HomeMy Public PortalAbout5011 HELEO AVE_Mechanical__ TB ARBA - EE BIB.- B-T' APPLICATION FOPE MIT
HEATING - VENTILATING - AIR CON0140NING
COUNTY OF LOS ANGELES ADDRESS OZ
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY Temple City
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER John Marshall Const Co.
(PRINT OR TYPE ONLY)
NO. TYPEOFAPPLIANCE OR EQUIPMENT FEE
ADDRESS 26 Temple City Blvd.
ABSORPTION UNIT, BTU cITYTemple City TEL. NO. 2$699$22
CONTRACTOR O A PO n t
AIR HANDLING UNIT, CFM ADDRESS BOX 3067
BOILER, BTU CITY Pasadena 911031EL. NO. 792-2177
COMPRESSOR, BTUSTATE 220$62 LIC. C20
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GRouP HE ssso er
EVAPORATIVE COOLER U p 1
POLC_
FURNACE: FAU IL GRq,V66k-- C. 0 INSPECTION RECORD cD
1 FLOOR BTU 1IJ J
HEATER: SUSPENDED_UNIT
WALL W
d
Z
Plan check fee 2S% Of above. See reverse.
PERMIT ISSUING 14'Ei; c 3 OD
'1.0TA I.. 1'EE 81. 00
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 ORDINANCESAND LAWS REGULATING HEATING. VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING.
ROUGH 10.,IC�'7C ery) ray pA -
HEREBY CERTIiY HAT AM NO ACTING IN VIOLATION F -
OF CNAP CHAPTER 9, OIVI5101 3. OF THE B ESS ND PROFESSIONAL FINAL ��i7�
CODE
OF THE STATE OF C LIFO 11
SIGNATURE ✓ PERMIT VALIDATION c M.D. CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.D. CASH
x
3.
619'P UG 28 4 1 0 8.0 0 A96
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORK, ILS (O:dPFN5ATiON DIX LARATION 76A364C
1 hereby. affirm that I have d certificate of consent to self CE -818(2.80) APPLICATION FOR PERMIT
insure, or a certif!:ate of Workers'COmpensation Insurance,of HEATING-VENTILATING-AIR CONDITIONING
a certified copy thereof(Sec.3800,Lab.C.)
Policy No. Company -
❑ CertlRCOUNTY OF LOS ANGELES
cd .ops is hereby furnished. BUILDING AND SAFETY
❑ Certified copy is filed with the county building inspection
department. FOR APPLICANT TO FILL IN BUILDING
',SOS/ e%b
C'
Date Applicant (PRTOPE ONLY)
LRTIFIGUE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE
LOCALITY OR EQUIPMENT FEE
COMPENSATION INSURANCE NEAREST
(This section need not be completed if the work involvedABSORPTION UNIT. BTU— CROSS ST. h/',>- U.1 d
by the permit is for one hundred dollars (SI00) or less.) DISTRICT NO. PRO"5SED a` V
1 certify thit in the perform Ince of the work for which this AIR HANDLING UNIT,CFM
permit is issued, 1 shall not empl, any person in any manner
so as to become subject to the d'o kers' r, npensaiion Laws. BOILER, BTU
nr 42-A
`y� APPROVALS DATE INSPECTOR'S SIGNATb..c U
UatGJ G(J z.� Applicant_ COMPRESSORBTU CL
,
ROUGH
NOTIC•L TO APPLICANT'. 14 after making this Certificate ofVENTILATION SYSTEM FINAL 0)
Exemption, you should become %object to the Workers' _
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION
with comply with such provi;ioru or this permit shall be /n1 �y
decreed rewired. FURNACE: FAU_ GRAVITY - ///`Oj/�.�✓
LICENSED(ONTR ACTORS I IICLARATION FLOOR: BTU
I hercl•1 aftum that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT
9 (cnarmcroinP with Section 7000) of Division 3 of the Busi- WALL
ness and Proft.sions Code. and my license is in full force and n r v
License Numbcr,l992 5Z Lie. Class_IV'1
Contractor____ Date
❑ I am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer Plan Check fee 25%of ab( B.
acting in m)• profe, onal capacity (Section 7051. Bus-
loess and Protessiuns Code). PERMIT ISSUING FEES �(>(/
Lie.or Reg. No.___ _Date TOTAL FEE
HOkIF OWNFR BI!ILDFR DECLARATION PLAN CHECK APPLICANT X14'0 Q 9 A
1 hereby affirm that 1 am exempt from the Contractor's NAME #I-'o a e e 8
License Law for file following reason (Section 7031.5, Busi-
ness and Nntcssions Cod,)- ADDRESS 2'-!- 3 3.5
E30
1, as owner oCITY f the property. will do the work and the TEL. NO.structure is .of Intended or offered for sale (Section eye a 3350'0_
7044, Business and Professions Code).
OWNER �- C (j YeO Ly2 .
I, as owner of lb. property', am exclusively contracting /N_y/f ��'� � fJ,2 O;82
with licensed contractors to construct file project MAIL
(Section 7044. Business and Prolessions Code). ADDRESS ISO" }}
-
CONSTRUrTIONLENDINGAGENCY CITY �� � Cg �y TEL.NO.,236--1J1y
I hereby affirm that thane is a construction lending agency' ✓��,/ n
for the-performance of the work for which this permit is CONTRACTOR o5'rl YC o$tS' r
issued(Sec.3097.Civ.C.).
Lender's Name_ ADDRESS
��--yy Z7 �i i ��Lr� 9.r,� It
Lender's AddresscITY fl05. . TE L.N0.aa6 Jypi.
I certify that i hale read this application and state that the STATE VVI` Gy �yy LIC. /
_abose information is LOVITO. I agree to comply with all County LICENSE NO. 3 l J / �'2— CLASS
ordinances and State laws regulating Heating, Ventilating and
Ayr Conditi- Ig. and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County 'a r [er a 0' the above mentioned property for
inspectil n PI,,uses. _
/e4^—�J�
Signature of Permittee Dare
3,