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Home My Public Portal About10936 DANBURY ST_Mechanical__ 'B"'BAK Ce9189 /'S APPLICATION FOR PERMIT {� HEATING - VENTILATING - AIR CONDITIONING u BUILD[ AND SAFETY DIVISION FOR APPLICANT TO FILL IN BUILDING 1 (PRINT OR TYPE ONLY) ADDRESS loc)36 NBURY LOCALITY NO. TYPE 0 APPLIANCE OR EQUIPMENT FEE NEAREST CROSS S ABSORPTION UNIT, BTU OWNER KEN GOLDRERY AIR HANDLING UNIT, CFM MAIL ADDRESS 10936 DANBURY BOILER, BTU CITY TEL. NO. TEMPLE CITY NO- 448-5119 COMPRESSOR, BTU CONTRACTOR AQUATIC POOLS VENTILATION SYSTEM ADDRESS 101 E. HUNTINGTON DRIVE EVAPORATIVE COOLER CITY ARCADIA TEL. NO 446-4661 STATE FLOORCE: FAU BTU RAVITV LICENSE NO. 315620 CLASS C-53 HEATER: SUSPENDED—UNIT— MSTRICT NO. ^u,P zONE (\/��n/¢y/MESSED BY WALL \l ` C INSPECTION RECORD (D v w a h Z_ Plan check fee 25%G of above. - PERMIT ISSUING FEE S ZI(� TOTAL FEE PLAN CHECK APPLICANT NAME ADDRESS CITY TEL.NO. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDIN ANCESANO LAWS REGULATING HEATING, VENTI- LATING, AIR CONDITION I NO. HEREBY CERTIFY THAT I AM NOT D I$ ESPION APPROVALS DATE INSPECTOR'S SIGNATURE OF CXAPTER 9, DIVISION 3, OF BUSINES AND E ION L RO GH CODE OF THE Si AL AJ S I SGNATURE ��. [NAL 1-7-1 2- T1 SPERMITTEE dd��' I e2 PLAN CHECK X ALIDATION CK. M.O. CASH PERMIT VALIDATIOV x M.0. CASH 2.7 8`[MAY 13 4.1 D 1 5.7 5 eyn Q r� WORKER'S COMPENSATION DECLARATION 20-0046 DPW 9189 I hereby affirm that I have a certificate of consent to self insure, 76A364C APPLICATION FOR PERMIT � GREEN, or.a certificate 4 Worker's Compensation Insurance, or a certified HEATING -VENTILATING -AIR CONDITIONING cop }h/eerect(S�c. 800 L C.) Icy IdnD.3. (at, Ln�A COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.- ❑ Certified copy is hereby furnished. ❑ Certified copy Is filed with the cou wilding Ins Yon FOR APPLICANT TO FILL IN BUILDING /n�2/ D�� /jv n T Date �p�/ `f Applies A- g (PRINT OR TYPE ONLY) ADDRESS LOCALITY V CJv v /S / • NO. TYPE OF APPLIANCE OR EQUIPMENT FEE �� C O CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS ST. COMPENSATION INSURANCE ABSORPTION UNIT,BTU SSOR (This section need not be completed it the work involved by the MAPEBOOK PAGE PARCEL permit Is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED By I certify that in the performance of the work for which this permit yyy is issued, I shall not employ any person in any manner so as to BOILER.BTU become subject to the Workers' Compensation Laws. U COMPRESSOR,BTU 34enCl /O APPROVALS DATE INSPECTORS SIGNATURE Date Applicant VENTILATION SYSTEM _ NOTICE TO APPLICANT: If, after making this Certificate of _ ROUGH Exemption,you should became subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Cade, you must forthwith comply with such FINAL Alf provisions or this permit shall be deemed revoked. FURNACE: FAU K GRAVITY V DATION o LICENSED CONTRACTORS DECLARATION / FLOOR BTU /0 I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED—UNIT— (commencing USPENDED - UNIT_ -r (commencing with Section 7000) of Division 3 of the Business and HEATER: WALL H�bl ._ Professions Cade,and my license is in full force and effect Z 2-q //�� 0D �{� �i/� .JOS 77.05 License Number ��11r� Lic.Class ��R111 ITEM } �e$6A3—;197 D TI)TAL ae ie_gV Contractor r q� p ❑ 1 am exempt under Sec. Plan check fee i-� 0 A7M,I �z�(p-Q� r It /I " HECK L,.a B.&P.C.forthis'reason PERMIT ISSUING FEE �C` d0 CHANGE FLU U Date: TOTAL FEE Q W Signature 0000-0004P_.' Gj,:'b' ;CO OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT _ , I hereby affirm that I am exempt from the Contractor's License Law NAME y..yrJ _Z for the following reason (Section 7031.5, Business and Professions Code): ADDRESS ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do the work and the CITY ` TEL.NO. - structure is not intended or offered for sale (Section 7044, ,� Business and Professions Cade). OWNER Al O .