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APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS
LOCALITY
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST
ABSORPTION UNIT BTU
OWNER
AIR HANDLING UNIT CFM MAIL
ADDRESS U 4EN41154
BOILER BTU CITY TEL NO
/ COMPRESSOR BTU O ' OV CONTRACTOR
VENTILATION SYSTEM
ADORES
H
Z EVAPORATIVE COOLER CITY TEL N
7
FURNACE FAU_GRAVT' STATE LIC
FLOOR BTU LICENSE NO �G CLASS 20
HEATER SUSPENDED UNIT_ APPROVALS DATE InSPECTORS IGNATURE
WALL
ROUGH
FINAL O
INSPECTION RECOIR& V
DL
0j
Plan check fee 25% of above 6
PERMIT ISSUING FEE$ mo _
TOTAL FEE {3 00
PLAN CHECK APPLICANT PLAN CHECK VALIDATION
NAME
ADDRESS
CITY TEL NO 38385A
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL # 4 1
ORDINANCES AND LAWS REGULATING HEATING VENTILATING AIR
CONDITIONING PERMIT VALIDATION 2 • • 3 3 0 0
1HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF
CHAPTER 9 DIVISION 3 OF THE BUSINESS AND PROFESSIONAL CODE
OF THE STATE OF CALIFORNIA 1� 33000
SIGNATU
OFPERMITTEE 1226-79
DISTRICT NO PROCESSED Y
CE 818 (REV 11/78) V
m. ' N FOR RMIi
HEATING - VEPLIC OTING -- IDITI ING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
7HANDLING
PLICANT TO FILL IN BUILDING Q
PRINT OR TYPE ONLY) ADDRESS S
LOCALITY C r
NNCE OR EQUIPMENT FEE
NEAREST
CROSS ST
NIT BTU
OWNER
UNIT CFM MAIL V
ADDRESS
BOILER BTU CT' TEL NO
COMPRESSOR BTU CONTRACTOR ./
VENTILATION SYSTEM
ADDRESS &S— ^/ 6y6,-i
EVAPORATIVE COOLER CITY O .�nr� �gmvTEL NO1�
FURNACE PAU_GRAVITY STATE LIC 'J
FLOOR BTU LICENSE N CLAS -?6r-
HEATER SUSPENDED UNIT_ ^-
WALL O APPROVALS DATE DATE INSPECTOR 5 SIGNATURE
/{J
ROUGH �/ y
i 6
FINAL v O
v
INSPECTION RECO pE
Iy0-
Plan check fee 25% of above S
N
PERMIT ISSUING FEE; Q O ?
TOTAL FEE 12-1120
PLAN CHECK APPLICANT [PLAN CHECK VALIDATION
NAME
ADDRESS
CITY TEL NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND q { U
STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL Ifr ® 2
ORDINANCES AND LAWS REGULATING HEATING VENTILATING AIR
CONDITIONING PERMIT VALIDATION 0225-80
1 HEREBY CERTIFY THAT 1 AM NOT ACTING IN VIOLATION OF
CHAPTER 9 DIVISION 3 OF TH BUSINESS AND PROFESSIONAL CODE
OF THE STATE OF OIA
SIGNATURE /
OF PERMITTEE
I / /
DISTRICT NO PROCESSED B Ce
3,P� a7 0o cy�
TeAGea-c Ee,e-e eB APPLICATION FOR PERMIT 047
HEATING - VENTILATING - AIR CONDITIONIN
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING O OF OC
BUILDING AND SAFETY DIVISION ADDRESS J
JOHN A LAMBIE COUNTY ENGINEER
C:470 00 Cok
COLEMAN W JENKINS, SUPERINTEN O R NT OF BUILDING LOCALITY �' µ � 'l'
NEAREST �/
FOR APPLICANT TO FILL IN CROSS ST i/
(Print or type -MY)
OWNER O
NO TYPEIOFAPPLIANCE OR EQUIPMENT FEEit
MAIL _/y
ADDRESS / Q D/ S
ABSORPTION SYSTEM 8TU CITY �O EL N
AIR HANDLING UNIT CFM CONTRACTO 0
BOILER, HORSEPOWER ADDRESS d �0
COMPRESSOR HORSEPOWER CIT L N
STATE LI O
VENTILATION SYSTEM LICENSf=NO CLASS
DISTRICT NO GROUP ZONE P ESS D BV
EVAPORATIVE COOLER
FURNACE FAU G VITY / D / Q,
FLOOR—BTU of INSPECTION RECORD
HEATER SUSPENDED_UNIT_
WALL
O
U
LC
O
N
Z
NEW_ ADDI TION PERMIT $ 3 00
ALTER-REPAIR TOTAL FEE S
Plan check applicant
Name
Address
City Pel No
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AMD STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCESAND LAWS REGULATING HEATING VENTI APPROVALS ATE INSPE 00 3 SIGNATURE
LATINO AIR CONDITIONJ NO
ROUGH
I HEREBY CERTIFY THAT AM NOT AC MO R VIOLATION
OF CHAPTER B DIVISION 3 OF THE BUSINESS D POFESf IOHAL FINAL
CODE OF THE (TATE OF CALF JACK
MIA
JACK R ALLEN,SUPERVISING MECHANICAL ENG'R
SIGNATURE PERMIT VALIDATION<� 0 M O CASH
