HomeMy Public PortalAbout5715 OAK AVE_HVAC_8/9/1979_r �
76A364C
CE - 818 (REV. 11 / 78)
®s APPLICATION F PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
FOR APPLICANT TO FILL IN
(PRINT OR TYPE ONLY)
NO. TYPE OF APPLIANCE OR EQUIPMENT
ABSORPTION UNIT. BTU
AIR HANDLING UNIT, CFM
BOILER, BTU
COMPRESSOR. BTU
VENTILATION SYSTEM
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY
FLOOR BTU
HEATER: SUSPENDED UNIT
WAL,:
FEE
Plan check fee 25% of above.
PERMIT ISSUING FEE $
17
I TOTAL FEE /,3
PLAN CHECK PLICANT
NAME
ADDRESS
CITY del TEL. .
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING HEATING. VENTILATING. AIR
CONDITIONING.
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF
CHAPTER 9. DIVISION 3. OF THE BUSINESS AND PROFESSIONAL CODE
OF THE STATE OF C ORNIA.
SIGNATURE _h1
OF PERMITTEE li
DISTRICT NO. V ;ED B
BUILDING AND SAFETY
BUILDING
ADDRESS���
•
LOCALITY
w
NEAREST
CROSS ST.
OWNER
MAIL
ADDRESS
CITY
Te
TEL. NO2
CONTRACTOR.
ADDRESS
•
CITY ^ ^lC� TEL. NO.
STATE 0v LIC.
LICENSE NO. CLA
F
OVALS LATE I PE TOSIGNATURE
�§
INSPECTION RECORD
PLAN CHECK VALIDATION
PERMIT VALIDATION
01
-260c,7A
#00.0041
20013.00
00013.002
o809-79
.1
• 1
WORKER'S COMPENSATION CERTIFICATION '
B certify that I will be responsible for the work to be done under 'this
permit and 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 become
subject to the Worker's Compensation laws of California.
l •`, �� �� ` �'• I further certify that if during the course of construction under this
permit 1 should become subject to Worker's Compensation requirements,
I will file the required certificate of insurance and realize that fai:pre
to do so will necessitate suspension of the permit. I have received to _
!+ `; o o explanation of the limits and conditions of this certificate and h2ve,!RNd
and fully understand them.
o
Signature , .__..... .
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