�-m R6 • jAW .517 7t!7,01,11❑ 1, as owner of the property, am exclusively contracting ' MAIL - /-1 /� q L with licensed contractors to construct the project (Sec- ADDRESS (� DHN6dR S �• - tion 7044,Business and Professions Code). CITY '��/" ' L� C� TEL.NO6179_ 9�0� CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction lending agency for CONTRACTOR / �+ 76- }- /7 IC D the performance of the work for which this permit Is issued CONTRAL (Sec. 3097, Civ. C.). 2 In/y) ADDRESSI � ' X7L� Lender's Name ✓✓✓rrr••... - CITU �D YV R•. /1A TEL.N 0 �00Qa Lender's Address STATE LICC . s I certify that I have read this application and state that the above LICENSE NO. CLASS information is correct. I agree to comply with all County ordinances and State laws relating 4o building construction,and hereby authorize - representatives of this County to enter upon the above-mentioned , per ormspec' urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 'SIGNATURE OF APJPLICANT OR AGENT DATE WORKERS*COMPENSATION DECLARATION 76A364C APPLICATION 1p1 /^ p p� I� PERMIT 4 ' CE -81812-80) AP LICATION FOR PE Y'(MI 1 [ hereby affirm that 1 have a certificate of consent to self �'ILIIII insure, or a certificate of Workers'Compensation Insurance,or HEATING-V EDIT ILATI NG-AIR CONDITIONING a certifie cr h re4 (Sr• 9 0,Lab.C. ,,,. .(psai�� I�1-f� Policy No. Company UHrU /nLi(k(�L� Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IM BUILDING departmentQQ t/ �/' ADDRESS 1C1�3(��rgu2YT Dalel/J"��'VpplicantViM_Py�r'3. — (PRINT OR TYPE ONLY) ' LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ` FFA_ TY r I COMPENSATION INSURANCE NEAREST L�t• t' d/�, Q d (This section need not be completed if the work *involved ABSORPTION UNIT, BTU CROSS ST. —�1v+ `„ �� ' `V� O by the permit is for one hundred dollars (5100) or less.) DISTRICT Nom, PROCESSED By U I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM ` `Ucr permit is issued, I shall not employ any person in any manner v O so as to become subject to the Workers' Compensation Laws. BOILER,BTU H APPROVALS DATE ECTOP'S SIGNANRE W Date Applicant COMPRESSOR, BTU _ � ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL ►�� ? 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 deemed revoked. FURNACE: FAU— GRAVITY_ LICENSED CONTRACTORS DECLARATION FLOOR: BTU ' 1 hereby affirm that 1 am licensed under provisions of Chapter HEATER: SUSPENDED UNIT 9 (commencing with Section 7000)of Division 3 of the Busi. WALL ness and Professions Code, and my license is in full force and /� pL.Jr✓TS effect � License Number i7 922pp,� Lie.Glas/s_K--7-1 _ �3 3 5 1 A ContractorpL)S.fhf1:I_KtYrCrDate C--Zg—&s f#Ie o e e,. a 1 am exempt from the licensing requirements as 1 am a ' licensed architect or a registered professional engineer Plan check fee 25% of above. 2 • is 2 0.5 0 acting in my professional capacity (Section 7054, Bus- iness and Professions Code). PERMIT ISSUING FEE$/v ,ale e 2 Q 5 06 Lie.or Reg. No. Date TOTAL FEE 14Z I ' I PLAN CHECK APPLICANT 8 3 7,�'1 HOME OWNER-BUILDER DECLARATION i- 1 hereby affirm that 1 am exempt from- the Contractor's NAME License Law for the following reason (Section 7031.5, Busi. ness and Professions Code): ADDRESS I, as owner of the property, will do the work and the CITY TEL. NO. structure is not intended or offered for sale (Section 7044, Business and Professions Code). ❑ OWNER ��_—I_ �E%�l.dLs"bv1 I, as owner of the property, am exclusively contracting •.�-=- with licensed contractors to construct the project MAIL (Section 7044, Business and Professions Code). ADDRESS f 5 1+ CONSTRUCTION LENDING AGENCY CITY •rffMPN TEL Nc%.3�5,'�n,� I hereby affirm that there is a construction lending agency f �1 7 for the performance of the work for which this permit is CONTRACTOR ' Us�_ m—KRtEF T issuedSec. 3097.Civ.C.). •' Lender's Name � ADDRESS Lender's AddressCITY Gov!NA a►3)96L93�1 TEL.N � I certify that I have read this application and state that the STATE LIC. pe' above information is correct. I agree to comply with all County LICENSE NO.1 �p CLASS fJ ordinancesd State lases regulating Heating. Ventilating and Air Condit' ping, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE COu t enter on the above-mentioned property for his cctio purpos Signature of Permittee Date /