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Home My Public Portal About9123 BROADWAY_Mechanical__ 6A364n<EBIe=In0 APPLICATION FOR PERMIT 4HEATING - VENTILATING - AIR CONDITIONING 7'3 `COUNTY OF LOS ANGELES BUILDING /n J DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER + NEAREST - COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN OWNER (PRINT OR.TYPE-ONLY) MAIL _ NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS A CITY // A TEL: NO. ABSORPTION SYSTEM, BTU l.r 34 CONTRACTOR AIR HANDLING UNIT, CFM ADDRESS G . BOILER, HORSEPOWER CITY TEL. NO.,.?-, . .- COMPRESSOR, HORSEPOWER STATE LIC. LICENSE NO. CLASS VENTILATION SYSTEM DISTRICT NO. CLASS GROUP ZONE PROCESSSEED.BAY. EVAPORATIVE COOLER j(J 67' � -� � 7 ' ZFURNACE: FAU GRQAVIT_Y' FLOOR BTU p,p INSPECTION RECORD HEATER:. SUSPEND D_UNIT_ WALL--,,T_ a a _ U CC O H U NEW—ADDITION PERMIT $ 3 00 d H Z_ ALTER�REPAIR_ TOTAL FEE $ [�(� PLAN CHECK APPLICANT ` NAME ADDRESS CITY TEL.NO. 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, VENTI- APPROVALS DAT II TOR'S BIGNPTURE LATINS, AIR CONDITIONING. ROUGH G. I HEREBY CERTIFY THAT' I AM ACTING IN VIOLATION OF CHAPTER 9, DIVISION 3. OF AND PR FESSIONAL FINAL CODE OF THE STATE OF IFOR SIGNATURE JACK R. ALLEN, U VI$IN ECMANICAL ENG'R. OF PERMITTEE i PERMIT VALIDAT cH. M.O. ' CASH PLAN CHECK VALIDATION SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 76A364-CE818-1/70 III111 P CATION FOR MIT HEATING VENTILATING - AIR .CONDITIONING COUNTY OF LOS ANGELES BUILDING n Q -DEPARTMENT OF COUNTY ENGINEER ADDRESS (- BUILDING AND SAFETY DIVISION - LOCALITY JOHN A. LAMSIE, COUNTY ENGINEER 76 NEAREST COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN OWNER L 7L.� .4� (PRINT OR TYPE ONLY) i MAIL NO! TYPEOFAPPLIANCEOR EQUIPMENT FEE ADDRESS CITY TEL. NO. ABSORPTION SYSTEM, BTU. � •, CONTRACTOR AIR HANDLING UNIT, CFM ADDRESS BOILER, HORSEPOWER CITY r TEL: NO. QS= ' :2/rl' COMPRESSOR, HORSEPOWERSTATE LIC. )(J LICENSE NO. CLASS Z VENTILATION SYSTEM DISTRICT NO. ,CLyASS GROUPJQE Ppo sSEo BY EVAPORATIVE-COOLER � Q % _L � ` FURNACE: FAU_GRAVITY INSPECTION RECORD FLOOR' BTU HEATER: SUSPENDED—UNIT— WALL Y d O U K U PERMIT '$ 3 00 NEW—ADDITION_ + y Z_ ALTER—REPAIR_ TOTAL FEET S Ll - - PLAN CHECK APPLICANT ' NAME ADDRESS CITY TEL.NO. • I HEREBY ACKNOWLEDGE THAT I HAVE READ THISJCOMFLY - _ AND STATE.THAT THE ABOVE 15 CORRECT AND AGRE - - WITH ALL ORDINANCES AND LAWS REGULATING HEAPPROVALSDATE INSPECiOpS SIGNATURE LATING, AIR CONDITIONING. ROUGH IbHEREBY CERTIFY THAT I AM NOT ACTING tOF CHAPTER 9, DIVISION 3, OF THE INE55 AND ' FINALCODE OF THE'STATE 0 ALIFORNISIGNATURE _ JACK R. ALLEN,SUPERVISING MECHANICAL ENG-R. OF PERMITTEE �- PERMIT VALIDATION CK. . M.O. CASH -PLAN CHECK VALIDATION • 4 6',2''AP,R• 10.4-1 .0 1 3 Q,Q ♦9d SEE BACK OF APPLICATION FOR COMPLETE GEE SCHEDULE - m v_ .