HomeMy Public PortalAbout4856 GOLDEN WEST AVE_Mechanical__ (2) CITY OF TMLB CITY
70A354-CES18-1/70 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR C.ONOITION4NG
COUNTY OF LOS ANGELES Apl ON 4 .�6 'N. Golden West Ave•
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIQN LOCALITY Temple Cit
JOHN A. LAMBIE, COUNTY ENGINEItR
COLEMAN W. JENKINS, SUrtRINTKMDKNT Q-F BUILDING. NEAREST.
ST.
FOR APPLICANT TO FILL IN OWNER First South Ba�llist Chore
(PRINT OR TYPE ONLY)
NO. YPEOFAPPLIANCE-OR EQUIPMENTFEE ADIDREss 4856 K. Golden Pest
CIT`ft Temple City-TEL. No. 286-9324
ABSORPTION SYSTEM, BTU }
CONTRACTOR' e1 4�C cT HtC s e ry C O
AIR HANDLING UNIT, CFM ADDRESS 2379 First St• }
BOILER, HORSEPOWER
�I� La Verne T� NO• 339-6011
2 COMPRESSOR, HOF2SEPOWER O STATE 26195 LIC• . C20
LICENSE NO. CLASS
VENTILATION SYSTEM D STRICT NO. CLASS R oMe C[SSED BT
EVAPORATIVE COOLER
FURNACE: FA G INSPECTION RSCORD
2 FLOOR BTU 12-50.
HEATER: .SUSPENDEDUNIT_
WALL
I F
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8
NEW—ADDITION—
PERMIT S g 00
ALTER—REPAIR— TOTAL FEE S 25-50
PLAN CHECK APPLICANT
NAME
ADDRESSLL
CITY TEL.NO.
I H[REEY ACKNOWLED SE THAT I HAV[ READ THIS APPL'1CATIOX
AND STAT[ THAT'TH[ ASOV[ IS CORRECT AND ASREL TO COMPLY
WITH ALL ONDINAXCES AND LAWS R[•ULATIX[ H[ATIN[, VENTI- APPROVALS, DAT[ StS r[CTO11'S SNINATU a'
LATIN[, AIR COXDITIPNINS.
RO L1G H
I H[R[BY CERTIFY THAT I AM "NOT IX IN VIOLATION _
OF CHAPTER 0, DIVISION 3,'OF THE BUSIN[KP
A ROFESSIOKAL FINAL .
COD[ OF THE STAT[ LIFbRNIA /� /
SIGNATURE ✓�•��� 'JACK R. ALLEN,SUPERV131 ECHANICAL ENG-R.
OF.PERMITTE '
PERMIT VALIDATION CK. M.0. CASK,'
PLAN CHECK VALFDATION
75 szir� 20-41, D ,�
SQ BACK OF APPLICATIOIIFOR COM M-ErE FI12CH[DU LE --
76+A.aE4- CSE e I e- eta
APPLICATION FOR. PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDR
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPEDNLY)
MAIL
NO. YPEOFAPPLIANCE OR EQUIPMENT FEE AD
CITY TEL NO
ABSORPTION UNIT, BTU
CONT CTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CITY TEL. NO.
COMPRESSOR, BTU STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE R //ED BY
EVAPORATIVE COOLER
FURNACE: FAU GRAVITY INSPECTION RECORD
FLOOR BTU
HEATER: SUSPE UNIT_
WALL �J
p�
c�
0
w
CL.
Plan check fee 25% of above. See reverse. z
PERMIT ISSUING FEES s 00
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE I/ CORRECT ANP AGREE TO COMPLY
WITH ALLORDINANCEB AND LAWS REGULATING HEATING, YENTI- APPROVALS DATE "PECTOR'S SI/NATURE
LATIN/, AIR CONDITIONING.
