The URL can be used to link to this page

Home My Public Portal About6242 HART AVE_Mechanical__ 76'-A 364 - C.1= 818 - 9-71 �AL ION PERHflIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING -� DEPARTMENT OF COUNTY ENGINEER ADDRESS AV- BUILDING AND SAFETY DIVISION LOCALITY age Ive- NEAREST CROSS ST. FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) MAIL NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS CITY TEL. NO. ABSORPTION UNIT, BTU CONTRACTOR AIR HANDLING UNIT, CFM ADDRESS BOILER, BTU CITY TEL. NO. `2 COMPRESSOR, BTU STATE LIC LICENSE NO. 7�� CL ASS VENTILATION SYSTEM DISTRICT NO. GROUP ZONE -PRO ED ev EVAPORATIVE COOLER to y FURNACE: FAUGRAVITY �J INSPECTION RECORD FLOOR-- BTU HEATER: SUSPEND UNIT_ ^U O WALL (� Lu 00 N z Plan check fee 25% of above. See reverse. PERIMIT ISSUING FEF. S 3 00 TOTAL. FEE d PLAN CHECK APPLICANT NAME ADDRESS 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- APPROVALS DATE INSPECTOR'S SIGNATURE LATING, AIR CONDITIONING. ROUGH r " I HEREBY CERTIFY AT I NOT AC ING IN O ATION OF CHAPTER 9, DIVISIO OF E BUSINE NO PR etIONAL FINAL �� 924 - CODE OF THE STATE OF IFO IA. SIGNATURE PERMIT VAL DATION CK. M.O. CASH OF PERMITTEE PLAN CHECK VALIDATION CK. M.d. CASH E 335 '3 SES -4 41 D SEE BACK OF APPLICATION FOR COM PLETE FEE SCHEDULE �j�p p WORKERS'COMPENSATION DECLARATION CEA 818(2-80)- - A If— If—:L�,U��'�II V 1f� �u If\S '�UIS llVU,ll� _. I hereby affirm that' I have a' certificate-of consent to self insure, or a certificate of•Workers'Compensation,Insurance,or z C a certified copy thereof(See.3800,Lab.C.) C�IEATIWC's-VENTILATING-AIR ONDITIONING. : - W.P8.113HQ4" Fremont Indemnity Polley ,vy. �ompauy - - _ � C� - C0�3I�TV OF LOS ANGELES. ` BUILDI`N "AN D SAFETY 0 Certified copy is:hereb_y furnished. _, .- • .; - ".• ,- - X Certified copy is.filed with the county building inspection BUILDING department: F _ OR APPLICANT TO FILL IN 'OR TYPE ONLY)' 62-4-2—Har ADDRESS- (PRINT ; .' . Applicant 6242 Hart, CERTIFICATE O NO: TYPE OF APPLIANCE OR EQUIPMENT FEE ' Temple City LOCALITY Date F EXEMPTION FROM WORKERS' 'COMPENSATION-INSURANCE NEAREST } (This, section need'-:itot •be completed if,the work involved ABSORPTION UNIT,,BTU _ p, 'CROSS ST by-the permit is 'for one Hundred.dollars ($100) or less:) bSTRMTNO. PROCEssEo r U. I certify that in•the performance.of the work forw.ich this AIR HANDLiNG'UNIT CFM 0(� �` cc I 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 INSPECTOR'S SIGNn URE U 1.. 15 00: Date—'Apptscant :z COMPRESSOR,BTU N. ROUGH Exemption, you should bei after making this Certificate of - VENTILATION SYSTEM / Z NOTICE'TO APPLICANT If ^” _ come subject to the Workers' Compensation provisions of•fhe Labor Code you must forth- EVAPORATIVE COOLER.' FINAL VALIDATION f NA q,d ` with comply with such provrslons','or, this permit, shall be (/f :!. deemed revoked 1 c1R01OM Y FURNACE: F.,AU^ X LICENSED CONTRACTORS"DECCARATION" FLOOR: t3TU 1S 00 - LICENSED hereby affirm that'l a`m licensed underpiovisions-of Chapter HEATER: SUSPENDED - UNI-T 9 (commencing with Section 7000)of Division 3'of.the'Busi- WALL . ness and Professions Code; and my license is in full force and z effect. = ''Lie' 'Nurnbe�221J51 ;� :'Lic.`Class'`C-2 C 4, Contractor__ 2, f Date xJ " a I am'exempt from the licensing reyuirements'as I am a~' licensed architect of -,a registered,professional engineer• ;Plan cheek4ee 25%'of above., acting-'in my, professional capacity'(Section 7051, Bus-" iness'and Professions Code),,, ' PERMIT,ISSUING.FEE'S 8 0. Lic.or Reg.No. _ Date TOTAL FE:E . 38 50 HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I ,am,'exempt from- the Contractor's NAME License Law for the following reason (Section 7031•,-,5, Busi- ness and Profession's`Code);:. " ADDRESS' .. I as owner of the property,�v✓il] do"the work-and-the: TEL. NO ' CITY structure is noC intended or-offered' :for sale (Section �ftl 0 0 A 7044, Business and.Piofessions Code).' r OWNER I,,as owner of the,property, arr 'exclusively-" coritractin•g DOna.l.d W.—ThoIIIp_S-OTl ' # 01 a o o 0"8 project MAIL with licensed, co=ntract'ors fo„construct thep ) ; , � a (Section 7044, Business and Professions Code), ADDRESS .6242 `dart �,e CONSTRUCTION LENDING AGENCY CITY TEL NO. 9 i I hereby:.affirm that there is a'construction lending,agency T-empl- :City -32--4130 for the of the,Work.for which•this permit'is CONTRACTORBT ant Heat.. 8c A/C j # for y �f�:�.7 ed:(Sec.