� WORKER'S COMPENSATION DECLARATION 20-0066 DPW 9189 APPLICATIONFORPERMIT p I herebkaffirni that I have a certificate of consent to self insure, 76A364C n ,� �. GREEN or a certificate of Worker's Compensation Insuraocd, of a certified - HEATING VENTILATING-AIR CONDITIONING ILIy GREEN copy th�ejreof(Sec.3800 Lab.C.) ' " - - - - - Poli 6��2' Companyt7..YC COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS BUILDING AND SAFETY DIV. M Certified copy is hereby furnished. ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING Z� department. - (PRINT OR TYPE ONLY) ADDRESS Date�1"I Z'-4� � APPlicantli-jQ2 1R -•k't; LOCALITY •C . NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' CNEARESTT. COMPENSATION INSURANCE RS OSS ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed if the work involved by the PARCEL BOOK 'PAGE P B permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT MAP B No. PROCESSED er. I certify that in the performance of the work for which this permit p� - is issued, I shall not employ any person in any manner so es to BOILER,BTU �- U(-J become subject to the Workers'Compensation Laws. - G- COMPRESSOR,BTU Date Applicant VENTILATION SYSTEM - - AaPRovALS, DATE INSPECTOR'S SIGNATURE `NOTICE TO APPLICANT: If, after making this Certificate of ROUGH .. Exemption,you should become subject to the Workers'-Compensation " EVAPORATIVE COOLER provisions of the Labor Code. you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAUGRAVITV LICENSED CONTRACTORS DECLARATION 3 FLOOR BTu t�. VALIDATION 1 hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED—UNIT— (commencing USPENDED UNIT_(commencing with Section 7000) of Division 3 o1 the Business and HEATER: WALL - Professions Code.and my license is in full farce and effect. License Number 5So lSro Lic.Class Contractor AiES Date loCILQ ❑ I am exempt under Sec. Plan Check fee BAR.C.for this reason PERMIT ISSUING FEE$ O F Date: TOTAL FEE 2 SD J(D - - - W Signature OWNER-BUILDER DECLARATION - PLAN CHECK APPLICANT _ U) I hereby affirm that I am exempt from the Contractor's License Law NAME Z for the following reason (Section 7031.5, Business and Professions Code): ADDRESS ❑ I, as owner of the property, or my employees with wages �AC�C1T.i cf1 as their sole compensation, will do the work and the CITY TEL,NO. J.7V3 250.1C structure is not intended or Offered for sale (Section 7044, ' . I ' Business and Professions Code). OWNER 1 ITEMS ❑ I, as owner of the property, am exclusively contracting MAIL - TOTAL 1E) � 1� with licensed contractors to construct the project (Sec- ADDRES- g ��(� tion 7044, Business and Professions Code). - CHECK .' 250.10 CONSTRUCTION LENDING AGENCY CI TEL.NO. 1 hereby affirm that there is a construction lending agency for CONTRACTOR CHANGE '.00 the performance of the work for which this permit Is issued S �VtiS D - (Sec. 3097, Civ. C.). _ . ADDRESS ..- _ - _'._ a't?. •l Lender's Name �'L0 �0.-0001 _ 10/12/9. CI TEL.NO. 6 2776 -1 AM11238 Lender's Address - STATE / LIC. I certify that I have read this application and state that the above LICEN ENO, S50/ CLASS "-- 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 upon the above-mentioned - pro arty for inspection pL r ses. SEE REVERSE FOR EXPLANATORY LANGUAGE - a /O-/2-9�' NA RE OF APPLICANT RAGEIt DATE