HomeMy Public PortalAbout10602 KEY WEST ST_Mechanical__ 7,-4.aSE 818-1/75 `
AP CATION FOR RMIT,
HEATING - VENTILATING - A R CONDITIONING
COUNTY OF LOS ANGELES. f
ILDING
DEPARTMENT OF COUNTY ENGINEER DRESS
BUILDING AND SAFETY DIVISION CALITY
Lo/10-lz
ARESOSS ST
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FOR APPLICANT TO,FILL IN
,OWNER
' -(PRINT'OR TYPE ONLY)
NO TYPE` SIZE OF MAIL
SEQUIPMENT' FEE ADDRESS'
_ > SEE BACK OF APPLICATION - /� ;Ve;r CITY � ��, [r' TEL' NOFORCE AIR FURNACE, BTUCONTRACTORCOMPRESSOR, BTU ADDRESS • D 7 VENTILATION FAN � C
CITY Q TEL:'NO a/�
LIST ALL OTHERS BELOW, STATE
LICENSE N 77 a-/ C ASS .3- 49 -
DISTRICT
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'-t I I T NO GROUP ZONE +PROCESSED BY '
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INSPECTION MCORD
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Plan check fee See reverse. z
Pb Fi111'I ISSiJINC F1'J s
'I OT 11,
PLAN CHECK APPLICANT � 7 us*
NAME
ADDRESS '
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CITY TEL NO
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALLORDINANCES AND LAW REGULA NG HEATING, VENT I- APPROVALS '' DATE INSPECTOR'S SIGNATURE
LATING AIR CONDITIONING „
ROUGH ✓ ✓� '
I HEREBY CERTIFY T T A ACTING IN VIOLATION
OF CHAPTER 9; DIVISION 0 THE, INES,1,AND PRO tSSIONAL FINAL
CODE OF THE STATE OF L OR
SIGNATURE PER IT VALIDATION' CK M 0 -CASH '
OF PERMITTEE
'PLAN CHECK VALID ION VKMD
CASH
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WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT
I hereby affirm thdle'I hava certificate of consent to self ,
insure, or a certificate of Workers' Compensation Insurance, HEATING - VENTIL•ATING - AIR CONDITIONING
or a certified copy thereof (Sec 3800, Lab C ) 76A364C _
620857-8A:ompany P•State Com CE-818'(REV 10/81)
Policy No -
Certified copy is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING
tion department ADDRESS 10602 E. Key West St.
9,/22/87 San Marino.P16 (PRINT OR TYPE ONLY)
Date Applicant g• LOCALITY Temple Cit
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST
(This section need not be completed If the work Involved by ABSORPTION UNIT, BTU DISTRICT NO PROCESSED BY
the permit is for one hundred dollars ($100)or less.)
AIR HANDLING UNIT, CFM
I�certify that in the performance of the work for which this - _ _ va
`permit is issued, I shall not employ any person in any manner BOILER, BTU
,/
so as to become subject to the Workers'Compensation Laws APPROVALS DATE INP TOR S SIGNATURE
Date Applicant COMPRESSOR, BTU ROUGH
NOTICE TO APPLICANT If, after making this Certificate of VENTILATION SYSTEM FINAL
Exemption, you should become subject to The Workers',
Compensatiori provisions of the Labor Code, you must forth- EVAPORATIVE COOLER I O
with comply with such provisions or this permit-shall be
deemed revoked t FURNACEFAU C,g VI Y
, LICENSED CONTRACTORS DECLARATION FLOOR 1 BTU j�.UGT 10 00 �J
I hereby affirm that I am-licensed under provisions of Chapter 9 SUSPENDED—UNIT—
(commencing-
USPENDED UNIT(commencing-with Section 7000)-of Division 3 of the Business HEATER WALL
and Professions Code, and my license is in full force and effect =-
License Number 452357 Lic Class C20/C36 __ __ - v
Contractor
San Marino Plbgcate 9/22/87 j p
II-
❑ I am exempt under Sec W
Plan check fee 7 9 $A h
B &P C for this reason PERMIT ISSUING FEE10 Z
/ Date # e e o • • 8
Signature
TOTAL FEE 20 150 ,o°0 2 Q 5,0
- OW ER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor's License o • • 2 0,5 0 5
Law for the followLng reason (Section 7031 5, Business and NAME ,
Professions Code)
❑ 9,2`�I, as owner of the property, or my employees with ADDRESS `-8 7
wages as their sole compensation,will do the work drill CITY TEL NO
the structure is not Intended or offefed for sale(Section
704 Business and Professions Code) I I - I • „
❑ I, as owner of,the property; OWNER John Robinson am exclusively contracting ,
with licensed contractors to construct the project (Sec- MAILr
tion 7044, Business and Professions Code) ADDRESS 10602 E. Ke West St.
CONSTRUCTION LENDING AGENCY CITY TEL NO
I hereby affirm that there is a construction lending agency for Temple Cit — -
66
the performance of the work for which this permit is issued CONTRACTOR
(Sec 3097, Civ C ) San Marino Plumbing Service _
: r
Lender's Name ADDRESS 1465 San Marino Ave-., ' - -
Lender's Address CITY San Marino _TEL NO 796-7116 -
STATE LIC
I certify that I have read this application and state that the I LICENSE NO 452357 CLASS C20/06 r -
above information is correct I agree to comply with all County
ordinances and State jaws relating to building construction,
and hereby authorize representatives of this County to enter `
upon the ed property fo inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
9/22/87
Signature of Applicant or Agent Date _ `-