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Home My Public Portal About9743 VAL ST_Mechanical__ 76 A 36 - CEO15-1/)S APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONOI110NING COUNTY OF LOS ANGELES BUILDING C• DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY 7CM PLZ G NEAREST CROSS ST IIJIt4wesT FOR APPLICANT TO FILL IN OWNERt V (PRINT OR TYPE ONLY) MAIL 1 y1 ry Vo TYPE&SIZE OF EQUIPMENT ADDRESS SEE BACK OF APPLICATION FEE CITY ^ /' TEL NO ! V FORCE AIR FURNACE BTU l� � 7 CONTRACTOR �10S COMPRESSOR BTU ADDRESS VENTILATION FAN q CITY TEL NO LIST ALL OTHERS BELOW STATE LICc� O LICENSE NO 144, CLASS C DISTRICT NO GROUP IONE O Y /1E P-.Y INSPECTION RECORIK r a 0 V K O r U W a Plan check fee See reverse I'1 li\III I��1,1\( FII $ 101 \I I 1 I PLAN CHECK APPLICANT �a 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 WIT ALL GROIN ANCES AND LAWS REGULATING HEATING VENA APPROVALS DATE INSPECTOR S SIGNATURE LATINO AIR CONDIT I0NI NO ROUGH HEREBY CERTIFY THAT 1 M NOT A[TING IN VIOLAT IOM OF CHAPT CR Y DMS 3 0! T OUSINE SAND OFESSIONAL �S coo OF THE STAT P LIF A FINAL Z�7� SIGNATURE PERMIT VALIDATION cR M o CASH OF PERMITTEE PLAN CHECK VALIDATION c,c M G CASH 9 0 9 DEC 27 41 1_ 2.0 O wo • WORKERS COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby.affrcm that I have a certificate of consent to self insure or a certificate of Workers Compensation Insurance or a cenified copy thereof (Sec 3BOO Lab C ) 74A3W HEATING - VENTILATING - AIR CONDITIONING (� CE BIB(REV 10/8I) ' P❑ollcy No Company STr�r1F CAH T Certified copy is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY 19--Cenified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING /' tion department7% (PRINT OR TYPE ONLY) ADDRESS 7 Z/ 3 (_ � Date 9 k__Apphcont C.41 •/. eo 'V a>7 LOCA1ITv_r1F-,--t PC C f T CERTIFICATE OF EXEMPTION FROM WORKERS NO TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST COMPENSATION INSURANCE CROSS ST (This section need not be completed If the work Involved by ABSORPTION UNIT BTU MSTRICT Na Ppcx E c`By the permit Is for one hundred dollop ($100)or less) AIR HANDLING UNIT CFM l'. I certify that in the performance of the work for which this .N permit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws BOILER BTU APPROVALS DATE Ns CT SIGNATURE Date Applicant COMPRESSOR BTU ROUGH NOTICE TO APPLICANT If after making this Certificate of VENTILATION SYSTEM FINAL Exemption you should become subject to the Workers Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER V IDACIA with comply with such provisions or this permit shall be deemed revoked FURNACE FAU_GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU , I hereby affirm that I am licensed under provisions of Chapter9 HEATER SUSPENDED—UNIT— '(commencing USPENDED UNIT_'(commencing with Section 7000)of Division 3 of the Busmess WALL and Professions Cade and my license is in full force and effect > r3COo2 �XTC—� V aEsTb (� License Numbe L¢ Classes , to ,� .! CoA+S? —(2-8� 289S9A 9 contractor Dote ❑ I am exempt under Sec B 8P C for this reason Plan check fee # • • • • • 8 N Dote PERMIT ISSUING FEE$ 1 - 2 Q 5 0 i Signature , 1TOTAL FEE is - s 2 Q 5 0 0 OWNER BUILDER DECLARATION RAN CHECK APPLICANT C• S+7- 0212-88 I hereby affirm that I am exempt from the Contractor s License PW for the following reasonN(Section 7031 5 Business and NAME SLC(t T O Professions Code) ❑ I as owner of the property or my employees with ADDRESS L wages as their sole compensation will do the work and T p the structure Is not Intended or offered for sale(Section CITY { C'/.