HomeMy Public PortalAbout9458 PENTLAND ST_Mechanical__ 74A3649 CK8110 '"° I APPLICATION FOR PERMIT -
HEATING - VENTILATING - AIR CONDITIONING
A
BUILDING SAFETY DIVISI
FOR APPLICANT.TO FILL IN BUILDING
n�land
(PRINT OR TYPE ONLY) ADDRESS
LOCALITY C, }
No TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST
CROSS ST
ABSORPTION UNIT BTU
OWNER m 0-MA
AIR HANDLING UNIT CFM MAIL
ADDRESS
BOILER BTU I CITY-EmDk TEL NOa 5.81
5
COMPRESSOR, BTU
CONTRACTOR
VENTILATION SYSTEM ADDRESS
M-VEVAPORATIVE COO R � CITY /t ' _Ij TEL NOa
FURNACE FAU G IT
Y STATE IFJ� LIC
FLOOR i' BTU LICENSE NO 1 CLASS C_
HEATER SUSPENDED—UNIT_ DISTRICT NO GROUP zONE PRO ss[D ex
WALL 6 /I - ` .
INSPECTION RECORD
W
_ , H
2
Plan check fee 25%D of above
PERMIT ISSUING FEE S
. -TOTAL-FEE -
PLAN CHECK APPLICANT -
NAME
ADDRESS -
CITY TEL NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE.ASOVE 19 CORRECT,ANO AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING VENTI-
LATING AIR CONDITIONING ^
1HERESY CERTIFY THAT I AM NOT ACTING IN VIOLATION APPROVALS DATE INSPECTOR 5 SIGNATURE
OF CHAPTER 9 DIVISION 3 OF THE BUSINESS AND PROFESSIONAL
CODE OF THE STATE OF CJLIF IA ROUGH
SIGNATURE t
SFINAL PERMITTEE /
PLAN CHECK VALIDATION EK MD CASH
PERMIT VALIDATION - M D CASH
383NOV, 19.4,Y_D 12.00 ��
i
WORKER'S COMPENSATION DECLARATION 204M Df+YV 9f LIME GREEN
7�3fHD APPLICATION FOR PERMIT
1 hereby affirlQ that I hats a certificate of consent to self insure, �-I
or a certificate of Worker's Compensation Insurance, or a certified HEATING • VENTILATING - AIR CONDITIONING ylLlll
copy thereof(Sec.3800 Lab.C.) y� �,
Policy No. Company &64C. COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑(/Certified copy is hereby furnished.
LJ Certified copy is filed with the county building inspectign FOR APPLICANT TO FILL IN ADDRESS
Qdepartment. 1 (PRINT OR TYPE ONLY)
Date ✓ Applica 7 LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FRO ORKERS' NEAREST
CROSS ST.
COMPENSATION INSURANCE ABSORPTION UNIT,BTU
(This section need not be Completed if the work involved by the ASSESSOR
AP BOOK a PAGE elo2 PARCEL din
permit Is for one hundred dollars($100)or less.) AR HANDLING UNIT CFM
wsmim xo. ProcEssso e.
I certify that In the performance of the work for which this permit / p
is issued. I shall not employ any person In any manner so as to BOILER,BTU
become subject to the Workers'Compensation Laws.
COMPRESSOR,BTU
µpeoy.LL9 WiE NSPECipI'a elelUNnE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL
provisions or this permit shall be deemed revoked. FURNACE: FAU_G VrrY VALIDATION
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 and WALL
Professions Code,and my
licensees Is in full force and effect. !� y
License Number • 0�`� Lic.Class y
I 3 0
Contractor eor A bate
E] I am exempt under Plan Check fee O
B.aP.C.for this reason PERMIT ISSUING FEE h
^ U
Date: TOTAL FEE IJ O d(L
Signature
OWNER-BUILDER DECLARATION PIAN CHECK APPLICANT Z
I hereby affirm that I am exempt from the Contractor's License Law NAME
for the following reason (Section 7031.5, Business and Professions I
Code): ADDRESS R0 O - 0- +
E] 1, as owner of the property, or my employees with wages Q
as their sole compensation. will do the work and the CITY TEL.N0.3��� �� -
structure is not Intended or offered for sale (Section 7044,
Business and Professions Code). OWNER
❑ I, as owner of the properly, am exclusively contracting MAIL 1 -'
with licensed contractors to construct the project (Sec- ADDRESS"W" 00
tion 7044.Business and Professions Code). CITY � q oilI TEL 2c'10-1/45t
�NO. '(q �0Lf
CONSTRUCTION LENDING AGENCY
I hereby affirm that there isa construction lending apenvy for CONTRACTOR 1 11110l
(Sec.
performance of the work for which this permit Pe Issued Ll✓TY� f1/\
(Sec.3097,Civ.C.).
ND N ti ADDRESS Or vn 0
Lender's Name 06 CrrYMI I QA I 1 _TEL.NO. a5��� _
111 EW V
Lender's Address STATE �j�fy1 L� LIC.
I certify that I have read this application and state that the above LICENSE NO. -/ 1_I V CLASS
information is correct. I agree to comply with all County ordinances
and Stale laws relating to building construction,and hereby authorize
representatives of this County to enter upon the above-mentioned
party for inction p rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
a-
SMWTUHL PMAW OR ADEM DATE