HomeMy Public PortalAbout5329-5331-5333-5335 VILLAGE CIRCLE DR_Mechanical__ 76 A364- CE 818- 5-73 APPLICA ION FOR PERMIT .
HEATING - VENTILATING.- AIR CONDITIONING
COUNTY OF LOS ANGELES rNEAREST
D SS y 532-9 9Z .0333, S33.5
DEPARTMENT OF COUNTY ENGINEER ) �
"'B.UILDING AND SAFETY DIVISION ALITY
SS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT'OR TYPE ONLY)
MAIL _ ®_
NO. TYPE OFAPPLIANCEOR EQUIPMENT 'FEE ADDRESS S.�oU l��•�
Y y�p,o3�a7
ABSORPTION UNIT, BTU CITEL. NO. ,
CONTRACTUZ
AIR HANDLING UNIT, CFM
ADDRESS haw
BOILER, BTU CITY TEL. NO. 'r.fLsO
COMPRESSOR, BTSTATE lSa�I«- CLIC LS �a0
LICENSE'NO. AS
VENTILATION SYSTEM DISTR ICT.NO. GROUP ZONE PROCESSED BY
EVAPORATIVE COOER . 60 T/ P ,�
FURNACE: FAU_GR ITY INSPECTION RECORD
FLOOR BTU
HEATER: SUSPENDED UNIT_
WALL
—
C)
U
O
W
L00el-
00
Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEES 0
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY �TEL.NO.
LLATING,
BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION '
E THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
IR CONDITIONING.REBY CERTIFY THAT I AM NOT ACTING IN VIOLATION ROUGHER 9, DIVISION 3, OF THE BUSINE AND PROFESSIONAL FINAL17 f(�THE STATE OF CA IFOR NIA.URE PERMIT VALIDATION cK? M.O. CASH
MITTEE
PLAN CHECK VALIDATION CK. M.0. CASH
2'.4 $N'FB 19 41�-� 6.4.5 0 A98
ION
WORKER'S I have
a certificate
of consent to
7GA34sDPW9/s9 APPLICATION FOR PERMIT LIME GREEN
I hereby affirm that I have a certificate of consent to self insure, 176A384C
or a certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING
copy thereof(Sec.3800 Lab.C.) I
Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑ Certified copy is hereby furnished.
❑ Certified copy is filed with the county building Inspection FOR APPLICANT TO FILL IN PUILDING
DDR SS /`/
department. I (PRINT OR TYPE ONLY) v r l/ L ` ��L-
Date Applicant LOCALITY /e e
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST J'J
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. ;*41-l.L,i
COMPENSATION INSURANCE ABSORPTION UNIT,BTU
This section need not be completed if the work Involved ASSESSOR
( b P y the I MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any Tf
n in an manner so as to I BOILER,BTU
become subject to the Workers'Coation
Z/ / COMPRESSOR,BTU
Date AppicantV v VENTILATION SYSTEM APPROVALS DATE INSPECTOR'S SIGNATURE
NOTICE TO APPLICANT: If, of• making thls Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code,you must forthwith comply with such FINAL
provisions or this permit shall be deemed revoked. / FURNACE: FAU A GRAVITY
LICENSED CONTRACTORS DECLARATION ! FLOOR BTU R do b VO4 ATION
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
(commencing with Section 7000)of Division 3 of the Business and WALL -/► �/
Professions Code,and my license is in full force and effect. A
d
Zc�
License Numer@r_``" c� Lic.Class `/ ,
1AJ E'7ef-
_
fContractor C
F1I am exempt under Sec. f / Plan check fee D
B.&P.C.for this reason PERMIT ISSUING FEE$ C
Date: TOTAL FEE �O i U
a
Signature
PLAN CHECK APPLICANT
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law NAME
for the following reason(Section 7031.5, Business and Professions
Code): ADDRESS
>-i -�•r es
I, as owner of the property, or my employees with wages
as their sole compensation, will do the work and the CITY TEL.NO. I "r
structure is not intended or offered for sale(Section 7044,
Business and Professions Code). OWNER &J},q ' I;
❑ I, as owner of the property, am exclusively contracting I MAILi I I i ?
c- / LSI_ `'r- m
.00
with licensed contractors to construct the project (Sec- ADDRESS .J 0�55 (pCev Cie,le—
tion i
tion 7044,Business and Professions Code). �
CONSTRUCTION LENDING AGENCY CITY / _eM e C! TEL.NO.57_5_v-7 ( CHA
I hereby affirm that there is a construction lending,agency for 1`"�`
the performance of the work for which this permit is issued CONTRACTOR •I AJ,�
(Sec.3097,Civ.C.).
ADDRESS /N ✓', Ja•C�I.�S�U.I A!
Lender's Name 2 !_- V
CITY f✓ �+ n !�- TEL.NO. i 7Jr9 .s ;; r,z C.
Lender's Address r hirill 0-5
STATE LIC.
I certify that I have read this application and state that the above LICENSE NO. SOtj'7 CLASS
information is correct. I agree to comply with all County ordinances
and State laws relating to building construction,and hereby authorize
Jsentatives of this Couq y to enter upon the above-mentioned
erty for inspecSEE REVERSE FOR EXPLANATORY LANGUAGE
TORE"APPU A 0 AGENT DATE