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Home My Public Portal About10105 GREEN ST_Mechanical__ 76A4354-Cee1e-1/70 APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING couNTY QF LOS ANGELES ADIDRFQS 10105 Green St. DEPARTMENT F COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY Ie cit JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUFIIRINTIENDIRNT OF BUILDINGI NEAREST CROSS ST. FOR APPLICANT TO FILL IN OHhIER George Booth (PRINT OR TYPE ONLY) MAIL NO. YPEOFAPPLIANCE.OR_ EQUIPMENTFEE ADDRESS '10105 Green St.- T4411 EL-Temple City TEL NO, 443:7575 ABSORPTION SYSTEM, BTU CONTRACTOR Global Comfort S stems AIR HANDLING UNIT, CFM ADDRESS 9852 Alpaca St. BOILER, HORSEPOWER CITY S. El Monte TEL. No. 444-4779 COMPRESSOR,-HORSEPOWER— 5 © STATEisE NO. 277580 aA% C-20 LICEVENTILATION SYSTEM DISTRICT NO.- EVAPORATIVE CdOLER /0 FURNACE: FA _GRA1(}�j 5 0 INSPH N RECORD FLOOR BTU ��SSVVPP1l HEATEFi: .SUSPENDED UNIT_ <' WALL 8 CY I � I NEW—ADDITION— PERMIT $ 3 .DO ALTER_REPAIR— TOTAL FEE s FLAN CHECK APPLICANT NAME ADDRESS LPITH TEL.NO. ESY ACKNOWLEDSE THAT I HAVE READ THIS AFr LICATH)N r TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY . L ORDINANCES AND LAWS R TING HEATING, VENT[- Ar PROYALS D [ SHrE TOR'S SIGNATURIL IR CONDITIONING. ROUGH REBY 'CtRTIF}}'' THAT I AM MOT ACTING IN VIOLATIONTER D,.DIVIBIbN 3", OF 61 S AND r110FESSIOIUL FINAL THE STAT[ 0 ]A. URE JACK R. ALLEN,SUPERVISI-NO MECHANICAL ENG'R, MITTEE PERMIT VALIDATION CE—: .O. CASH PLAN CHECK VALI TION Af' 0 8' 0 X73 AM 26- 4 1 0 1 3.0 0, co SEE BACK OF APPLICAT"FOR CSM rL[TE FEE SCHEDULE -. -A—--`WORKERS'COMPENSATION DECLARATION APPLICATION FOR P E RM I T I hereby trffkm that J have a certificate of consent to self Insure, os a cettFFJcate of Workers' Compensation Insurance, HEATING VENTILATING - AIR CONDITIONING or a-certified copy thereof (Sec. 3900, Lab. C.) 76A.'i64C 'a-918(REV. 10/21) Policy Nor Company ❑. Certified copy Is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑, Certtfled copy Is filed with the county building Irspec- FOR APPLICANT TO FILL IN BUILDING tion department. r 1 (PRINT OR TYPE ONLY) ADDRESS 1 LOCAllTY Date APP IlcnnT NO. TYPE OF APPLIANCE OR CQUIPMBNi FEE � - CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATIONINSURANCE CROSS a a (This secHon need not be completed If th•work Invo#ved by ABSOkPFION UNIT, BTU DISTR KT NO. PRO(ESIPD BY the permit is for one hundred dollars (=100}or less.) - K:,-- l J(� I certify that In the performance of the work for which this AIR HANDLING UNIT,CFM lJ permit Is Issued, l shall not employ any rson In any nnor BTU APPROVALS DATEstowrurtf so arsto become w�lect to The Worke peniatl Laws. Date Ilcant COMPRE5SCA' BTU C! ROUGH ✓ NOTICE O PLICANT:'If, lifter making this Certificate of VWnLATK)N SYSTEM FINAL Exemption, you should become subject to the Workers Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER ALIDATI with comply with such provisions or this permit shall be deemed revoked. FURNACE: FAU GL24VhY JI 1 LICENSED CONTRACTORS DECLARATION FLOOR BTU (J(/ I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDC5 UNrf' '(corriMehdng with Section 7000) of Division 3 of the Business W and Profen#low Code,and my license Js In full force and effect. IL �1 O License Number Llc. Class - V Contractor Date ❑ I am exer'npt under Sec Plan check fee IUL B:BP.C. for this reason 0 8 9 Z 3 A PERMIT ISSUING FEE # Date: # e's o • • 8 _ TOTAL FEE Signature •s. .� o 037.50 OWNER-BUILDER DECLARATION PLAN CHK A�IICANT r I hereby affirm that I am exempt from the Contrdctor's License , ° • - 37.50 6 Law for the following reason (Section 7031.5, Business and NAME Professions Code): ❑ 1, as owner of the property, or my employees with ADDRESS ebu 8 8 wages as their sole compensation,will do the work andTEL the structure Is not Intended or offered for sale(Sectlan 7044, Business and Professions Code).. 01NNFJR I, as owner of the property, am exclusively contra ctlnp with licensed contractors to construct the project (Sec MAIL tion 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY qTY TEL NO. I hereby affirm that there Is a construction lending agency for , the performance of the work for which this permit Is Issued CONTRACTOR (Sec. 3097, Civ. C.). - . ADDRESS Lender's Narpe CITY TEL NO. - - Lender's Address ATE LIC_ I certify that 1 have read this applicatloh and state that the LICENSE NO. CLASS bove Information Is corre . I agree to comply with all County o Inances and State.I relating to building construction, here au rize re rose tives of this County to enter po v endo pr. erty for Ins Ion p SEE REVERSE FOR EXPLANATORY LANGUAGE gnvtur•of Appllmnt or Agent - .