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Home My Public Portal About5954 KAUFFMAN AVE_Mechanical__ 76A364–CE818,t'-68 APPLICATION FOR PERMIT HEATING VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER fN UILDING BUILDING AND SAFETY DIVISION DDRESS !� JOHN A. LAMBIE, COUNTY ENGINEER -Zl 'c '�`� COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDINGOCALITY EARESTFOR APPLICANT TO FILL IN ROSS ST. Lt! (Print or type only) t FEE OWNER �?'LI NO.. TYPE,OFAPPLIANCE OR EQUIPMENT MAIL ADDRESS slur Q� ABSORPTION SYSTEM, BTU CITY TEL. NO. AIR HANDLING UNIT, CFM CONTRACTOR BOILER, HORSEPOWER ADDRESS COMPRESSOR, HORSEPOWE CITY S'GYN.. T L. NO.Z��r�(�b STATE /_ �^ LIC. �,�6 VENTILATION SYSTEM LICENSE NO. 6 CLASS G O DIST&UCT NO. GROUP ZONE PROC SED BY EVAPORATIVE COOLERC� �J FURNACE: FAU GRAVITY t�I fG �L FLOOR—BTU INSPECTION RECORD v HEATER: SUSPENDED UNIT WALL T" Z'c• � �-G, O U Lu _ cn NEW—ADDITION PERMIT $ 3 00 ALTER—REPAIR— TOTAL FEE $ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HEATING, VENTILATING, AIR CONDITIONING. I HEREBY CERTIFY THAT IQ"AM N T ACTING VIOLATION OF CHAPTER 9, DIVISION 3, OF, B AND OFE SS,ONAL CODE OF THE STATE OF CALIP,Q APPROVALS DATE INSPECTOR'S SIGNATURE SIGNATURE f ROUGH OF PERMITTEE FINAL / g.ID A TION JACK R. ALLEN M.O. CASH SUPERVISING MECHANICAL ENG'R. LA 635 S- SEP11 41 0 25150! SEE'SACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ION WOthat I have a certificate of consent to 76A346DPW9,69 APPLICATION FOR PERMIT LIME. GREEN 76A364C I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified HEATING -VENTILATING-AIR CONDITIONING copy thereof(Sec.3800 Lab.C.) � cy No. W C P 1 1 2 2 1 company S Ln e r i or COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished. Certified copy is filed with the count buildinginspection FOR APPLICANT TO FILL IN BUILDING department. y Ins p (PRINT OR TYPE ONLY) ADDRESS 5954 Kauffman Date Applicant LOCALITY Temple City NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS COMPENSATION INSURANCE ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed if the work involved by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO, PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU become subject to the Workers'Compensation Laws. �� /� COMPRESSOR,BTU r�o` f�T �� APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM `t NOTICE TO APPLICANT: If, after making this Certificate of 1 Q� ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. ` FURNACE: FAURAVITY LICENSED CONTRACTORS DECLARATION 1 FLOOR BTU (0O LM VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and HEATER: WALL Professions Code,and my license is in full force and effect. License Number 4 0 3 7 3 5 Lic.Class S C 2 0/C 3 8 IL Contractor W a y n e S . ConnOVate 4/30/93 O ❑ I am exempt under Sec. Plan Check fee cc B.&P.C.for this reason PERMIT ISSUING FEE$ 6TH U Date: TOTAL FEE LU Signature (n OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT Z I hereby affirm that I am exempt from the Contractor's License Law NAME for the following reason (Section 7031.5, Business and Professions Code): __?i.' _,L ❑ ADDRESS 1, as owner of the property, or my employees with wages i T as their sole compensation, will do the work and the CITY TEL.NO. �^-•�_ structure is not intended or offered for sale (Section 7044, j 52 . G__F0 ❑ Business and Professions Code). , OWNER I _T. C. Womens Club I, as owner of the property, am exclusively contracting MAIL with licensed contractors to construct the project (Sec- ADDRESS 5 9 5 4 Kauffman i;f j („ tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITY Temple Cit TEL.No. 287-2716 I hereby affirm that there is a construction lending agency for CONTRACTOR the performance of the work for which this permit Is issued Connor Air Conitioning , asi^q• ",; j;i (Sec.3097,Civ. C.). ADDRESS ° 4931 N. Encinita Ave . Lr_ i r rt� Lender's Name CITY Temple,,-'City TEL.No. 286-3157 Lender's Address STATE LIC. I certify that I have read this application and state that the above LICENSE NO. 4 0 3 7 3 5 CLASS S c 2 0 C 3 8 information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon the above-mentioned pr�finspection purposes. OltSEE REVERSE FOR EXPLANATORY LANGUAGE SIGNATURE OF APPLICANT OR AGENT ATE