[ PLC—LL C ( TEL NO 7044, Business and Professions Code) OWNER E S c--Q LA T C ❑ I, as owner of the property am exclusively contracting with licensed contractors to construct the project (Sec MAIL ADDRESS 7 y3 r— CONSTRUCTION 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY CITyr GF TEL NO I hereby affirm that there u o construction lending agency for ' the performance of the work for which this permit Is Issued CONTRACTOR QA.1 (Sec 3097, Civ C ) r • / / Lender s Name ADDRESS a• 4X. v y O Q CRY OS E AJT• TEL NOS7/ 4 Y Lender's Address TE I certify that I have read this application and state that the TENSE NO 3 Lo/� 's O above information Is correct I agree to comply with all County ordinances and State jaws relating to building construction and hereby authorize representatives of this County to enter upon a above mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 2 —L 2^?6:- Signature of Applicant or Agent Dote WORKERS COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affrtm that I have a certificate of consent to self Insure, or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING -.AIR CONDITIONING cFa Certified copy thereof (Sec 3800, Lob C ) 76A3MC 70 0046 DPW 9/8B Policy No Company Certified copy is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING tion department (PRINT OR TYPE ONLY) ADDRESS Date Applicant LOCALITY LI C s�l T'l/ NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST /'t OL c , COMPENSATION INSURANCE CROSS ST G E—. — Vy7 (This secllon nod not be completed if the work Involved by ABSORPTION UNIT Biu DISTRICT NO BY the Permlt Is for one hundred dollars ($100) or less) I certify that in the performance of the work for which this AIR HANDLING UNIT CFM U E4VL� permit is Issued, I shall not employ any person In any manner so as to become subject to the W en mpensatl n Lows BOILER BTU nrPRovALs o TE IIVSFECTORs iGNATURF DateApplicant fwiCOMPRESSOR BN O 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- EVAPORATIVE COOLER with comp)y with such provisions or this permit shall be deemI If - ed revoked FLOOR CE FAU BTU VIN I�1 LICENSED CONTRACTORS DECLARATION (�' ov I hereby offrtm 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 f and Professions Code,and my license is in full force and effect IAJLC fi e�T-L¢.r-S !D { /f 7 > License Number,Z ' `SG Lic Class 1. —0— , 6 ��LL , 1rQ'�-tf O Contractar CAL, WFS j" Date) q � ❑ 110 I am exempt under Sec - Plan check fee W B 8P C for this reason nate PERMIT ISSUING FEES TOTAL OTAL FEE OWNER BUILDER DECLARATION RAN CHECK APPLICANT I hereby affrtm that I am exempt from the Contractors License , Law for the following reason (Section 7031 5, Business and NAME Professions Code) O L11, as owner of the property, or my employees with ADDRESS v wages as their sole compensation,will do the work and ACCT.` the structure Is not intended or offered for sale(Section CIN TEL NO 7044, Business and Professions Code) OWNER J�7 41.00 ❑ I, as owner of the property am exclusively contracting 1 ITEM licensed contractors to construct the project (Sec- MAIL17 `4S T hon 7044 Busmess'ond Professions Code) TOTAL 41 .00 CONSTRUCTION LENDING AGENCY CIN 'T' p� TEL NO I hereby affirm that there Is a construction lending agency for CHECK 41.00 the Performance of the work for which this permit Ia Issued CONTRACTOR C. ► (Sec 3097 Civ C ) 0)-EST * CIN 1� .00ADDRESS / ✓�YA v� Lenders Name _�360 0 1 12/11/34 CITY AWAY"L 4A TEL No Lender sAddress p.// �1 I certify that I have read this application and state that the iA E NO d V CLASS C-2.(/ 7403 1 Ah 4:1b above information Is correct I agree to comply with all County ordinances and State jaws relating to building construction ` and In b authorize representatives of this County to enter n the ovMrryBnrlq property for Inspection purposes inspection 11 _r.,zy SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Appllcanl or Agent Date b_1 es