ROUGH
I H4R[BY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER D, DTVI/10 9, OF�THI'NKl NDP //TONAL FINALCOF TH[ 1TATEOF ALIF
SIGNATURE PERMIT VALIDATION
CK. M.Q. CASH
OF PERMITTEE
PLAN CrVALIDATION CK. M.0. CASH
7T
� 4053737 DEC 12 41 D 0900
/EE BAC%Of APPLICATION FOR COM MUTE FY[/CHEDUL[
x-a
I� v* -ren that
COMPENSATION cafe of con" APPLICATION FOR PERMIT
` I.rlFt�eby affkm that I have a certificate of consent to self
Nhs e, or a certlficate of Workeri Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
o certtfled copy thereof (Sec. 3800, Lab. C.) 76A.3W
J CF-919(REV. 10/91) .
'Polley No. Company
Certified copy Is hereby furnished.. COUNTY OF LOS ANGELES BUILDING AND SAFETY
❑ Certified copy Is filed with the county bullding Irapec- FOR APPLICANT TO FILL IN BUILDINGADDRESS ��S d o
tion department.' (PRINT QR TYPE ONLY) / S.
Date Applicant IALOCALITY "Ce//Ow
• NO. TYPE OF APPLIANCE COR CQ
R UIPMBJT FIS
CERTIFICATE OF E)CEMPTION FROM WORKERS' _CROSS Sim ^ J/
COMPENSATION INSURANCE
(This section need not be compleud If the work Involved by ABSORPTION UNIT, BTU DISTRICT NO.
the peanit Is for arm hundred dollars ($100)or leu.) (�
I certify that In the performance of-the work for which this AIR HANDLING UNIT,CFM c� Un
permit Is Issued, I shall not employ an'yn In any mannp-r
so as to become sublect to the Wofkers Compensation Laws.,./ LER• BTUu
AWRovs DATE i s SKR4AT-URE
Date I.H.47 Applicant Ar1rd COMPRESSOR, BTU ROUGH .'z-
NOTICE TO APPLICANT: If, after making this Certl cote of VENTILATION SYSTEM FINAL.
Exemption, you should become sublect to the Workers' .
Compensationprovisions of the Labor Code, you must forth- EVAPCKtATIVE COOLER VALIDAT N
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR ---------'.-BTU--
I
BTUI hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPEND® UNFT
`(commencing with k&ctloh 7000) of Dlvlslon.3 of the Bwlress WALL
and Professions Code,and myJlcense Is In full force and effect. >
v
License Number �Llc. Class_
OC
Contractor Date G
I am exempt under Sec. W
I
H
B.BP.C. for this reasPlan check fee
on' Z
PERMIT ISSUING FEE $
Date:
Signature TOTAL FEE 1Q
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):
I, as owner of the property, or my employees with ADDRESS 6 3 7.2 A
wages as'their sole compensatlop,wlII do the work and CITY TEL. NO # o c o o • 8
the structure Is not Ihtended or offered for sale(Sectlon
70.41, Buslneu and Professlors Code). . OWNER j� `` � - 20,50
.E1 1, as owner of the property, am exclusively contracting T.( `'oo�c A5�Q ( o
0 T5
with licensed contractors to construct the protect (Sec- •'• 2 Q 5
tlon 7014, Business arid'Professions Code). P.O.L�Ox I S 0 1.2 1 -87
CONSTRUCTION LENDINGAfENCY 'aTY �m �C C'� TEL No. .f 4P-�-12J
I hereby affirm that there Is a construction lending ogency.fo-r
the performance of the work for'which this permit Is IssuedA�7OR ,
(Sec. 3097, Clv. C.).
Lender's Name "i 49Y K
7B NO.
Lenders Add,—ItX4 AI. Cold" WocL L•C. Call
ATE LIC
I certify that I have read this application and state that the LICENSE NO. CLASS -
above Information Is correct. I agree to comply with all County
ordinances and State laws relating to building comtructlon, _
and hereby authorize representailves of this County to enter
upon the above-mentioned property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
�L7. �s•�sr . �.t7''1et� 1,!b -l''J
Stgrwture of Appll nt or Agent Dote