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Home My Public Portal About5503 PAL MAL AVE_Mechanical__ 16A364 -tEB1B - 3.69 APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING fl COUNTY OF LOS ANGELES FADDRFS/,O<:�� LDING 0� DEPARTMENT OF COUNTY ENGINEER RESS BUILDING AND SAFETY DIVISION JOHN A LAMBIE COUNTY ENGINEER ALITY COLEMAN W JENKINS,SUPERINTENDENT OF BUILDINGREST SS ST FOR APPLICANT TO FILL IN ER (PRINT OR TYPE ONLY) MAIL NO TYPE OF APPLIANCE OR EQUIPMENT FEE / ABSORPTION SYSTEMBTU CITYTEL NO CONTRACTO AIR HANDLING UNIT CFM ,_n ADDRESS L!/ BOILER HORSEPOWER CITY LF TEL NO �Y COMPRESSOR HORSEPOWER STATE Lid LICENSE NO Y CIASeSfl-zr VENTILATION SYSTEM DISTRICT NO GROUP ZONE 0 SSED BY EVAPORATIVE COOLER �' y T K FURNACE FAU GRAVITY FLOOR BTU INSPECTION RECORD HEATER S SPE N T_ WALL > u V w FO U LU D5 NEW_ADDITION_ PERMIT S 3 00 Z ALTER--REPAIR— TOTAL FEE $ PLAN C PPLICANT NA AODSESS CITY TEL N I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE ISC ORRECT AMD AGRCC TO C04PLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING VENTI• APPROVALS 0 TC INSPECTORS WGNA URC LATING AIR CONDITIONING I HEREBY CERTIFY I A4 NO CTING IN VIOLATION OF ROUGH DXAPTER 9 DIVISI 3 OF THE INESS A OFCSSIONAL FINAL CODE OF TXE ST OF IFORN SIGNATURE JACK R ALLEN SUPERV IN MECHANICAL EMG' OF PERMITTE PERMIT VALIDATION C A M 0 CASH PLAN CH K VALI TION U" 9530;3 OCT 3041 D 8.00- Q SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE DEC TION WORKERS COMPENSATION cafe of corse APPLICATION FOR PERMIT ' L tirebp bffem that I have a certificate of consent to self insure,,w ar certificate of Workers Compensation Insurance HEATING - VENTILATING - AIR CONDITIONING or ai certified opy thereof (Seat 3800, La C ) 76A36/C B��i0CoP1 n CE 818(REV 10/81) Policy No re y Certified copy is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is filed with the county budding mspec- FOR APPLICANT TO FILL IN BUILDING /-n. do de it ant ADDRE55J.1 v 10 -� (MINT OR TYPE ONLY) Dols Applicant LOCALITY NO TYPE OF APPLIANCE OR EQUIPMENT FEE (•� CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST COMPENSATION INSURANCE ST (This section Mad not M completed R the wont Involved by ABSORPTION UNIT BTU DISTRICT NO PROCESSED BY the permit Is for one hundred dollars($100)or len) 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 Fbecome subject to the Workers Compensation Laws BOILER BTU �) APPRaVAIS DATE OR 5 SgNAi r I Dote J y plicant cz-bi zi lArc COMPRESSOR BTU V ROILGH - 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 VALIDATIO with comply wdh such provisions or this permit shall be deemed revoked FURNACE FAU_GRAVITY '1 LICENSED CONTRACTORS DECLARATION FLOOR 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 6 / n O License Number y v`� Lic Classes , V > IN Contractor - flare 4&:�t& O ClI am exempt under Sec dis Plan check fee 1 9 5 Q 6 A H B&P C for this reason = Dole PERMIT ISSUING FEES � . • . . . $ Signature TOTAL FEE OWNER BUILDER DECLARATION PLAN CHECK APPLICANT I I • • 3 Q 5 0 1 hereby affirm that I am exempt from the Contractor's License ► e • • 30 505 Low for the following reason (Section 7031 5 Business and NAME Professions Code 1, as owner of the property or my employees with 'ADDRESS 0502-88 El wages as their sole compensation will do the work and the structure is not intended or offered for sole(Section Cm TEL NO 7041 Business and Professions Code) OWNER Mr L. E) 1, as owner of the properly am exclusively contracting with licensed contractors to construct the project (Sec ADD tion 7044 Business and Professions Code) ADDRESS e_ CONSTRUCTION LENDING AGENCY CITY TEL NO 1 hereby affirm that there is a construction lending agency for _ , the performance of the work for which this permit is issued CONTRACTOR r !sl G c (Sec 3097 CIv C ) af S• �� Lender s Name ADDRESS Lender s Address CITY S NO STATE i LIC v I certify that I have read this application and state that the LICENSE CLASS [� above mformation is correct I ogres to comply wish all County ordinances and State jaws relating to budding construction, aril h r y auth izerrepresenlatives of this County to enter upo above enrioned properly for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE pis of AppLc I or e I Doi.