OF PERMITTEE 1L�
PLAN CHECK VALIDATION
I4!'_ 3556n FEB 241 D 1450~
9E BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORKERS COMPENSATION DECLARATION
1 hereby affirm that 1 have a certificate of consent to self
78A364CGE B,B@BD. APPLICATION FOR PERMIT
Insure or a certificate of Workers Compensation Insurance or HEATING-VENTILATING-AIR CONDITIONING
a cerh0e py there (Sec 380 'LLaabb'J�(i)
Pollc�F�.y penYtlJ-LJ-1rJ�-' — / • �'
Certified copy Is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY
I]p
Ceipfiep copy is flied with the count} ulldmg inspection BUILDING 5570 f. �yy�
Unte� t FOR APPLICANT TO FILL IN ADDRESS 1�
� Applicant AiR�0 /„r `�' (PRINT OR TYPE ONLY)
LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS NO TYPE OF APPLIANCE OR EQUIPMENT FEE y��+ ,..�
COMPENSATION INSURANCE NEARESTCROSST �—f']J /VNAS d
(This section need not be completed If the work Involved ABSORPTION UNIT BTU O
by the permit IS for one hundred dollars (SIBO) or less) qq//yy��^ DISTRICT NO I/ PROCESSE By O
1 certify that in the performance of the work for "Inch this AIR HANDLING UNIT CFM—?M--P—
permit
Or
r O
permit IS Issued I shall not employ any person In any manner z C
so as to become subject to the Workers Compensation Laws BOILER BTU
Date Applicant COMPRESSOR BTU 6 p 4 eM0 APPROVALS DATE INSPECTOR SSIGNATURE
yWy
ROUGH y
NOTICE TO APPLICANT after making ilioCertificate of VENTILATION SYSTEM FINAL ?
Exemption jou should becec ome subject to [he Workers
withComcomply pith such
of the Labor Code you must forth EVAPORATIVE CO R ��3- y VALIDATION
with comply with such Prov¢ions or this permit shall be !/
deemed res oked FURNACE F A UW_ YLTJC—
LICENSED CONTRACTORS DECLARATION e, FLOOR --
I hereby affirm that 1 am licensed under prosmons of Chapter HEATER SUSPENDED UNIT
9 (commencing with Section 7000) of Division 3 of the Bust WALL
ness and Professions Code and my license Is in full force and
effect
License Number Lie Class
Contractor Date
I am exempt from the licensing requvcments as 1 am a
licensed architect or a rLgtstered professional engineer Plan check fee 15%of above
acting In my professional capacity (Section 7051 Bus PERMIT ISSUING FEE $ O f
(ness and Professions Code
Lie or Reg No Data TOTAL FEE ,j0 1f6
HOME OWNER BUILDER DECLARATION PLAN CHECK APPLICANT
1 hereby affirm that I em exempt from the Contractors NAME
SE� C 3 88 6 A
License Law for the follosnng reason (Section 7031 5 Busl K
ness and Profession 55C Code) ADDRESS 0 Rescm # • • • 8
El I as owner of the property will do the work and the
structure Is not Intended or offered for s.Ile (Section CITY L TEL NO 2'a - 50,50
7044 Business and Professions Code) i
F1ownerGpTEMfC •
I as owner of thL property am exclusively contractingOWNER 50506
With hcensed contractors to construct the project MAILC�+ p 0722-83
(SCLUon 7044, Business and Professions Code) ADDRESS �_�V BO
CONSTRUCTION LENDING Ab ENCY CITY TEL NO >, _
1 hereby affirm that there Is a construction lending agency
for the performance of the work for which this permit Is CONTRACTOR1 ('
Issued (Sec 3097 Civ C )
Lender's Name ADDRESS
Lender s Address CITY TEL -76
1 certify that 1 have read this application and state that the STATE �� Ll
abovL Information is correct 1 agree to comply with all County LICENSE NO qJ5CLASS 0
ordinances and State laws regulating Heating Ventilating and
ir Conditioning rind hereby authorize representatives of this SEL RLVLRSE FOR EXPLANATORY LANGUAGE
yin y to ent upo above mentaw ed property for 1
m p tion DI es �' Alis
gnature of P.rm ee to IfbfV� _