- MAIL
ADDRESS d 4.Art
N `S
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY CITY-TC I ('; TEL. NO.. �_ 3�
I hereby affirm that there is a construction lending agency for ` . V Q
the performance of the work for which this permit is issued CONTRACTOR f:-,;j 4 A Lc—
(Sec.
(Sec. 3097, Civ. C.).
ADDRESS ba S. Vl N
Lender's Name
l
Lender's Address CITY TEL. NO.
STATELIC.
I certify that I have read this application and state that the LICENSE NO. �jt� 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
o above-mentioned roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
9 818
Signature of-Applicant or Agent Date