HomeMy Public PortalAbout4839 PERSIMMON AVE_Mechanical__ o76A384- CE81B- 5-73
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APPLICATION FOR P RMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES 7ADDRE
9 -2
DEPARTMENT OF COUNTY ENGINEER G 5 �')I'rl 0AJ
BUILDING AND SAFETY DIVISION LOCAL-IT ✓yt
FOR APPLICANT TO FILL 1N(PRINT OR TYPE ONLY)
3�
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CI E TEL. NO. 144 3oS16
ABSORPTION UNIT, BTU
CONTRACTO CIJ I�
AI-R HANDLING UNIT, CFM
ADDRESS 9 4_,.l
BOILER, BTU
CITY-la
M , TEL. NO. ��
COMPRESSOR, BTU STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE CESSED BY
EVAPORATIVE'COOLER g G",
FURNACE: FAU_GRAVITY
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED—UNIT—
WALL
USPENDED UNIT_WALL _
koW JJ,& O ' CD
CD
I—
U
W
a.
G7
Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE $ 3 00
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT 1 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 INSPECTOR'S SIGNATURE
LATING,AIR CONDITIONING.
ROUGH
f HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION '
OF CHAPTER 9, DIVISION 3, OF THE BUSINEMS AND PROFESSIONAL FINAL LIy/7G/- 7y
CODE OF THE STATE OF CA DRY
PERMIT VALIDATION cK. , M.O. CASH
OF PERMITTEE (� e `
PLAN CHECK VALIDATION CK. M.O. CASH -
0:::65-AMM 1-74.1 ;U 8..0 0 m .
` /APPLICATION 76411 I t CC�
76 A384- CE 818- 5-73
PLICATION FOR P RMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING 2 S rn
DEPARTMENT OF COUNTY ENGINEER ADDRESS J m u AJ
BUILDING AND SAFETY DIVISION LOCAL IT
NEAREST. l
CROSS T
FOR APPLICANT TO FILL IN OWNER I �q /p—
(PRINT OR TYPE ONLY)
MAI L
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
CI TEL. NO.
ABSORPTION UNIT, BTU E /� �� 30��
CONTRACTOA 10
G•I4-� _
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CITY�En,� ! TEL. NO.
COMPRESSOR, BTU STATEJ LIC. C�
LICENSE NO. �f d CJ CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP I ZONE CESSEO BY
EVAPORATIVE COOLER -�
FURNACE: FAUGRAVITY
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED UNIT_
WALL
l nli 1 CSD o
0
U
W
CL
Z
Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE S 3 00
TOTAL FEE OZ)
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
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 INSPECTOR'S SIGNATURE
EATING, AIR CONDITIONING.
ROUGH
ALT
CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSIN S AND PROFESSIONAL FINAL �.
CODE OF THE STATE OF CaORNJ/f' 7
SIGNATURE //VV���,,, IGG,� PERMIT VALIDATION CK. M.O. CASH
OF PERMITTEE
PLAN CHECK VALIDATION M.0. CASH
0 6 Via►?W 17 41 D 8.0 0 ♦-t-i
WORKER'S COMPENSATION DECLARATION 76A364C 46DPW gigg APPLICATION FOR PERMIT LIME GREEN
76A3
I hereby affirm that I have a certificate of consent to self insure, I or a certificate of Worker's Compensation Insurance, or a certified HEATING VENTILATING - AIR CONDITIONING
copy there f( ec. 3806 Lab. C.) ' �
Policy No. Company ��� COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILD NG AND SAFETY DIV.
❑ Certified copy is hereby furnished.
�,a
d with the co my building inspection FOR APPLICANT TO FILL IN BUIL 9S e �(PRINT OR TYPE ONLY) LOCALITY
Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
CROSS ST.
COMPENSATION INSURANCE ABSORPTION UNIT,BTU
This section need not be completed if the work involved ASSESSOR
( b P Y the MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU {
become subject to the Workers'Compensation Laws. r ��U �'ip�J L�•C�
COMPRESSOR,BTU f`1�"006�
APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption, you should become subject to the Workers' Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL I
provisions or this permit shall be deemed revoked. FURNACE: FAUGRAV /
LICENSED CONTRACTORS DECLARATION FLOOR BTU 7 L V LI ATION
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED-UNIT-
(commencing
USPENDED UNIT(commencing with Section 7000) of Division 3 of the Business and WALL
Professions Code, and my license is in full force and effect. �!�
�" 76
License Number Lic.Class '�
i }
HCt�,�* a
Contractor
^,LI.jI 1 M1� C
❑ I am exempt under Sec. Plan Check fee i tBE,
..,C
PERMIT ISSUING FEE$
B.&P.C.for this reason i NL
_ _
TOTAL FEE +`Q
Date: ��
Signature �.r-FANG i
PLAN CHECK APPLICANT t
OWNER-BUILDER DECLARATION •I�
I hereby affirm that I am exempt from the Contractor's License Law NAME f
for the following reason (Section 7031.5, Business and Professionsi1+1ij. 5 c
Code): ADDRESS
❑ -t-+c
I, as owner of the property, or my employees with wages
�C
as their sole compensation, will do the work and the CITY TEL.NO.
structure is not intended or offered for sale (Section 7044,
Business and Professions Code). OWNER
❑ I, as owner of the property, am exclusively contracting MAIL
with licensed contractors to construct the project (Sec- ADDRESS qq
fill0 Aj
tion 7044, Business and Professions Code). l
CONSTRUCTION LENDING AGENCY CITY TEL.N
I hereby affirm that there is a construction lending agency for CONTRACTOR
the performance of the work for which this permit Is issued {6
(Sec.3097, Civ. C.). / /` ._a^
ADDRESS 1 /✓--�ti �
Lender's Name
CITY TEL.NO.
Lender's Address STATE LIC.
I certify that I have read this application and state that the above LICENSE NO.__W CLASS
information is correct. I agree to comply with all County ordinances
and State laws relating to building construction,and hereby authorize
4re tivesothisCounty to enter upon the above-mentionedpection purpsesSEE REVERSE FOR EXPLANATORY LANGUAGE
U A LICA OR D E