HomeMy Public PortalAbout9809 DAINES DR_Mechanical__ 76 A364- CE 81 B- 5-73
APP ATION FO ERMIT
HEATING - VENTILATING AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS 9800 DAINE-S DRIVE
BUILDING AND SAFETY DIVISION LOCALITY TEMPLE CITY
NEAREST
CROSS ST
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL 9809, DAINES DRIVE
NO TYPE OFAPPLIANCE OR EQUIPMENT FEE ADDRESS
CITY TEL NO.
1231.
ABSORPTION UNIT, BTUTEMPL -
CONTRACTOR AQUATIC POOLS
AIR HANDLING UNIT, CFM
J�IDDRESS '101 E. HUNTINGTON DRIVE
BOILER, BTU e® Z CITY ARCADIA TEL. NO 446-4661
' COMPRESSOR, BTU STATE LIC -
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO PGROUP ZONE OCE SS ED BY
EVAPORATIVE COOLER Qom/ 0�fi w
FURNACE FAUGRAVITY INSPECTION RECORD
FLOOR BTU
HEATER SUSPENDED-UNIT-
WALL
USPENDED UNIT_WAL-L
a
0
U
O
U
W
cn
Plan check fee 25% of above See reverse. '
Z
PERMIT ISSUING FEE 8 0
TOTAL'FEE S
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 DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING
` ROUGH
I HEREBY CERTIFY THAT I AM NOT.ACTING IN VIOLATION
OF CHAPTER 9, DIVISION THE BU NESS AJflr�20F IONAL FINAL -��
CODE OF THE STAT ((/✓`�
SIGNATURE , PERMIT VALIDATION EK M o cnsH
OF PERMITTEE ,
PLAN CHEC ALIDATION CK M o CASH
5,3,8 r!►CT 6 4 1. 9 1 5.7 5 ®��
WORKERS'GOMPENSAT,IONDECLARATION
I het? CE,-818 (2-80) 4
by affirm that I have a�certificate,of consent to self - ;
insure,ora certificate of Workers'•Compensation Insurance,or HEATING-VENT ILATING-AIR CONDIYIONINa
aIcerti£iel-se'oYp _thre -1_3800,Lab - - -_ ,, •
'
Policy � .���-pp-/J�(yJln Pany� a CO= - ,
r UNTY-OF LOS ANGELES , BUILDING Ab SAFETY
Certified eopy is hereby furnished • - F° _
Certified'copy is filed with the county building inspection E�UILDI,NG (�
YYY p tin FOR'APPLICAN'T TO FILL IN (g�� �`�n 5- D
` Date�� Appic ate" - (PRINT,OR TYPE ONL•Y),L ADDRESS'
cant `� � - _
�. e -i p LOCALITY =f
t CERTIFICATE OF EXEMPTI FROM W ERS' NO TYPE•OF,APPLIANCE OR EQUIPMENT FEE
�)
COM (L
-, - �; NEAREST'
_ . I CROSS ST 6 ^ d
,�'i(This section need`not be completed if_the�work involved ' ABSORPTION UNIT, BTU ,t p
b tate Crmit is for One hundred"dollars =�" " t DISTRICT NO � PROG SED BY,
y _ 'p . . r 0100) or less.) a . ^. _ U
T}certify that,in 4be,-performance,of the work for�Which,this AIR HANDLING UNIT,CFM p/ Cc
permit is issued, I shall not employ-any,person In arty manner 01
' so as to become subject,to,the Workers'Compensation Laws BOI LE W,'BTU M
rt f h APPROVALS DATEcy INSPECTOR
ySSIGNATUREUJI
(�
Date- Applicant ` <� COMP_�RESSOR;BTUV ROUGH 'Tt'�! /•�"'-" -
N16 ICE;TO-APPLICAN`J' If, after making4is Certrftcate of • VENTILATION, r ��� j Z
l FINAL
Exemption,9 you' should, become subject'to the Workers''' -
_'a Compensation.provisions of the,:Labor Code- must forth- ' = - -' '° ` i �� =VALIDATION
� f EVPsj?O IATI.VE COOLER a `� f ,
with comply with such_provisions or this permit 'shall•be ; ^
deemed revbked: s
r •I FURNACE FAU r, Vt
LICENSED CONTRACTORS DECLARATION l FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter IiE'ATER•, SUSPENDED UNIT _
9'(commegcmg with Section 7000) of Division 3 of the Busi-,.,, WDLL-
nesse and Professions Code, and my,license is-in fuil,force and
effect. _ i/I
Lwense,Numbei � 1 Lic Class
Contractor_I1ZL W �� ► Date l _ - y
I^am-exempt from the licensing requirements as•I am a t
licensed architect-'or, a registered'professional' engineer Plan check fee 25%of above.
e acting.in my,professional` capacity (Section 7051, Bus-,
mess and,ProfessionsCode) t' _ PERMIT ISSUING FEE $
,Lia or Reg No Date TOTAL FEE
HOME OWNER-BUILDER DECLARATION. PLAN'CHECKAPPLICANT
I -hereby affirm. that.I am 'exempt from- the Contractor's NAME'.+'
License Law for the followrng,,reasbn-(Section 7031 5, Busi-` ^v
ness and Prof;ssrons Code)',, => r :; �- ADDRESS ? K.� A
�I' as.owner of.the property, will�do the work and the x s TESL NO 7 ^° '" uY "'
s50
tructure is not intended,or offered Jor sale-,(Section CITY, , 3307 e _ e
-7044, Business-and Professions Code) � � :°i *
O W N E,R•' '-�I � am
% `' _��- 1 EM
I, as owner of the property, am;exclusively contracting ' _
with hcensed'.'contractors to construct the project. ��m ;MAIL �� �� OTA, 30' 50
(Section 7044,Business and.Professro`fls Code) ADDRESS
CONSTRUCTION LENDING AGENCY 4i,_ CITY �f�! 50
TEL, NO j�$��_ �xi � •
�� /� (� >�
I hereby affirm that'there is a construction lending agency CH t .(XI
for the, performance of the work for,%+hich this permit is CONTRACTOR`, - �
issued(Sec 309,7,Civ e) �
Lender's Name ADDRESS a
-s -M-0061 9714/v9,
Lend.er's Address CITY rang-:
+ TEL ,NO
St6Aft
n a
f I certify thatI have read this application and state that the STATE (( rLIC �- - �. tfl111J�•J`
above information is correct.I agree to comply with all County. LICENSE NO' l CLASS ¢'l1 _
ordinances and State laws regulating Heatmg,,Ventilating and .e
Air Conditioning, and hereby authorize representatives of this s, SEE_REVERSE FOR EXPLANATORY LANGUAGE
County to enter upon the above-mentioned proper{y for' ,
uispecti
Signatu a of Perraittee Date ti