-3097,Civ.C.). ! Lender's Name, ADDRESS 1350 - E. Las Tunas. Dr*. Lender's address CITYSan Gabriel nnnffL.No.286-1141'> I certify,that I have read this application and state that the STATE 221751 LIC. C20 .above information is correct. I agree to comply with all County' LICENSE NO. CLASS ordi es and State laws re ulating Heating, Ventilating and Ai Con it` b, a d .� y uthorize representatives of this - SEE REVERSE FOR EXPLANATORY LANGUAGE C)unty o a to pr.1 a above-mentioned property for ir-p t'o i ature of Permittee Date __ l` to o, 76A364C WQ� KER'_"..COMPENSATION DECLARATION' 0 nI�p n Tj (gip I� n �/� CE-81.8 (2-80) A I� U` Imo.��1r1 U II.CIO•U�S If� •If�S'UVU�� I herebyffirm tt>iat I have a certificate of•-consent to self;c insure,,or a certific to of Workers'Comps sation Insurance,of a certified copy thereof(Sec. 3800,Lar • • ,- ',C•'9(EL��IWG-!!(��Y'IL��,I�G-�1IV@ C�G�I�IY'1®G�)01�'IQ"s Policy No Company ' COUNTY O LOS ANGEL S' WILDING AND',SAIFETY Q.Certified copy is hereby,,£,nished. - " �.- •, � - � �. l'' t/l Certified copy is filed with the coup •b;" Jing inspection � BUiLD1NG Daf _3 0= ADDRESS enactment. OR APPLICANT TO FILL IN (PRINT GR TYPE ONLY)' - -- Ap01ican' — _, • - FEE LOCALITY` , CERTIFICATE OF EXEM'PTIONYROM"WORKERS NO". TY-PE OF APPLIANCE OR"EQUIPMENT — COMPENSATION INSURANCE, I CEA }. (This section.need not be completed if the,'work`nvplved :, ' ., ABSORPTION UNIT, BTU�)_ � R REST _- ROSS ST DISTRICT NO.; ,'. _ P �11 'U by 'the permit is for one"hundred dollars,($100)'or less) ao s I certify that in the performance of',the work,for which this , A1Fi HANDLNG UNIT,CFM ' permit is issued; I shall not,employ any person in any manner' _-. tr so a to become subject'°toahe Workers' Cptnpensatlon Laws. BOhLER;°BTU' ` �. - APPROVALS' DATE TDR`S'SIGNATItr� �U• Date- Applicant COMPRESSOR, BTU' :; aw NOTICE TO APPLIC,A T!'If; after making this Certificate of VENTiLATI:ON SYSTEM �`�� — Z e. — FINAL Exemption, you should become subject to' the Wor'kers'- ., - Compensation provisions of the Labor Code, you must forth- with. comply with �su'ch provisions or this permit shall be EVAPORATIVE COOLER. gL,I>pgTiON , deemed revoked. FURNACE;., ;FAU_ /�G, RAVITY I j 'LICENSED;CONTRACTORS DECLARATION. , .� ,; FLOOR Thereby•affirm that I am`licensed`under provisions of Chapter,'- - H'EATER': SU$P.ENDED r UNIT• 9 (commencing with Se.ctiori 7000)`of Division;3 of the Busi, 'WALL - n,ess and Professions Code, and my license'is in full force and, ° effect: q�/�s'�y�� License Number�T_i�`�4rs Lie.Class_ " �''�� • Contract Date 1.am,exempt from the licensing requirements as I a`tii a� - I , licensed .architect.,or a:.registered pro.fessional'`cngineer Plan check fee 25%•of.above. acting.in my'professional-capacity;(Section 7051 Bus-;' mess and Professions Code) f' PER S$WING FEE$ Lie.or Reg::No. Date TOTALTEE 'HOME OWNER-BUILDER DECLARATION, OLAIN CHECK APPLICANT a•2 I hereby affirm 'that I,.arrf exempt from-.the Contractor's`. NAME _• 0�4 License Zaw'for.the following,'reasoti (Section'7031;5, Busi-` _ : , l�6�I� # e oto 0 08 Y,, ness and:Professions Code): ADDRESS t*. , F] 1, as owner, of•the property; will-do the work'and the.' CITY EL'.TEtt'NO, 0 2 0 0 2:7,'o t� structure is.,not intended'or.offered for sale`(Section. CIT Gt`p� =• . ,!�V� o o to 7044;Busmes"s and.Professions.Code) ' j ] . 2�7 Q++O 'I,•as owner of the property; am exclusively..contracting:; OWN ( ' S NER with licensed' contractors to construct the,; project N14IL ADDRESS, (Section 7644, Business and Professions Code).: , J�d I, hereby ,affirm that there is a construction AGENCY . CITYlC�� iEL NO, �>6� CONSTRUCTION.LENDING lending agency �w for the performance,of the,work for which this permit Is CONTRACTOR issued-(Sec:3097,C`iv.C.)• ,- •. •_/' Q� < Lender's Name ADDRESS /o w/�Sa�t�g /Sten Lender's Address CITY ,TEL. NO 3 Lob I certify.that I have read this application and state that the STATE " LIC. Q" above information is correct:I,agree-to comply with all County LICENSE NO. ' �OZlo CLASS !7. ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter 1pon .ne above-mentioned property for illsqzoeeLion purpo s. , 2 8iP ture of Permittee Da%t! g �