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Home My Public Portal About4905 BALDWIN AVE_Mechanical__ 76A364E Ite PISA) 11/76 APPLICATION FOR PERMIT 1 HEATING - VENTILATING - AIR.. CONDITIONING M � C TY OF LOS ANGEL DEPARTMENT OF COUNTY ENGINEER t' BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN ADDRESS (PRINT OR TYPE ONLY) LOCALITYP t NO TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST CROSS ST �i ABSORPTION UNIT BTU OWNER J O HN L• My`L +, AIR HANDLING UNIT CFM MAIL ADDRESS IqS & W tw A\/ �� c i BOILER BTU 1 CITY �lrf(/� l _ TEL NO +W1 Z•�7,� COMPRESSOR BTU f CONTRACTOR u1,,� VENTILATION SYSTEM ADDRESS l,QA Wjt%JWGT*H EVAPORATIVE COOLER CITY \jj jirrrITEL NO 44� o3GI FURNACE FAU GRAVITY STATE �/CL ' LIC w FLOOR BTU LICENSE NO i CLASS 131 HEATER SUSPENDED UNIT- DISTRICT NO GROUP �7{1NE ROCESSED BY WALL -C' 7 j INSPECTION RECORD 0 u C Plan check fee 25% of above , PERMIT ISSUING FEE$ Z TOTAL FEE ' PLAN CHECK APPLICANT }j' NAME i E 1 • ADDRESS W^SH, CITY \41411"r'fj61- TEL NO o Q3GI p IHEREBY 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 APPROVALS DATE INSPECTOR S SIGNATURE CHAPTER 9 DIVISION 3 OF THE SSIONAL CODE OF THE STATE OF C LIFORNIA ROUGH Z-z 1,,mr SIGNATURE FINAL !Z� OF PERM ITTE PLAN CHECK VALIDATION CKl Mo CASH PERMIT VALIDATIO cK Mo CASH WORKERS COMFTNtATON ,q9 -SEP 28 4 1 D 1 2 0 0 Az�b POLICY HOLDER: � POLICY NUMBER. a . i- *wORKERS COMPENSATION DECLARATION I APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self insure 4or 15 certificate of Workers Compensation Insurance or a certified copy thereof (Sec 3800 Lab C 76A364C HEATING - VENTILATING AIR CONDITIONING ) CE 818(REV 10/81) 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 Q� h Date Applicant LOCALITY NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST COMPENSATION INSURANCE CROSS ST (This section need not be completed if the work involved by ABSORPTION UNIT BTU DISTRICT NO PROC the permit is for one hundred dollars ($100)or less ) U t AIR HANDLING UNIT CFM 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 bbeecoom subject to the Workers Compensation Laws BOILER BTU APPROVALS DATE INSPECT S SIG ATURE Date ✓ pplicant COMPRESSOR BTU ROUGH NOTICE APPLICANT If r a n this Certificate of VENTILATION SYSTEM FINAL / Exemp on you should come subject to The Workers Compensation provisions of the Labor Code you must forth EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deemed revoked FURNACE EAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU 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 WALL n e10 and Professions Code and my license is In full force and effect d O License Number Lic Class 1 U OC Contractor Date 0 ❑ I am exempt under Sec ` M Plan check fee H B 8P C for this reason PERMIT ISSUING FEE $ U Z Date Signature TOTAL FEE OWNER BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that 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 L wages as their sole compensation will do the work and CITYL NO the structure is not intended or offered for sale(Section 7044 Business and Professions Code) OWNER ;253 1 5A f G ❑ I as owner of the property am exclusively contracting with licensed contractors to construct the project (Sec MAIL # 0 0 0 o e 8 tion 7044 Business and Professions Code) ADDRESS Y CONSTRUCTION LENDING AGENCY CITY TEL NO • - 2(150 j hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTOR c— o o e205002: (Sec 3097 Civ C &=n 4t ADDRESS r 0 $26-86 Lender s Name CITY TEL NO _ Lender s Address STATE LIC I certify that I have read this application and state that the LICENSE NO p� 7 CLASS �v above information is correct I agree to comply with all County ordinances and State laws relating to building construction and hereby authorize representatives of this County to enter " UPOPA41 abovei operty for inspection urposes SEE REVERSE FOR EXPLANATORY LANGUAGE ignature o p icant or Agent Date - �M COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0107190009 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285 0488 EXT LEGAL ID FEES PAID BUnDING ADDRESS TR 9848 LT 19 4905 BALDWIN AV FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917804009 SS -INFORMATIONNEAREST CROSS STREET LOWER AZUSA 8589 025 015 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID B5 LOCALITY TEMPLE CITY 02 COMPRSR < 100 KBTU 2 00 COM 54 00 TENANTO8 FURNACE/HEATER <100 2 00 UNI 54 00 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON 30 AIR INLETS/OUTLETS 16 00 UNI 69 60 07/19/01 JK 01/15/02 TOTAL FEES 205 35 OWNER TEL FINAL '2 CODE W[LDE JOHN L BETSY N (626) 4488 2175 T 4905 BALDWIN AV TEMP 917804009 n-S-MPTION OF WORK NEW HVAC SYSTEM APPLICANT TEL NO AIR TECH HEATING & AIR INC (626) 795 8880 204 S ROSEMEAD SPECIAL CONDITIONS PASADENA, CA CONTRACTOR AIR TECHHEATING AND AIR CONDITIONI (626)N795 8880 � ��11'� APPROVALS DATE INSPECT SIGNATURE 204 S ROSEMEAD BLVD LIC NO FAU/WALL FURNACE PASADENA, CA 91107 541161/C20 COMBUSTION AIR OPENI GS ARCHITECT OR ENGINEER --rgT-- 0 R LIC NO I 1111111 AC/COMPRESSOR J , THERMOSTAT f— �FU Dn �n�0K� FIRE DAMPERS ILIA !!�`-J_ 1 I�Jl;IU,=l�] 3`'WC I ON DEVI-CfS- COMMERCIAL HOOD REPORT ID DPR264 ROUTE TO BS0508