HomeMy Public PortalAbout9830 VAL ST_Mechanical__ 76A364 - CES18 - 3-69 e�?4 LICATION OR PERMIT
EATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES FADDRESS9<1/6
DING aO
DEPARTMENT OF COUNTY ENGINEER RESS J
BUILDING AND SAFETY DIVISION
JOHN A LAMBIE COUNTY ENGINEER ALIT
COLEMAN W JENKINS SUPERINTENDENT OF BUILDINGREST
FOR APPLICANT TO FILL IN ER UZ
(PRINT OR TYPE ONLY)
LNO TYPE OF APPLIANCE OR EQUIPMENT FEE
ABSORPTION SYSTEM BTU CITY 6V TEL NO
CONTRACTO
AIR HANDLING UNIT CFM
ADDR
BOILER HORSEPOWER
TEL NO
COMPRESSOR HORSEPOWER STATE LIC
4-1 LICENSE -GMf/Jf
VENTILATION SYSTEM DISTRICT NO/')/ GROUP ZONE PROCESSED 8Y
EVAPORATIVE COOLER a I 4
FURNACE FAU RA VITV //r'
FLOOR BTU INSPECTION RECORD
HEATER SUSPENDED_UNIT_
WALL
O
V
oe
FO
V
w
NEW—ADDITION— PERMIT $ 3 00 Z
ALTER--REPAIR_ TOTAL FEE $
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE ISC ORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING,VENTI-
LATING AIR CONDITIONING APPROVALS DATE INSPECTOR'S SIGNATURE
HEREBY CERTIFY THAT 1 AM NOT ACTING IN VIOLATION OF ROUGH
CHAPTER 9 DIVISION 3 C THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE T CA RMIA '�
SIGNATURE JACK R ALLEN, SUPERV
OF PERMIT T MECHANICAL ENG p
PERMIT VALIDATION cK M 0 CASH
PLAN CHECK VALIDATION
00~E !'Ar- 6 +) 2i9 .a23 4 1 D 1 1.00-
E
BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORK COMPENSATION DECLARATION APPLICATION FOR PERMIT
I hereby affirm
h;ve m that have o certificate of consent to self
Insure -oeo certificate of Workers Compensation Insurance HEATING - VENTILATING - AIR CONDITIONING
.oT a certified copy there f (Sec 3800 Lob C ) 76A364C
��r CE SIB(REV 10/81)
❑PdTcykNoyy3 y3 s Company—T rt= �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
hon depart ret (PRINT OR TYPE ONLY) ADDRESS
Dote Applicant LOCALITY
NO TYPE OF APPLIANCE OR EW IPMENi FEE
CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST
COMPENSATION INSURANCE CROSS ST
(This section need not be cornplefed 0 the work Involved by ABSORPTION UNIT BTU DrsrRKr NO ^ PROCE
the permit Is for one hundred dollars ($100)or less) AIR HANDLING UNIT CFM U Q
I certify that in the performance of the work for which this v r
Permit is Issued I shall not employ any person in any manner
so as to become subject to the Workers Compensation Lows BOILER BTU APPROVALS DAIS OR S S NA RE
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 VALIDAT ON
with comply with such provisions or this permit shall be
deemed revoked FURNACE FAU ��GRAVITV
LICENSED CONTRACTORS DECLARATION FLOOR TU
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 Y
and Professions Code and my license is in full farce and effect C
N O
License Number Lic Class V
sA , 09
Contractor Date —rte a— O
O IwG�cO u
I am exempt under Sec to
Plan check fee d
N
B 8P C for this reason PERMIT ISSUING FEES o v Z
Dore
Signature TOTAL FEE -212
ER BUILDER DECLARATION PLAN CHECK APPLICANT
hereby affu of I am exempt from the Contractor s License ,
Law for the following reason (Section 7031 5 Business and NAME
Professions Code) '
❑ I as owner of the property or my employees with ADDRESS
wages as their sole compensation will do the work and CITY TEL NO
the structure is not intended or offered for sale(Section
7041 Business and Professions Cade)
❑ OWNER �J
I as owner of the property am exclusively connecting
with licensed contractors to construct the project (Sec MAIL ;2599. 2A
tion 7044 Business and Professions Code) ADDRESS `�L
CONSTRUCTION LENDING AGENCY CITY TEL NO V 06 # e e e e e 8
1 hereby affirm that there is a construction lending agency for C�
the performance of the work for which this permit is issued CONTRACTOR , 1 - 4620
(Sec 3097 Civ C )
ADDRESS S �� _ e e e 4206
6
Lenders Nome
Lender s Address CITY TEL NO —1'i7� _ _ 1 1,20-86
STATE C C LIC
I certify that I have read this application and state that the LICENSE NO a CLASS
above information is correct I agree to comply with al,County
ordinances and State laws relating to building construction,
and hereby authorize representatives of this County to enter
upon the ab e-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
nature of Applicant or Agent Dole