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HomeMy Public PortalAbout5521 CLOVERLY AVE_Mechanical__ 76,A364-CEa18-1/70 APPLICAT N FOR PERM ` HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS J�c� 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 N G� (PRINT OR TYPE ONLY) MAIL NO TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS ch cc A' CITY TEL NO ABSORPTION SYSTEM, BTU CONTRACTOR � AIR HANDLING UNIT, CFM ADDRESS BOILER, HORSEPOWER CITY - TEL NO qq S COMPRESSOR, HORS POWER O �� STATE LIC LICENSE NO CLASS VENTILATION SYSTEM DISTRICT NO CLASS GROUP ZONEP CESSEs EVAPORATIVE COOLER ; / vpf v 3 FFURNACE'FAU�B GRAVITY co INSPECTION RECORD HEATER SUSPENDED UNIT_ i WALL _ 0 o C.7 O I-- C� W NEW_ADDITION PERMIT $ 3 00 Z ALTER-REPAIR- TOTAL FEE $ fro /l 111JJJ 1� PLAN CHECK APPLICANT wIr ` NAME yC G ADDRESS �`7FV ,$ /G A/ A CITY G. TEL NO 1 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 DATE INSP R'S SIGNATURE LATING AIR CONDITIONING ROUGH l 1 HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF CHAPTER 9 DIVISION 3 OF THE BUSINESS AND PROFESSIONAL FINAL CODE OF THE STATE OF A IFORNIA SIGNATURE JACK R ALLEN,SUPERVISI ECHANICAL ENG'R OF PERMITTEE PERMIT VALIDATION cK M O CASH PLAN CHECK VALIDATION 23 41 0 8 C.50 SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 76A364—CE818 -1/:0 APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING SZ' COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER pL L' / BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST �r COLEMAN W JENKINS, SUPERINTENDENT OF BUILDING CROSS ST G �_ �,i FOR APPLICANT TO FILL IN OWNER / S (PRINT OR TYPE ONLY) MAIL T. Ltc NO TYPE OF APPLIANCE OR EQUIPMENT FEE MAIL Q CITY TEL NO ABSORPTION SYSTEM, BTU t CONTRACTOR In Alt AIR HANDLING UNIT, CFM- O ADDRESS C L BOILER, HORSEPOWER CITY TEL NO COMPRESSOR, H 00FIS EP OW ER I% STATE LIC LICENSE NO CLASS 41 VENTILATION SYSTEM DISTRICT NO CLASS GROUP Z NE/ PROCESS EVAPORATIVE COOLER 1 0 C FURNACE FAU_GRAVITY ✓ INSPECTION RECORD FLOOR BTU_jtb HEATER SUSPENDED UNIT_ WALL 1) vlu a O U O h— U W NEW—ADDITION V PERMIT $ 3 00 cl— Z_ ALTER_REPAIR_ TOTAL FEES PLAN CHECK APPLICANT vt NAME' ADDRESS �c, 110 CITY TEL NO ff 2ff S j� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY r WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALSr DATE INSPECTOR'S SIGNATURE + LAT IN G, AIR CONDITIONING ROUGH I HEREBY CERTIFY THAT 1 AM NOT ACTING IN VIOLATION OF CHAPTER 9, DIVISION 3, OF THE BUSINESS ND PROFESSIONAL FINAL CODEOF THE STATE-0F A ORNIA SIGNATURE JACK R ALLEN,SUPER HANICAL ENG' OF PERMITTEE PERMIT VALIDATION c M O ASH PLAN CH CK VALIDATION Ile L ACOA 9 aor`- JUL I Q v 0 �7 J C . al SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ^ r v 3 76A364C CE 818(REV 6/78) ©1, APPLICATION FOR PERMIT HEATING - VENTILATING - `AIR CONDITIONING t. 'COUNTY OF LOS ANGELES BUILDING AND SAFETY ` FOR APPLICANT TO FILL IN BUILDING (PRINT OR TYPE ONLY) ADDRESS 5521 N. C 1 ove r 1 "' + LOCALITYY NO TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST I + ., CROSS ST ABSORPTION UNIT BTU , r OWNER ' St Luke's School AIR HANDLING UNIT CFM MAIL ' 3 ADDRESS 5521 N BOILER BTU I CITY Temple City TEL NO -- COMPRESSOR BTU" 12 nnn10 00 CONTRACTOR E.