HomeMy Public PortalAbout4840 KAUFFMAN AVE_Mechanical__ o
76A364E7 CE818B-9/75 �1 '16:66 -fl ft-ol� �I[
-VENTILATING - AIR CONDITIONING
BUILDING AND SAFETY DIVIS►ON-lz_
FOR APPLICANT TO FILL IN ADDR SNG S
(PRINT OR TYPE ONLY) ADDRESS ' - Kauffman Ave.
LOCALITY Temple City
No. TYPE OFAPPLIA.NCEOR EQUIPMENT .. FEE. NEAREST
CROSS ST. Lower.rAzusa.Rd.
ABSORPTION UNIT; BTU{
OWNER J. B. Weber
AIR HANDLING UNIT., CFM• MALL
ADDRESS
,r,9 eMple City"Blvd,
BOILER, BTU - -� CITYTEL. NO.
COMPRESSOR, BTU _Y✓ \ CONTRACTOR DaVld L Peacock Inc.
VENTILATION SYSTEM ADDRESS :124 .Wheeler
EVAPORATIVE COOLER CITY Arcadia TEL.-NO. L"-8752'"
FURNACE:•FAU GRAVIT STATE LIC.
FLOOR • BTU 5 LICENSE NO. 287502 CLASS C-20.
HEATER:. SUSPENDED-UNIT- DISTRICT NO. GROUP ZONE ESSED BY
WALL
INSPECTION RECORD F�-
LLJ
CL
Cn
Plan check fee 25% of above.
PERMIT ISSUING FEE
TOTAL FEE
PLAN CHECK APPLICANT �✓
NAME
ADDRESS
CITY TEL.NO.
1 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, VENT[- -
LATING, AIR CONDITIONING. - -
-! HEREBY -CERTIF..Y THAT I AM NOT ACTING IN VIOLATION - APPROVALS DATE" INSPECTOR'S SIGNATURE
OF CHAPTER 9, DIVI O 3, OF THE BUSINESS AND PROFESSIONAL -
CODE OF THE S.TA 7. OF AU FORNIA. - ROUGH .r
2-
SIGNATURE /1 _j/J r
-OF PERMI.TTE � .FINAL
PLAN CHECK VALIDATION PERMIT VA'.LI DA TI ON CK. '� M.O. CASH
CK. M.O. CASH
V,�
364
'WOR;1e&RS'COMPENSATION DECLARATION• CEA 8 8C(2=60) b= Ir- I� l� C AT�®1`YI 'FOR ' IC" Lam.R UVA T
I hereby affirm that I have a' certificate of consent to self
insure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-Al R CONDITIONING
ace, fifie,^2^�o�y-'.t�h�er7e�of/�c-c. 3800,T^h(.�G�.)�
Y��•y"No�rlCornpany_
U�, • 1 COUNTY OF LOS ANG LES r BUILDING AND SAFETY
tL ertified copy is hereby furnished.
Certified copy is filed with the county building inspection BUI ADDRESS
leoa tmem. i Ir�j FOR AP T OR-T T TO FILL IN ADDRESSy
Date.__%_1_.Applicant�\ ` :(PRINT OR TYPE ONLY) _
LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT ' FE
NEAREST
COMPENSATION INSURANCE
(This section need not he completed.if the work involved ASSORPTI'ON UNIT, BTU l,_ CROSS ST d
O'
by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. Paoct U
I certify that in the performance of the work for which this AI.R HANDLING UNIT,CFM
permit is issued;I shall not employ any person in any manner (1� G4 O
so as to become subject to the Workers' Compensation Laws. BOILER; BTU
APPROVALS DATE SPECTOR'SSIGN RE LU
Date Applicant' COMPRESSOR,"BTU ROUGH N
NOTICE TO APPLICANT: If, after making this Certificate ofVENTILATION SYSTEM z
Exemption, you should become subject to the Workers' FINAL
Compensation provisions of the Labor Code,you must forth- EVAPORATIVE COOLER VALIDATION
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR; BTU
I hereby affirm that I am licensed,under provisions of Chapter HEATER: SUSPENDED UNIT'
9 (commencing with Section 7000) of Division 3 of the Busi- WALL
ness and Profeminns Code, and my license is in full,force and
effect.
License Nu be 1i.ic.Class
Contracto `�_
1 am exempt from the licensing requirements as I am a
licensed'architect or a registered' professional engineer Plan check fee 25%Of above.
acting in.my professional capacity (Section 7051, Bus-
iness and Professions Code). PERMIT ISSUING FEE$
Lic.or Reg.No. date TOTAL FEE
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'Professions Code): ADDRESS` '
EI, :as owner of the property, will do the work and the TEL NO.
structure is not intended or offered for sale (Section CITY
7044, Business and Professions Code):
OWNERLIS
I, as owner of the property, am exclusively contracting �� z 2 0 3; 1. A.-
with licensed contractors to construct the project MAIL
(Section 7044,Business and Professions Code). ADDRES'5 __ _ _ '
`# o o'�'0 4 1•
CONSTRUCTION LENDING AGENCY CITY `C _ TEL.NO. ;
I hereby affirm that there is a'construction lending agency 2'9 o 2-700.
0.
for the performance of the work for which this permit is CONTRACTOR -- t. _
issued(Sec. 3097,Civ.C_).' a o 6 2 7,0 0.5
Lender's Name. ADDRES� F icevllt�65
Lender's Address CITy�_ — ►►7 EL.ND�J 9.O�J�:-$0
I certify that I have read this application'and state that the STATE LIC.-
above
IC•
above information is correct. I agree to comply with all County LICENSE NO. _ ty�- CLASS
ordinances and State laws regulating Heating, Ventilating and )-
Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
;ountyl to�1 r ter upon'.the above-mentioned property for
signature of Permittee Date