HomeMy Public PortalAbout5234 GOLDEN WEST AVE_Mechanical__ 76 A,364 - CE 818-1/75 ' -
.' APPLICATION FOR PERMIT
HEATING- VENTILATING - AIR CONOIT'IONIN-G `
COUNTY OF LOS ANGELES BUILDING 5234 N. GOLDEN WEST
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING. AND SAFETY DIVISION LOCALITY
'NEAREST
CROSS ST, LA ROSA DR.
FOR'APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY), • ' PIGGOTT, H.
MAIL _
NO TYPE&SIZE OF EQUIPMENT - FEE ADDRESS ABOVE
SEE BACK OF APPLICATION ,
'CITY TEL. NO, 286-8789"
FORCE AIR FURNACE, BTU ;
CONTRACTOR •L&J COPPER PLUMBING CO. -
COMPRESSOR, -BTU
ADDRESS 507. W.' RICHARDSON' •LANE
VENTILATION FAN CITY GLENDORA = TEL. NO 963_1093
s LIST ALL OTHERS BELOW STATE 303946 , LIC C36
LICENSE NO. CLASS
SDI T ICT NO 4 ROUP 0 E PROLES 81 '
/9-
INSPECTION RECORD
O
U
Plan check fee. See reverse.
PF ItVI'I' 11.6ldN'C Vl%E S
PLAN CHECK APPLICANT
NAME,
ADDRESS .�
,C1 TY TEL NO -
I HEREBY ACKNOWLEDGE-THA7'1 HAVE READ THIS APPLICATION -'
AND• STATE THAT THE ABOVE IS CORRECT AND AGREE'TO COMPLY
WITH ALLORDINANCES•AND'LAWS REGULATING HEATING, VENTI- APPROVALS ` DATE INSPECTOR'S SIGNATURE '
LATING, AIR CONDITIONING 1 - -
ROUGH e'
I HEREBY CERTIF,Y,`THAT I,•AM, NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL �Q
CODE OF THE STATE OF CALIFORNIA -
SIGNATURE I PERMIT VALIDATION- CK iM O r CASH
OF PERMITTEE• - -
PLAN CHECK \J'hfLIfffATION CK M o CASH
4 '5 3-kpR r� 1 .D 1 5:7'5
� l
W6.iKi-�RS'COMPENSATION DECLARATION 76A364C' qq, �+ q �y�` ® _ ,-
1 hereby affirm that I have a certificate of consent to self CE -81'8 (2-80) • P"�A P P L IC h1 T I®1 tl F®,ff"`C PERMIT ,
insure,or a certificate of Workers'Compensation Insurance,or
HEATING-VENT ILATING-AlR CONDITIONING
a cert2f3 1 07 thp-79(Sec.3800,Lab C)
Policy No Conipany Ca_.:Casualty: lndeinni'ty ' _ �r°�
,Certified copy is hereby furnished
COUNTY OF LOS.ANGE LES, ;'BUI LOING,AND SAFETY-
Certiffed copy is filed with the county building inspection :• '
department. FORa�APPLI,CANT TO"FILL IN. ;� BUILDING
Dite_1-2_8-80 Applicant E. L. PAYNE• COMPANY- .(PRINT-OR TYk,ONLY.)�,
��' -ADDRESS _5234aN. -Goldenwest '
air - L6tALIITY'
CERTIFICATE OF EXEMPTION FROM WORKERS' NOTYPE,OF APPLIANCE OR EQUIPMENT "" ` `FEE Tem '1 a�CY.ty
COMPENSATION U4SURANC> ,, • NEA'REST�. r }
(This section need not be,commppleted•if,the work involved ABSORPTION UNIT, BTU CROSS ST LdS Tunas l),C.I Ve d
'by the'permit is for one hundred dollars ($100)"or less. DISTRICT,NO "'}e� PROCESSE BY t'
-
I certify that,to the performance of the work for which this 14,AIR HANDLING UNIT,CFM__
fit :5'
,permit is-,issued, I shall,not employ,any person in ajny manner'
so as to become subject to the Workers' Compensation-Laws' BOILER BTU" s
i4PPROVALS s DATE INS4C, R'S SIGNATURE U
UJ ,
Date i Applicant COMPRESSOR,,BTUP ROUGH." ' ' ' e W
Z ,,
NOTICE TO APPLICANT: If after making this,Certificate of, - .VENTILATION SYSTEM ' ;
Exemption,- you should become subject ,to -the,-Workers' FI•NAL, '
Compensation provisions of the Labor Code, you must forth-' � ;� VAI°I DATION�!
with comply•with'suca provisions ot'this permit'shall be EVAPORATIVE COOLER_
deemed revoked. FURNACE FAU—X" GRAVI^7Y '
LICENSED CONTRACTORS`DECLARATION 1 FLOOR, BTU ��QC� �'_ 1 Q 00 -
I hereby affirm that I am licensed under provisions-of Chapter_ HEATER. -SUSPENDED -UNIT
9 (commencing with Section 7000)of'Division 3 of the Busi- WALL K e
ness-and Professions Code, and my'license is.in full force and
effect
License Number_110228_, Lic.Class C-20 ' n
Contractor Ei L. .PAYNE Date,,- 12-9-80
.1 am exempt from the licensing'requirements•as I am a `
licensed architect or a registered,professional engineer Plan Check fee of above. Ia -
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). 'PERMITASSUING FEE $
Lic or-Reg No. Date TOTAL FEE"
HOME OWN ER-BUILDER,DECLARATION PLAN CHECK APPLICANT --
I hereby affirm=that I. am exempf from, the Coptractor's- 'NAME -
License
NAME License Law foe.the following reason (Section 71331 5;-Busi-
ness
,• Busi-ness aria Professions Code) ADDRESS r �. �I; • ,, - �` ,
owner of the'- roperty, will do the work and the. i�' `` io- - �'
structure is not intended or offered'for'sale,(Section CITY^ TEL. NO, ^rte, : 39. A r
7044,Business and Professions-Code). -' - ^ .
I, as;owner of the property, 'am exclusively contracting OWNER - ��1'. an
Mrs• .H. Piggott ��
with licensed contractors to construct the, project MAIL , , ;' �"p, oto
(Section 7044, Business and Professions Code). _ ADDRESS ,52'34 N. GoTddenWeSt . ��' a ^' 2 it 7'�'.d
TEL�N � �. e O
CONSTRUCTION LENllING AGENCY CITY 9l
.o U
A hereby affirm that there is a construction lending agency j • r ? ""5 _" T 4
for tfie performance of the work for which this permit is CONTRACTOR s E._L.._PAYN.E=C�MPANY �• ` 1 1` "�
issued(Sec.3097,Ctv.0).
Lender's Name ADORES - _ - 166''W. Live TOak:Avenu'e -
-Lender's Address -'TEL NO. - 446=6.118 , � �. ,i f• 1` :r•
cl�v` A►dad iaa. _
I certify,that I have,read'this application and state that the STATE LIC:»'� - e �,, t'•� 3
above'mformation is correct.I agree to comply with all County LICENSE NO 1-2,0.228` '� ' CLASS_ C-20
ordinances and State laws regulating Heating, Ventilating and - -
Air Conditioning,••and hereby au t rize representatives of this SEE REVERSE 1'OR:EXPL`,ANATORY LANGUAGE
County nter upon the a', e-mentoned- ;roper
ns�ect', urpeses.
,nD
ature of Permittee ate