- L. PAYNE COMPANY r i + VENTILATION SYSTEM r r ADDRESS _ 166 W. Live Oak Avenue EVAPORATIVE COOLER' CITY Arcadia TEL NO 446-6118 1 FURNACE FAU BTU G VITx STATE LIC v0�- I Inn LICENSE NO 120228 CLASS C-20 HEATER SUSPENDED UNIT_ APPROVALS DATE INSPECTOR 5 SIGNATURE WALL ROUGH m FINAL IV a INSP CTION RECORD V Plan check fee 25% of above IL PERMIT ISSUING FEE$ 00 Z TOTAL FEE PLAN CHECK APPLICANT PLAN CHECK VALIDATION ' NAME r' ADDRESS � � b7y00�� , CITY TEL NO I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND r STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL �16 '� �( '� A ORDINANCES AND LAWS REGULATING 'HEATING VENTILATING AIR CONDITIONING PERMIT VALIDATION '#'o oiO'O'(j l I HEREBY CERTIFY THAT I AM NOT ACTING M VIOLATION OF CHAPTER 9 DIVISION OF THE BUSINESS AND P ESSIONAL CODE ` THE STATE OF AL O IA' 2'- OF 2 1,O O SIGNATURE iQz 1. r OFPERMI E ' 4 O'O 0,2 7,O O U DISTRICT NO { �P/R/OfD BY O 6_1 9 + } ' 1 r WORKNS' COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affirrrt'that I have a certificate of consent to self insureA.gr 111,certificate of Workers' Compensation Insurance, 620-0046 DPW 9/88 HEATING - VENTILATING - AIR CONDITIONING or-..-Vified 7A364C cgpy thereof (Sec. 3800 Lab. ) Policy No. Company Company /vim ❑ Certified copy is hereby furnished. COUNTY OF LOS ANGELES ,S.�U DING SAFETY K Certified copy is filed with the county buil Ing inspec- FOR APPLICANT TO FILL IN BUILDING tion department. ADDRESS d) ,rte (PRINT OR TYPE ONLY) 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. PROCESSED BY the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this AIR HANDLING UNIT, CFM permit is issued, I shall not employ any person in any manner O [� .so as to become subject to the Workers'Compensation Laws. BOILER, BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date. Applicant COMPRESSOR, BTU ROUGH C q NOTICE TO APPLICANT: If; after making this Certificate of VENTILATION SYSTEM FINAL 41 eAn� Exemption, you should become 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 deem- ed revoked. . FURNACE: FAU ITY LICENSED CONTRACTORS DECLARATION J S+eOR BTU e v 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, and-Professions Code,and my license is in full force and effect. 311 A. License Numb ��P41O Lic. Class �� O 7jasJ B-Y k/ , v Contractor - Date �r I am exempt under Sec. V Plan check fee LU B.&P.C. for this reason. PERMIT ISSUING FEE $ -p Z Date: _ Signature TOTAL FEE 9` e2 C) 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): _ ADDRESS L ❑ I, as owner of The property, or my employees with wages as their sole compensation,will do the work andl Ir the structure is not intended or offered for sale(Section CITY TEL. NO. L.'r 7044, Business and Professions.Code). OWNER ❑ 1, as owner of the property, am exclusively contracting i i;PID with licensed contractors to construct thero•ect (Sec- MAIL 0 a tion 7044, Business and Professions Code). 1 ADDRESS a)iii. CONSTRUCTION LENDING AGENCY CITY TEL. NO. .:(tL : f z_EI_G I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTOR �� , s aka*3G +_I) (Sec. 3097, Civ. C.). ADDRESS �5' Lender's Name CITY TEL. NO QS= Lender's Address - I certifythat I have read this application and state that the STATE LIC. PP LICENSE NO. CLASS �. (i C' 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 uDay the above- entioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �r 47-?