HomeMy Public PortalAbout5343 CLOVERLY AVE_Mechanical__ L
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76A364 - CE818 - 3-69 PLICATION OR PERMIT
HEATING - VENTILATING - AIR COND 10NING
COUNTY OF LOS ANGELES FNEAREST
DING
DEPARTMENT OF COUNTY ENGINEER ESS Cloverl
BUILDING AND SAFETY DIVISION
JOHN A LAMBIE COUNTY ENGINEER LITY Temple Cit
COLEMAN W JENKINS,SUPERINTENDENT OF BUILDINGQ11Ve
S ST
FOR APPLICANT TO FILL IN W Nunamaker
(PRINT OR TYPE ONLY) OWNER W.
MAIL
NO TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS 5343 Cloverly
ABSORPTION SYSTEM BTU CITY Temple CitZ TEL NO
CONTRACTOR Lemke Air Uonditioning Co.
AIR HANDLING UNIT, CFM
ADDRESS4937 Encinita ave.
Q
CITY Temple Cit TEL NO 287-1640
COMPRESSOR, HORSEPOWER ) QQ STATE LIC
LICENSE NO 195617 CLASS C-20
VENTILATION SYSTEM DISTRICT NO GROUP ZONE RO SSED BY
EVAPORATIVE COOLER � lx'c/
1
FURNACE FAUX GRAVITY
1 FLOOR BTU 00 INSPE TION-RECORD
HEATER SUSPENDED UNIT cj
WALL }
0
U
oc
O
I-
U
Lu
CL
V1
NEW_ADDITION_ PERMIT $ 3 00 Z
ALTER_REPAIR_ TOTAL FEE $ d 00
W I
PLAN CHECK APPLICANT
I
NAME 1
I
ADDRESS j
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 D TE INS TOR S S NA;URE
EATING AIR CONDITIONING
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH
CHAPTER 9 DIVISION 3, OF THE BUSINESS D PROFESSIONAL FINAL
CODE OF THE STATE Of CALIF IA
SIGNATURE i,�i1i 1 JACK R ALLEN, SUPERVISING ECHANICAL ENG'R
OF PERMITTEE
PERMIT VALI ION CK M 0 CASH
PLAN CHECK VALIDATION J
I
2 1 7 4 i3� jUL 12 4 1 D 1 3,0 0
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
64C-
WORKERS'COMPENSATION DECLARATION CEA 818 (2 80) A P P UC A T U®N FOR P E R W T
I hereby affirm that I have a certificate of consent to self
i;sure or a certificate of Workers'Compensation Insurance,or p IE A YING_V ENT IL AYII�IG`-�i16@ CONDITIONINGa certified copy thereof(Sec 3800,Lab C)
Policy No Company COUNTY OF LOS ANGELES T (f BUILDING ARID SAFETY
Certified copy is hereby furnished /
Certified copy is filed with the county building inspectionFOR APPLICANT TO FILL IN BUILDING
department F " J,f
Date Applicant (PRINT OR TYPE ONLY)` ADDRESS 3 �/�N C/B VCf-�
LOCALITY "'�
CERTIFICATEeOF EXEMPTION FROM'WORKERS' NO I IF
TYPE OF APPLIANCE OR EQUIPMENT FEE �/�/t' ��
COMPENSATION INSURANCE NEAREST
(This section need not be completed if the work involved ABSORPTION UNIT BTU CROSS ST ®�(�Q d
by the permit is for one hundred dollars ($100) or less) DISTRICT NO PROCESSF ev L)
I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM U (/ cc
permit is issued, I shall not employ any person in any manner O .1 �i fJ O-
so as to become subject tPf
Workers' r'umpensation Laws BOILER BTU—'Z /�Oy v -
rr APPROVALS DATE - INSPECTORS SIGNATURE
k,ate 6- ��a�ApplicaCOMPRESSORBTU NROUGH' 34 NOTICE'TO APPLICANT , fter n ►s Certificate o
Exemption, you should become subject to the Workers' VENTILATION SYSTEM FINAL z
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION
with comply with' such provisions or this permit shall be
deemed revokeds
FURNACE FAU GRAVITY _ s -
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter HEATER SUSPENDED UNIT j
9 (commencing with Section 7066),of Division,3 of the Bus► WALL '
ness and Professions Code, and my license is"in full force and,
effect '
License Number Lie Class
Contractor Date
0 lam exempt from the licensing requirements as I`am a
licensed architect or a registered professional engineer Plan check fee 26°%of above
acting In my professional capacity (Section 7051, Bus
mess and Professions Code) PERMIT ISSUING FEE $
Lie or Reg No Date TOTAL FEE
HOME OWNER BUILDER'DECLARATIQN PLAN CHECK APPLICANT
I "hereby affirm that I am exempt from,the Contractor's NAME
License Law for the following reason (Section 7031 5, Bust
ness add Professions Code) ADDRESS, _
❑ I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section CITY TEL NO
7044, Business and Professions Code)
t - f
I,,as owner of the property, am exclusively contracting
g Vv _ f�C�'J•-i �' moo^ x e
with licensed contractors to construct the project MAIL
(Section 7044, Business and Professions Code) ADDRESS /BU��� 2,0 1 1 7,A
= CONSTRUCTION LENDING AGENCY Y CITY �� /e C/ TEL NO �������� # •i° •'4 1
I hereby affirm that thbre is a construction lending agency
for the erformance of the work for which this permit is CONTRAC- OR _
issued(Sec 3097,Civ C) p _ 2j• 2'7.0 0
Lender's Name ADDRESS a ie 2 7 O'O U
Lender's Address CITY TEL NO
0{6.29-81
I certify that I have read this application and state that the STATE V LIC
above information is correct I agree to comply with all County LICENSE NO CLASS'
ordinances and State laws regulating Heating, Ventilating and -
Air Conditioning, and hereby .authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County to Ie ter upon the above mentioned property for
` d
m p poses I
Z 9–
o -
�ignature o" rmittee Date