HomeMy Public PortalAbout6418 TRELAWNEY AVE_Mechanical__ )S A3GA= CE PIP - R-)I pp CATION F PERMIT
HEATING V NTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADDRESS 1
DEPARTMENT OF COUNTY ENGINEER
IN
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST
FOR APPLICANT TO FILL IN OWNER 1 '
(PRINT OR TYPE ONLY)
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NO TYPE OF APPLIANCEOR EQUIPMENT FEE ADDRESS L I
CIT7T ^l 1� TEL NOL J.ED .Y ABSORPTION UNIT, BTU 1CONTRACTOR ��AIR HANDLING UNIT, CFMADDRESSBOILER BTU rrCITU I TTEL NOCOMPRESSOR, BTU STATE LICLICENSE NO �-( CLASS
VENTILATION SYSTEM DISTRICT HO GROUP ZONE
EVAPORATIVE COOLER 8 S a
1 FURNACE FAU_GRAVITY
FLOOR BTU/L1� OLc DD INSPECTION RECORD
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HEATER SUSPENDED_UNIT_
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WALL-
Plan
ALL Plno ch(c], fee 25' of Rha%I See re,,r,t
PLR\11I ISSUING 1 FE S 3 00
I01AI FFF (j
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
I Hf Rf IY ACKNOWLEDGE THAT I HAVE READ THISICOMPLY
AND STATE THAT THE ABOVE IS CORRECT AND AGREWITH ALL ORDINANCES AND LAWS REGULATING HEAAPPROVALS DATE PfCTOP SI ATURE
LATINO AIR CONDITIONINGOUGH
IHEREIN CERTIIO THAT E NOT ACTINO CO CHAPTER 9 DIVISION 3 OFTHE GUSINfS3 ANO PINALCODEOF THE STATE OF CALIFOP MIASIGNATURE (�'G^/V / PERMIT VALIDATION CK M D CASH
OF PERMITTEE 7�1N
PLAN CHECK VALIDATION CK M 0 CASH
1 6 I'`WV $4 0 8.0 0 AJc
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SEE SACK OF APPLICATION FOR COMPLETE IEE SCHEDULE
]B ASBA - CE 8I8•1/75 �v/ ' '
APPLICA N FOR PERM
HEATING - VENTILATING - AIR CO 1/110HI G
COUNTY OF LOS ANGELES BUILDING
UIL N s N
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY L�
NEAREST
CROSS ST
R APPLICANT TO FILL N (OWNER F
(PRINT OR TYPE ONLY)
NO TYPE&SIZE OF EQUIPMENT ADDRESSNC.'�'�
SEE BACK OF APPLICATION FEE
CITY /S � EL N �3
FORCE AIR FURNACE BTU V
CONTRA TOR - �{
COMPRESSOR BTU
ADDRESS A
VENTILATION FAN CITY /jQ/J� TEL NO
LIST ALL OT ERS BELOW STATE LIC
LICENSE NO L CLASS
OUR ZO.E ESSED eT
S- Uo rl
INSPECTION RECORD
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Pion check fee See reverse
PI H\III I��I IN IF FII S
101 \I FII
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALLORDINANCES AND LAWS REGULATING HEATING VENII APPROVALS DATE INSPECTOR B SIGNATURE
LAYING AIR CONDITIONING
HEREBY CERTIFY THAT NOT ACTING IN VIOLATION RO JG H
OF CH
A
PTER D DIVISION 3 OF THE
BUl1Nf53 AND PROFESSIONAL FINAL
CODE OF THE STATE F CAL I_ FOONIAI , / Vv
OF NAT URE DIY!/� 1E'1W`1—�(—rp��J Y�p PERMIT VALIDATI N / 7 D DASH
sI PERMITTEE (`
PLAN CHECK VALIDATION CK M G CASH
909
t affirm
that
I haveCOMPENSATION
ate of consent
7 gf� APPLICATION FOR PERMIT LIME GREEN
I hereby alflrm that I have a certificate of consent to Ball Insure
or a certificate of Worker s Compensation Insurance or a certified HEATING -VENTILATING-AIR CONDITIONING
copy thereof(Sec 3800 Lab C) /��
Policy No 6o 13 Ccmpam y�"' COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
IJ'
Certified copy U hereby fummhed
❑ Codified copy is filed with the county building Inspection FOR APPLICANT TO FILL IN ADD ORES 6 / if,
_
department (PRINT OR TYPE ONLY)
—ii1 LOCALITYy /2 a
Dale AplNiwrtl NO TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FRO9 WORD NEAREST
COMPENSATION INSURANCE CROSS
ABSORPTION UNIT BTU - r
SSOR
(rhba section need not be completed If the work involved by the MMAp BOOK PAGE �.'Z PARCEL KI
Permit Is for one hundred dollars(3100)or leu) AIR HANDLING UNITCFM
olsmcr ro mottsem er
I caddy 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 / n0
become subject to the Workers Compensation Laws a 4
COMPRESSOR BTU
Date Appiicem xrvnov,Ns o.rE sersmrneesuuTure
VENTILATION SYSTEM
NOTICE TO APPLICANT If after making this Certificate of 6= 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&hall be deemed revoked FURNACE FAU_GRAVRv
LICENSED CONTRACTORS DECLARATION FLOOR am VALIDATION
I hereby affirm that I em licensed under provisions of Chapter 9 HEATER SUSPENDED UNR
(commencing with Section 7000)of Division 3 o1 the Business and WALL
Professions Code and my license Is In lull force and affect
License Number 6 L, Clew ✓ G
}
Contractor/ ` -t,"
❑ I am ax under Sac Plan Check fee .,
J
B eP C for ties reason PERMIT ISSUING FEE$ 0 T a 0
a
Date TOTAL FEE ?317 't._'.`_c a
Signature
OWNER BUILDER DECLARATION PLAN CHECK APPLICANT L I1_n'_ Z
I hereby affirm that I am exempt from the Contractor a License Law NAME , TC 114L ?v m :5
for the following reason (Section 7031 5 Business and Professions _
Code) ADDRESS l'TbiG{/` 7`•c7
❑ I as owner of the property or my employees with wages r-
as their sole compensation will do the work and the CRY TEL NO -�r�NX]E •Lh1
structure Is not Intended or offered for sale (Section 70"
Business and Professions Code) ER _
❑ I as owner of the property am exclusively contrecling MAIL `~ O ��IJ�I]-I'I]tJ� 7/11192
with licensed contractors to construct the project (Sec ADDRESS OLA &A-k 4, 6 1 AM ill
lion 70" Business and Prefeesions Cade)
CONSTRUCTION LENDING AGENCY L, NO 11 -oS 3
I hereby affirm that there Is a construction lending agency for OR v 7
the performance of the work for which this permit s Issued
(Sec 3097 Civ C) 1 V
ADDRESS(4,,
Lander a Name
CITY TEL NO _ -I
Lander a Address STATE LIC _
I certify that I have reed this eppllcatlon and state that the above t10EluE fI0 I ,,� Ea cuss
Inlormabon Is coneci I agree to comply With all County,ordinances
and State laws retailig to building construction and hereby authorize
representatives of this County to enter upon the above mentioned
property for Inspection purposes BEE REVERSE FOR EXPLANATORY LANQUAGE
SKMTUAE O DATE