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CE •IOIREV 6l81
oI APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING /iJI
(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
BOILER BTU CITY TEL NO
COMPRESSOR BTU O O0 O CONTRA OR
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY c ! TEL NOFURNA `^ yj
LIC
FLOORCE FAU BTU GRAVITY O Ut) LGAENSE NO ;--d7 CLASS C-
HEATER SUSPENDED—UNIT— APPROVALS DATE INSPECTOR 5 SIGNATURE
WAL
ROUGH
FINAL C
INSPECTION RECORD u
Oi
O
Plan check fee 25% of above
PERMIT ISSUING FEE; 7 00
TOTAL FEE
PLAN CHECK APPLICANT PLAN CHECK VALIDATION
NAME , /� �� /
ADDRESS �Y/"I / 3 y y y C
CT' TEL NO C.-
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANDSTATE THAT ALL
ORDINAHESTH NDB LAWSREGULATINGOVE IS CORRECT D HEATING AGREE 0 VENTILATNGCOMPLY H AR �63133A
CONDITIONING Pt®r
ON '� . . . • 41 HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OFCHAPTER 9DIVISION 3 OF THE BUSINESS AND PROFESSIONAL CODEQ A67�OO
OF THE STATE OF CALI 1SIGNATURE
OPPERMITTEE R'617.005
I7. 00SC:TRICiHO PROC[SSEO p� ` lV/// O IR 2 UU8-7 9 U
S O 1V/ /\y►-//
T6A]•�C
CE 818(MV 6178)
(t. APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING
ADDRESS
ADDRESS ..:0 J E E�4
(PRINT OR TYPE ONLY)
LOCALITY O
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST
ABSORPTION UNIT BTU
OWNER
AIR HANDLING UNIT CFM MAIL
ADDRESS 9,01 'i5"4Aeeol
BOILER BTU
^ CITY /J, TEL NO
COMPRESSOR BTU OD , OLD O /' z1
CONTRACTOR O /�✓ �A C -
VENTILATION SYSTEM
ADDRESS O
EVAPORATIVE COOLER CITY TEL NO
FURNACE FAU_ VI Y STATE ^JJ LIC
FLOOR BTU ��— LICENSE NO1 d � CLASS
HEATER SUSPENDED UNIT_
WA APPROVALS GATE INSPECTOR SSIGNATURE
ROUGH
FINAL '
INSPECTION RECORD IJ
OI
O
Plan check fee 25% of above
PERMIT ISSUING FEE$ d _
TOTAL FEE p 0
PLAN CHECK APPLICANT PLAN CHECK VALIDATION
NAME
ADDRESS
CITY TEL NO Y9029A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND / �# • • • • 4
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING HEATING VENTILATING AIR I • * 4700
CONDITIONING
fto
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF PER IDA • • • 4 7 0 0 6
CHAPTER 9 DIVISION 3 F THE BUSINESS PROFESSIONAL CODE
SIGNATUTHE STATE OF CA IA _ �/ 0 2 1 5-8 0
OF PERM( 52
DISTRICT NOPROCESS/ED BY
WORKERS COMPENSATION DLCLARATION 76A364C APPLICATION FOR PERMIT
I hereby affirm that I have a certificate of consent to self CE 818 (2 80)
insure or a certificate of Workers Compensation Insurance or HEATING-VENTILATING-AIR CONDITIONING
a certified cop) thereof(Sec 3800 Lab C )
Policy No Company
❑ Certified copy IS hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY
Ccrptdmd copy is filed with the count) budding Inspection FOR APPLICANT TO FILL IN LDING
e ,[j
depart ment 6 'sJ I� /�-�� -Neaa
Date Applicant (PRINT PR TYPE ONLY)
LOCALITY
CLRTII KATE OF EXLMPTION 1 ROM WORKLRS NO TYPE OF APPLIA CE OR EQUIPMENT FEE
COMPENSATION INSURANCE NEAREST NEAREST F a
(This Section need not be completed if the Rork unsolved ABSORPTION UNIT BTU ✓ t!/r Or O
by the permit is for one hundred dollars ($I00) or less) DISTRICT NO PROCESSED BY U
I certify that in the performance of the work for which this AIR HANDLING UNIT CFM—
permit
ermit is issued I shall not emplo r+ m er !/ O
5o as to become subject to the ¢�P -o - BOILER BTU OF
APPROVALS DATE INSPECTOR SSIGNATURE-
Date IA-:/e -V/Applicant C.9Y/OS �((r_ 7i _ COMPRESSOR BTU-J` 4900 O-a/s -� 6
ROUGH /_y _ _ y
NOIRI TO APPLICANT If atter making this Cerh fieate of VENTILATION SYSTEM -Safi z
Exemption you should bee011LL subject to the Workers FINAL
Compensation provisions of the Labor Code You must forth
with compiv with such provisions or this permit shall be EVAPORATIVE COOLE VALIDATION
deemed revoked FURNACE FAU GRAVITY
LICENSED CONTRACTORS DLCLARATION 2 FLOOR TU_/000� /
1 hereby affirm that 1 am licensed under provisions of Chapar 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 q
License Number-Z7-7 9_6L,3Lic Class_Y=.(e
Contractor _ Date
I am exempt from thi, licensing requirements as 1 am a
1.421.1154-d amhttect or a rLgistered professional engmeer Plan check fee 25%of above
acting in my professional capacity (Section 7051 Bus
mess and Professions Code) PERMIT ISSUING FEE S
LIc or Reg No Date I TOTAL FEE 3�' Z
HOML OWNER BUILDER DLCLARATION PLAN CHECK APPLICANT v
1 hereby affirm that 1 tins exempt from the Contractors NAME
License I aw for the following reason (Section 7031 5 Busi '4'4 a.2 A
ness and Professions Code) ADDRESS
1 as owner of the propert) will do the work and the . 8
structure is not intended or offered for Sale (Section
7044 Business and Professions Code) J� �/� R ft/�1 2'-1- 3 e 5 0
F-1
OWNER K ��jyf yf7(� L ry6ry
1 as owner of the property am exclusively contracting r 1 V rJ •� x
with licensed contractors to construct the project MAIL /' �J.1 �' /!(1.71'IA�j� An.1--- �� �i� 3ta 50 tl
(SLCtion 7044 Business and Professions Code ADDRESS VC
CONSIRUCTION LLNDING AGENCY CITYS�I'nf l (1,�Q�� TEL NO io 0'
1 hereby affirm that there is a construction lending agency ��JJ __ vV�-r/�� ��
for the performance of the work for which this permit Is CONTRACTOR C17.0- /pf t�L/re+7ti
issued (Sec 3097 Civ C) _
Lenders Name ADDRESS Zppb? -�ary�'„r e—/ ✓r-.
Lender s Address
CITY _fid GEC Pke TEL NO ZZ 0-J dY
I certify that 1 have read this application and state that the STATE LIC
abuse information is correct 1 agree to comply with ell County LICENSE NO 2 7 1P 6 CLASS
ordinances and State laws regulating Heating Ventilating and
Air Conditioning and hereby authorvc representatives of this SEE RFVLRSC I OR EXPLANATORY 1 ANGUAGE
County to enter upon the above mentioned property for
mspcetiun sec
iz-/- s�
Signal rzvjf Permittee Date