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Home My Public Portal About5110 SULTANA AVE_Mechanical__ . 76A334'—CES18—I170 APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILOING 57 DEPARTMENT OF COUNTY ENGINEER ADDRESSfr—'FITEL H� BUILDING AND SAFETY DIVISION LOCALITYt JOHN A LAMBIE COUNTY ENGINEER NEAREST COLEMAN W JENKINS, SUPERINTENDENT of BUILDING NEARE ST Ql(/Q FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) �� - MAIL NO TYPE OFAPPLIANCE OR EQUIPMENT FEE ADDRESS A eAI/ CITY e NO 2 IVy7ABSORPTION SVSTEM, BTUCONTRACTORAIR HANDLING UNIT, CFMADDRESS BOILER, HORSEPOWER CITY NOCOMPRESSOR HORSEPOWER STATE LICLICENSE NOCLASS VENTILATION SYSTEM DISTRICT NO CLASS ROUP ZONE PROCESSED BY EVAPORATIVE COOLER �Qg �Z '�� FURNACE FAUGRAVITY INSPECTION RECORD FLOOR BTU HEATER SUSPE�j Q€D_UNI I WALL3J€J d O V HC F- la: O_ V NEW—ADDITION— PERMIT $ 3 DO Z ALTER—REPAIR— TOTAL FEE S PLAN CHECK APPLICANT NAME ADDRESS CITY TEL NO - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO !TATE THAT THE ABOVE 13 CORRECT AND AOREE TO COMPLY WITH ALLORDINANCES AND LAWS REGULATING HEATING VENTI APPROVAL! DATE IMPECTOWS SIGNATURE LATINO AIR CONDITIONING ROUGH j 1 HEREBY CERTIFY H I AM NOT ACTINO IN VIOLATION OF CHAPTER G DIV' 3 THE BUSINESS AND PROFE33IONAL FINAL CODE OF THE !TATE 0 C OSHIA SIGNATURE JACK R ALLEN,SUPERVISING MECHANICAL ENG'R OP PERMITT PERMIT VALIDATION CK M O CAS PLAN CHECK VALIDATION I 8r, 0 d 4, 6� hDtr14 4 1 D 7.00- SEE BACK OF APPLMATION FOR COMPLETE FEE SCHEDULE WtKELM RSOPI NSATION DECLARATION CE 81 � C' APPLICATION FOR PERMIT 1 hereby affirm teat 1 hay a certificate of consent to self CE 818 (p B0I insure or a Ccrttfaate of Workers Compensation Insurance or HEATING-VENTILATING-AIR CONDITIONING ' a certified copv thereof(Sec 3800 Lab C) I Policy No Com pant ❑ Certified copy Is hereby IumishLd COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is filed with the count) budding inspection - BUILDING department FOR APPLICANT TO FILL IN ADD RESS /O YI' SG1r-91�Lr1 Date ApplILent dPRINT OR TYPE ONLY) Ch RTI[ICATI.OC EXEMPTION I ROM WORKERS NO TYPE OF APPLIANCBE10161PMENT FEE LOCALITY COMPENSATION INSURANCE NEAREST `,E, }a (This section need not be completed if the work Involved ABSORPTION UNIT CROSS ST /� ! 0. by the permit is for one hundred dollars (5100) or less) OISTRICT NO PROCESSED BY 1 certify that in the performance of the work for which this AIR HANDLING UNypermit .s Issued, I shall not LmP10% an) person in any manner ( Qpso as to become subject to the Workers Compensation Laws BOILER BTU APPROVALS DATE INSPECTOR S SIGNATURE LU Date Applicant /� COMPRESSOR BTU IL ROUGH N NOTICE TO APPI ICANT If after making this Certificate ofVENTILATION SYSTEM ? Exemption you Should become s,hjeel to the Workers FINAL Compensatmn provisions of the Labor Code you must forth with comply with such provisions or this permit shall be EVAPORATIVE COOLER VALIDATION deemed resoked URNACE FAUBTU GRAVITY CFURNA LIC ENSLD CONTRA TORS DPCLAR ATION \\ I hereby affirm that I am licensed under provisions of Chapter- HEATER SUSPENDED UNIT 9 (commencing with Seetmn 7000) of Division 3 of the Bust WALL nets and Professions CodL and my [.cerise is in full force and effect License Number Ln: Class Contractor Date ❑ I am exempt from tht licensing regmrements`us 1 am a IICLn Sed archite,t or a registered professional Lngmeer Plan check fee 25%of above acting In my professional capacity (Section 7051 Bus mess and Professions Code) PERMIT ISSUING FEE $ Lic or Reg No Date TOTAL FEE HOME OWNP R BUILDER DECLARATION PLAN CHECK APPLICANT 1 hereby affirm that I am exempt from the Contractors NAME ' - L.cens, Law for the following reason (Section 7031 5 Bust ness and Professions Cod.) ADDRESS ' I as owner of tht property will do the work and the ' �•7563Q F-1 TEL NO structure a not Intended or offered fur sale (Section CITY s s # . . . . . g -7044 Business and Pndesvons Code) � r/i I , F1I as owner of the property am exclusively ely contracting Q_N��AJL4 1 2'-'- 8 5 0 , with licensed Contractors to construct the project MAIL (Section 7044 Business and Professions Code) ADDRESS b //Q )7•S//4 !fi e a 2 g 5 0125 CONSTRUCTION LLNDING AGENCY CITY � �p! '_ _� TEL NO /z 6�L I 1f5-82 I hereby affirm that th,rL .S a Lonstruct.on lending agent' CONTRACTOR g for tht performance of the work for which this permit Is issued (Sec 3097 Civ C ) L Lender s Name ADDRESS - Lender s Address CITY TEL NO 1 Lert.fy that I hast read this application and Stat, that the STATE LIC t abusL information Is cornet 1 agree to comply with all Count} a LICENSE NO CLASS ordinances and State law" regulating HLating Ventilating and Air Conditioning and hereby aulhorim representatwes of this SEE REVERSE 1 OR EXPLANATORY LANGUAGE Count to Litter upon thL above mtntiontd PrOP,rl) for In, .Ion,v>n para I s tee Dale