/ '5-gr%tJre of Applicant or Agent Date ©s t' WORKERS' COMPENSATION DECLARAZION APPLICATION FOR PERMIT I hereby offrrm that I have a certificate of consent to self Insure or a certificate of Workers Compensation Insurance =HEATING - VENTILATING - AIR CONDITIONING rifted c thereof (Sec 3800 L 1 76A364C #39$98 Po � ) .iOM`� WSURANCE CE Ste(REV 10AI) Policy No n ❑ Certified copy Is hereby furnished COUNTY OF LOS ANGELES - BUILDING AND SAFETY X❑ Certified copy Is filed with The county building inspec- FOR APPLICANT TO FILL-IN-- BUILDING tion department (PRINT OR TYPE ONLY) ADDRESS 21 North C 1 ove r 1 Date Applicant 5-15-84 E. L. PAYNE COMPAN : LOCALITY NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' - NEAREST COMPENSATION INSURANCE CRCSS ST Broadway (This section need not be completed if the work involved by ABSORPTION UNIT BTU DISTRICT NO PROCESSE BY the permit is for one hundred dollars ($100)or less ) 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 become subject to the Workers'Compensation Laws BOILER BTU { AP OVALS DATE INS ECTOR S SIGN TURE Date Applicant 1 COMPRESSOR BTU 36 r 000 10. 00 ROUGH NOTICE TO APPLICANT If, after making this Certificate of VENTILATION SYSTEM- FINALI Exemption, 'you should become subject to the Workers - Compensation provisions of the Labor Code you must forth- EVAPORATIVE COOLER A IDATI with comply with such provisions or this permit shall be deemed revoked FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER WALL SUSPENDED` UNIT (commencing with Section 7000) of Division 3 of the Business � and Professions Code,and my license Is In full force and effect d License Number 120228 Llc Class C-20 U E. L. PAYNE C� 5-15-84 0 Contractor ate ❑ 1 am exempt under Sec d Plan check fee H B 8P C for this reasonDate Z -PERMIT ISSUING FEE E 10 0 Signature TOTAL FEE -120 0 OWNER-BUILDER DECLARATION PAN CHECK APPLICANT 2 2 7 7,9 A I hereby affirm that I am exempt from the Contractor s License Law for the following reason (Section 7031 5 Business and NAME #tolo'o o+0 8 Professions Code) ❑ 1 as owner of the property or my employees with ADDRESS 2 -,-'2 0 5 0 wages as their sole compensation will clothe work and o�°'°,2 0 5 66 the structure Is not intended or offered for sale(Section CITY TEL NO t , 7044, Business and Professions Code) o 7, 1 '7'—8 4 ElI as owner of the property, am exclusively contracting OWNERS t.- Luke's School w with licensed contractors to construct The project (Sec MAIL ADDRESS 2'1 N, CI over 1 tion 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY CITY Te6p 1 e City TEL NO 287-0473 1 hereby affirm that there Is a construction lending agency for ' the performance of the work for which this permit Is IssuedCONTRACTOR (Sec 3097, Civ C E L. PAYNE COMPANY ) Lender s Name ADDRESS -- 9242 Beve r 1 y B 1 vd. - Lender s Address CITY Beverly Hills TEL NO 793-1131STATE LIC , I certify that I have read this application and state that the LICENSE NO 120228 CLASS C-20 above Information Is correct I agree to comply with all County ordinances and State laws relating to building construction, and hereba authorize representatives of this County To enter f on ove meovioned property for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE t 5-15-84 Si ature of Applicant or Agent Date t /