HomeMy Public PortalAbout9157 WEDGEWOOD ST_Mechanical__ 76A364-CES 16-1470.
APPLICATION FOR HERMIT
-HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
ZVI
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION ;LOCALITQI`
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING NEAREST * +
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OFAPPLIANCE-OR EQUIPMENT FEE ADDRESS
CITY TEL. NO.
ABSORPTION SYSTEM, BTU
CONTRACTOR�� L's
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, HORSEPOWER � CITY TEL. NO. /
COMPRESSOR, HORSEPOWER STATE _0 LIC
LICENSE NO. AR5 CLASS
VENTILATION SYSTEM DISTRICT NO. cLA ss GROUP ZONE
PROCESSED BY
EVAPORATIVE COOLER
FURNACE: FAU—GRAVITY INSPECT ON RECORD
FLOOR BTU
HEATER: SUSPENDED UNIT_
WALL
a
C
o
C
u
c
NEW—ADDITION— PERMIT $ 3 00
ALTER—REPAIR— TOTAL FEE $ /450
PLAN CHECK APPLICANT
NAME��Q s
ADORES a�
CIT r TEL.NO.
1 HEREBY AC NOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING,AIR CONDITIONING.
ROUGH
1 HERElIFY AT I AM NOT ACTING IN VIOLATION
OF CHAPTER DIV N 3THE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE S IFOR IA.
SIGNATUR JACK R. ALLEN,SUP RVISING MEC ANICAL ENG•R.
OF PERM TEE
PERMIT VALIDATION /aK. ) M.O. CASH
PLAN CHECK VALI N
T�.0 1 2-$X-2 INAY 6 4 1 D 1. 0.5 0-
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ,
WORKER'S I have
certiIONficate
of consent to 76A348DPW9le9 APPLICATION FOR PERMIT LIME GREEN
I heretiy aHlF�,t that I have a certificate o}consent to self insure, 76A364C
or a C@rtificate of worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING
copy tDferrree�of LSec.3800 Lab.C.) 11
Policy`IV�_ �I Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑ Certified copy is hereby furnished.
Certified copy is filed with the cou ty building inspects FOR APPLICANT TO FILL IN BUILDING
pa ment. �10 (PRINT OR TYPE ONLY) ADDRESS
LOCALITY
Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST.
ABSORPTION UNIT,BTU ASSESSOR
(This section need not be completed if the work Involved by the MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO. PROCESS V
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU -0�
become subject to the Workers'Compensation Laws. <J
COMPRESSOR,BTU
APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code,you must forthwith comply with such FINAL
-r—/7'9� dA-1y-
provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY i
LICENSED CONTRACTORS DECLARATION ® FLOOR BTU / VALIDATION
I hereby affirm that I am licensed under provisions of Chapter 9 HEATERSUSPENDED ----UNIT—
(commencing
NIT
:
(commencing with Section 7000)of Division 3 of the Business and WALL
Professions Code,and my license is in full force and effect.
License Number Lic.Class��
0.
Contractor Date , C
F1Plan check fee C
I am exempt under Sec. Q
BAP.C.for this reason PERMIT ISSUING FEE$ H
Date: TOTAL FEE C
Signature PLAN CHECK APPLICANT 7 U,
OWNER-BUILDER DECLARATION
1 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 5:.�_
�
❑ I, as owner of the property, or my employees with wages
as their sole compensation, will do the work and the CITY TEL.NO.
structure is not Intended or offered for sale(Section 7044, -'�t 59 OID
Business and Professions Code). OWNER N� ` a
❑ 1, as owner of the property, am exclusively contracting MAIL {:�'[EF.i ■i,l.t
with licensed contractors to construct the project (Sec- ADDRES �F7 r•' --
tion 7044,Business and Professions Code). � �'#'� °L�=
CITY TEL.NO.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for CONTRACTOR
the performance of the work for which this permit Is issued
(Sec.3097,Civ.C.).
,r
ADDRESS
Lender's Name
CITY TEL.NO.
Lender's Address STATE � LIC.
I certify that I have read this application and state that the above LICENSE NO. CLASS
information is correct. I agree to comply with all County ordinances
and State laws relating to building construction,and hereby authorize
J,. R.
v s this County to enter upon the above-mentioned
f ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
F LI O E DATE