The URL can be used to link to this page

Home My Public Portal About5271 SERENO DR_Mechanical__ 16 A 364- CE 6 1 6- 5-13 L �/ APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY NEAREST CROSS ST FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) MAIL NO TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRE C T L N ABSORPTION UNIT, BTU CONTRACTOR AIR HANDLING UNIT, CFM ADDRE F BOILER, BTU S� CIT TEL N Q. COMPRES STAT LIC LIC NSE NO CL VENTILATION SYSTEM DISTRICT NO GROUP ZONE v EBBED BY EVAPORATIVE COOLER r 504 �� ` FLO / FU AU I INSPECTION RECORD f!L HEATER SUSPEN NIT f .�Fnew-6D C` WALL "�rC F�P2�-r>'! �31JC 0 U W d C7 Plan check fee 255! of nboYe Sec rc,ertie z PFR\II I ISSUING M F L S Io 1Al I FF PLAN CHECK APPLICANT d 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 ORDINAMCES AMD LAWS REGULATING HEATING VENT) APPROVALS DATE I"PECTOR S SIGMATURE LATING AIR CONDITIONING ROUG H I HEREBY CERTII AT 1 AM 1 TII )N VIOLA TIO OF CHAPTER 9 DIVIS 3 OF THE B PROFE881 ON FINAL -/ CODE OF THE STAT CALI10 IA SIGNATURE PERMIT VALIDATION CK M G CASH OF PERMI I I PLAN CHECK YALIDATION CK M O CASH 7`4 4� tARi 16 6 52 5 ,&�= 1' D DEE BACK OI APPLCITIOM FOR[OU PtiTi iFI afuiM,l i '� DEC TION I hereby s CI`Jhave a TION cafe of corse APPLICATION FOR PERMIT �I hereby affem that I have a certificate of consent to self or certificate Workers Compensation Insurance or a c 76A3o4C HEATING - VENTILATING - AIR CONDITIONING ora certified copy thereof f (Sec 3800 Lab C ) CE BIB(REV 10/81) - PNo�1 ❑olic %2,53,V/ Company K Certified copy Is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY emfied copy Is Bled with the county bulldIng Inspec FOR APPLICANT TO FILL IN BUILDING tion department ADDRESS �7E(p //�� (PRINT OR TYPE ONLY) dkl Dote '?::z 9— ApplicantP,44- _ LOCALITY RR(( NO TYPE OF APPLIANCE OR EQUIPMENT FEE T CERTIFICATE OF EXEMPTION FROM WO KERS NEAREST COMPENSATION INSURANCE CRO55 ST �- (This sectlon need not b•completed If the work Involved by ABSORPTION UNIT BTU_ DISTR;C7 No P SsED BY the permit Is for one hundred dollars($100)or Ins ) /\1 I certify that In the performance of the work for which this AIR HANDLING UNIT CFM— I permit Is Issued I shall not employ any person In any manner so as to become subject to the Workers Compensation Laws BOILER BTU �7 APMVALS DATE IN 5 SIGNATYP Date Applicant a! COMPRESSOR BTU /!/ tel ROUGH NOTICE TO APPLICANT If after making this Certificate of VENTILATION SYSTEM FINAL Exemption you should become subject to the Workers Compensation provisions of the Labor Code you must forth 3 EVAPORATIVE COOLER 3� d VALIDA N with comply with such provisions or this permit shall be 5 ✓ deemed revoked FURNACE FA `@PO LICENSED CONTRACTORS DECLARATION FLOOR BTU 00 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 WALL and Professions Code and my license is in full forces/and affect d License Number.,&& ;1Uc Classes Q pollV Contractor Date�-ZQ-rqR 20797A O0 ❑ 1 am exempt under Sec # • • •,• • 8 W Plan check fee d B 8P C far this recson PERMIT ISSUING FEE $ ( • 1 3600 2 Date TOTAL FEE • • 1 3 6 0 0 5 S gnature OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT /36.U o9.28-88 I hereby affirm that I am exempt from the Contractors License , Law for the following reason (Section 7031 5 Business and NAME Professions Code) ❑ 1 as owner of the property, or my employees with ADDRESS wages os their sole compensation,will do the work and CITY TEL NO structure is not Intended or offered for sale(Section 7044 Business and Professions Code) ElOWNER I as owner of the property am exclusively contracting with licensed contractors to construct the project (Sec MAIL - - tion 7044 Business and Professions Code) ADDRESS O OQI CONSTRUCTION LENDING AGENCY CITY ' TEL NO I hereby affirm that there Is a construction landing agency for — , the performance of the work for which this permit is issued CONTR7 (Sec 3097 C,v C ) , L ADDRESS i .s Landers Name rzrloc OTY TEL NO Lender's Address STA E C I certify that I hove read this application and state that the LICENSE NO CLASS above mformaeon is correct I agree to comply with all County ordinances and State laws relating to building construction artd hereby outho rze representatives of this County to enter 04:zz entioned property for �mpection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 4 2g _Sor� Date - - - --