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HomeMy Public PortalAbout6261 ENCINITA AVE_Mechanical__ 'BASGAEI GES"a"5/J5 APPLICATION FOR PERMIT {� HEATING -'VENTILATING - AIR CONDITIONING u BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN BUILDING 6261 Encinita .4ve. (PRINT OR TYPE ONLY) ADDRESS LOCALITY Temple Gity " NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST caosssr. Las Tunas Dr. ' ABSORPTION UNIT, BTU OWNER Mr. and Mrs. Jerry -Inglis AIR HANDLING UNIT, CFM MAIL ADDRESS 6261 Eninita Ave. BOILER, BTU CITY Temple City TEL. NQ.286-0230 COMPRESSOR, BTU CONTRACTOR E.L. PAYNE COMPANY VENTILATION SYSTEM ADDRESS 166 W. Live Oak Ave. EVAPORATIVE COOLER CITY Arcadia TEL. NO. 446-6118 1 FURNACE: PAU=GRAVITY STATE LIC. FLOOR BTU 7 50 LICENSE NO. 120228 CLASS C-20 HEATER: SUSPENDED—UNIT DISTRICT NO. GROUP DINE OCESSED BY WALL d U INSPECTION RECORD U 06 4( filar 1y:Dr,1S FrIw crh,c rq duff' h Plan check fee 25% of above. PERMIT ISSUING FEES 50 TOTAL FEE 17 0 PLAN CHECK APPLICANT NAME A DDRESS II { 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- LATING, AIR CONDITIONING. ; HEREBY CERTIFY THAT I AM*NOT ACTING IN VIOLATION APPROVAL'S DATE INSPECTOR'S SIGNATURE OF CHAPTER 9, DIVISION 3, OF THE BUST NE55 D PROFESSjjj L ROUGH SIGN OF THE STA F CA IFOfl NI P. SIGNATURE \\I\\ll ' OF PERMIT EE FINAL ' PLAN CHECK VALIDATION CK. M.0. CASH PERMIT VALIDATION cK. ' M.D. CASH 027�'ISEP 241 0 1 2.00A98 WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affirm that I have o certificate of consent to self, Ll insure, ora certificate of Workers' Compensation Insurance, 76A3a4C HEATING • VENTILATING • AIR CONDITIONING or a certified copy thereof (Sec. 3800, Lab. C.) , - >- 20-0046 DPW 9/88 - Policy No. Company ❑ Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY L'Jt Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING ��"" tion department. (PRINT OR TYPE ONLY) ADDRESS cp' GhG i G NVE - - Date Applicant LOCALITY- Q. �e e� I 76 NO. TYPE OF APPLIANCE OR EQUIPMENT FEE YY1 ( CERTIFICATE COMPENSAT ON INSURANCE CROSS CROSSNEARESST. LO N a-Do(d ek EiK/q (`I I-Th C- (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. PR ES o E the permit is for one hundred dollars ($100) or less.) - ,—/ ^ f/ 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 so as to become subject to the Workers Compensation Laws. BOILER, BTU APPROVALS DATE INS CTOR'S SIGNATURE Date Applicant COMPRESSOR, BTU I ROUGH In ^ ' 1 NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL U Exemption,' you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- - •EVAPORATIVE COOLER r VA, ID,TIO with comply with such provisions or'this permit shall be deem- ed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR' - BTU 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. —7 'VENT' �:O Li AMl . 06 License Number Lic. Class It J N ZW CONST d ,,�eN-_ D o Contractor Date o[ ❑ : 1 dm exempt under Sec.' - 0 Plan check fee w B.BP.C..for this reason PERMIT ISSUING FEES 00 H Date: z Signature TOTAL FEE OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License D , Law for the following reason (Section 7031.5, Business and NAME - Professions Code): ❑ I, as owner of the property, or my employees with ADDRESS s wages theiras sole compensation, o the work and GT.t - the structure is not intended or offeredred for sale(Section " CITY _ . TEL. NO. _ 7044, Business and Professions Code). 07 27.00 OWNER © I, as owner of the property, aonstru t the contracting - i ITENS with licensed contractors to construct the project (Sec- MAIL t tion 7044, Business and Professions Code). ADDRESS - TO AL 27 - 00 CONSTRUCTION LENDING AGENCY CITY TEL NO. - GCHECK.I hereby affirm that there is a construction lending agency for - .27,011 the performance of the work for which this permit is.issued CONTRACTOR D CHANGE .00(Sec. 3097, Civ. C.). .. _.._ ADDRESS - - Lender's Name ' _ ciTr TEL. NO. 0000-0001' w/23/9r Lender's Address STATE - LIC. - — �2> 1- - 03:(t� certify that have read this application and store that the LICENSE NO. CLASS above information is correct-I agree to comply with all County ordinances and State laws relating to building construction, A&�� tives of this County to entererry for insp_Icttion urposes. - q�3 SEE REVERSE FOR EXPLANATORY LANGUAGE .. - . . Signy a of Applicant or Agent Dat ®s