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Home My Public Portal About5421 PERSIMMON AVE_Mechanical__ 76A384C CE-818(REV.6/78) ®S APPLICATION FOR MIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING AND/SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS (PRINT OR TYPE ONLY) NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY ka I I NEAREST / CROSS ST. ABSORPTION UNIT,BTU OWNER U�\ AIR HANDLING UNIT,CFM MAIL ADDRESS �.. BOILER,BTU CITY TEL.NCIW COMPRESSOR,BTU to CONTRACTOR C YSIrFifts VENTILATION SYSTEM ADDRESS Adv EVAPORATIVE COOLER CITY 4,d.4 TEL. FURNACE: FAU GRAVIT /� STATE LIC. //�� FLOOR BTU /(/ LICENSE NO. CLASS —9 HEATER: SUSPENDED UNIT_ APPROVALS DATE INSPECTOR'S SIGNA URE WALL ROUGH t n10,10, FINAL 7i 6 It INSPECTION RECORD C9 O Plan check fee 25% of above. ull PERMIT ISSUING FEE$ TOTAL FEE e PLAN CHECK APPLICANT PLAN CHECK VALIDATION NAME �.%+ �C 7ro //,��tu ..c•� ADDRESS p� QU 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, VENTILATING, AIR = .5 6 12,Ci A CONDITIONING. PERMIT VALIDATION 1 HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF }} 0 0 0 0 [� CHAPTER 9, DIVISION 3. OF THE BUSINESS AND PROFESSIONAL CODE OF THE STATE OFC RNIA. 2 O - 27,0r, SIGNATURE OF PERMITTEE O O O L DISTRICT NO. I—\ O ESSEQ 0 7.23-79 '23- 79 F +n*, WORKER'S COMPENSATION DECLARATION 76A3s4DPwsl89 APPLICATION FOR PERMIT LIME GREEN li 76A384C I h�e�'eby affirm that I have a certificate of consent to self insure, I or a'eertificate of Worker's Compensation Insurance,or a certified HEATING-VENTILATING-AIR CONDITIONING copy fher6f(Sec.3800 Lab.C.) Policy No.?_109-CY( Company 6f e, COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. - F-1 Certified copy is hereby furnished. UILDING IA Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN ADDRESS department. /I� (PRINT OR TYPE ONLY) z 4 Pie m Date 5.�7' / I Applicant 11�QS&_r ?emoa�.�CS LOCALITY T,e� CL NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. ABSORPTION UNIT,BTU ASSESSOR ��7� (This section need not be completed if the work Involved by the MAP BOOK / PAGF�3 E� PARCEL 6ZD permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROC I certify that in the performance of the work for which this permit �� is issued, I shall not employ any person in any manner so as to BOILER,BTU became subject to the Workers'Compensation Laws. ! COMPRESSOR,BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that i am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business and WALL Professions Code,and my license is in full force and effect. License Number q-1-5'9349 Lic.Class >� 1nY/11/p��.�•�O��dC1O..-,.�/,�//�y,,�-.e, Contractor� 1�7J� �1[ArHr>LCG`Kl�ate () ElI am exempt under Sec. Plan check fee O BAP.C.for this reason PERMIT ISSUING FEE$ U Date: TOTAL FEE D V W 4. Signature PLAN CHECK APPLICANT Z OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law NAME , for the following reason (Section 7031.5, Business and Professions Code): ADDRESS N ry ❑ 1, as owner of the property, or my employees with wages '�// , as their sole compensation, will do the work and the CITY ✓) TEL-40-. 9 .Z S J 33011 3"? structure is not intended or offered for sale(Section 7044, tA&blr.ri� Business and Professions Code). OWNER 'Pa() SU ! ITEM. ❑ I, as owner of the property, am exclusively contracting MAIL _ -;OT AL 37 ,: DO with licensed contractors to construct the project (Sec- ADDRESS SyLI �P.trSr✓Y)M O tion 7044, Business and Professions Code). 49/f90'7.15' ti.HEC K 7■s R3 CONSTRUCTION LENDING AGENCY CITY I TEL.NO v I t' t - I herpeby affirm that there is a construction lending agency for I , CHANGE °tit the performance of the work for which this ermit Is issued CONTRACTOR (Sec.3097,Civ.C.). ADDRESS O' w, 6wn Q•,e Lender's Name v" �" ' I;E+ i1 I}i_!IJy :+ irj�3 Lender's Address CITY w� �t/f nom` TEL. t 9��_r � AM 8:23 1 certify that I have read this application and state that the above LICENSE NO. �/Jr'$.3 LIC. o 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 upon the above-mentioned prop@rty for in pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE v)A dJ c5/7 51UNATU EOF APPLICANT ENT DATE ION ym thatR'SCOMPENSATate of consent to 20-0046 CPW9la9 APPLICATION FOR PERMIT LIME GREEN I hereby affirm that I have a certificate of consent to self Insure, or a`certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(/ �kSt1ec.3800 Lab.C.) J LJ Policy No. Z 73 Companyend COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. �j Certified copy is hereby furnished. Ipli Certified copy is filed with the county building Inspection FOR APPLICANT TO FILL IN BUILDING department. (PRINT OR TYPE ONLY) ADDRESS Date I —Applicant- LOCALITY pp NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERSNEAREST COMPENSATION INSURANCE I CROSS ST. ABSORPTION UNIT.BTU ASSESSOR (This section need not be completed If the work Involved by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) I AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to BOILER,BTU JPQ p become subject to the Workers'Compensation Laws. 3 /O / COMPRESSOR,BTU N APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code,you must forthwith comply with such FINAL -2 / provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VATIO LIDAN I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED—UNIT— (commencing USPENDED UNIT(commencing with Section 7000)of Division 3 of the Business and HEATER: WALL Professions Code,and my license is in full force and effect. 1-3 License Number IIIS91 Lic.Class , CL Contractor ate /_0 C ❑ 1 am exempt under Sec. Plan check fee Q B.&P.C.for this reason I PERMIT ISSUING FEE$ /lp C Data: /d-13/-9/ 1DO C �) TOTAL FEEU. Signature a PLAN CHECK APPLICANT U, OWNER BUILDER DECLAAAfON G 1 hereby affirm that I am exempt from the Contractor's License Law NAME 100.forthe following reason (Section 7031.5, Business and Professions - Code): ADDRESS - ❑ I, as owner of the property, or my employees with wages t; .% °` 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 �% c5llw) ❑ I, as owner of the property, am exclusively contracting MAIL " � i CI i AL 32 - 01D with licensed contractors to construct the project (Sec- ADDRESS �j ��,5�/yJIn D/v tion 7044,Business and Professions Code). Lr7'"�•�i uo�_ € CONSTRUCTION LENDING AGENCY CITY TEL.NO. 1- I hereby affirm that there is a construction lending agency for , t_IIF13 !13 the performance of the work for which this permit Is Issued CONTRACTOR A�(Sec.3097,Civ.C.). �/" �� ADDRESS Lender's Name 7/ �. //�e— �kq � CITYTEL-11C. �r � TELO. Lender's Address G q i €1 i i=��€� I certify that;I have read this application and state that the above LICENSE NO. �,sr3/ CLLASS information is correct. I agree to comply with all County ordinances and State Iau s relating to building construction,and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANT OR AGENT DATE I