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Home My Public Portal About9651 LA ROSA DR_Mechanical__ 76A364-�CES16 -1/70 APPLIC�T'19N FOR P IT HEATING - VENTILATING - AI IT _ COUNTY OF LOS ANGELES BUILDING9651 La Rosa-Dr. DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY Temple Cit JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS. SUPERINTENDENT OF BUILDING NEAREST CROSSST. Camellia FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) Kitchell MAIL NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADORESS 3310 Florecita Dr. ABSORPTION SYSTEM, BTU CITY Altadena TEL. NO. 798-1076 AIR HANDLING UNIT, CFM CONTRACTOR Owen Bros. PlumbinInc* ADDRESS 4265 No. Baldwin Ave. BOILER, HORSEPOWER CITY El Monte 9173 1 TEL. NO. -00 g COMPRESSOR, HORSEPOWER STATE LIC. LICENSE NO, 231741 CLASS C36-20 VENTILATION SYSTEM DISTRICT NO. CLASS I GRROOUP ZONE CfSSEO BY EVAPORATIVE COOLER 6,0 / i1 1 FURNACE: FAUGRAVITY y FLOOR BTU INSPECTION RECORD HEATER: SUSPENgE[._UNIT WALLS+IJIJU 1O. O a d 0 U _ C O N U W d NEW —ADDITION— PERMIT $ 3 00 Z ALTER—REPAIR— TOTAL FEE $ /� Q 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 LAT ING, AIR CONDITIONING. ROUGH HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF CHAPTER 9, DIVIS 3, THE BUSINESS AND PROFESSIONAL FINAL � � CODE OF THE STATE F L FO NIA. SIGNATURE JACK R. ALLEN,SUPERVCHANICAL ENG.R. OF PERMITTEE PERMIT V (DATION CK. M.O. CASH PLAN CHECK 'VALIDATION z :t a.:=� �N 4 UUU a 1 3.0 v SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE DEC TION Worm that have COMPENSATION cafe of corse APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, -CE 76A364C 818(REV. ID/ell HEATING - VENTILATING - AIR CONDITIONING or a certified copy thereof (Sec. 3800, Lab. C.)) /J - ' Policy NO.`<Zs3�11 Company -cfX/ff dirt" Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY 3--'Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING ,LL tion department. (PRINT OR TYPE ONLY) ADDRESS L mq d/L Date 16-28 _S7 Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY q0 /Y' CERTIFICATE OF EXEMPTION FROM W RKERS' NEAREST C.- COMPENSATION INSURANCE CROSS ST. . P (This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NOROCESSED BY the permit Is for one hundred dollars ($100)or less.) I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM c o permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws, BOILER, BTU �y APPROVALS DATE w _Eci SIG ATURE 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' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATI 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 9HEATER: SUSPENDED UNIT_'(commencing with Section 7000) of Division 3 of the Business WALL and Professions Code, and my license is in full force and effect. y 6 License Number t2r' r�Lic. Class CTZAO , U Contractor Date GG-2tF;-f37 FO ❑ I am exempt under Sec. _, - W Plan check fee H B.BP.C. for this reason PERMIT ISSUING FEE $ b J�� Z Date: Signature TOTAL FEE -28 5 7, 8 A OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT 1 hereby affirm that I am exempt from the Contractor's License , # • 0 .,• Law for the following reason (Section 7031.5, Business and NAME Professions Code): ( o -'4 Q,O O ❑ I, as owner of the property, or my employees with 'ADDRESS ' wages as their sole compensation,will do the work and o e,e_4 a O 0� the structure is not intended or offered for sole(Section CITY TEL. NO. - 7044, Business and Professions Code). OWNER �p� ( 2:1 4d 8 7 ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- MAIL L1� tion 7044, Business and Professions Code). ADDRESS - CONSTRUCTION LENDING AGENCY OTY/7 �� TEL NO.�$ ��2 Ld I hereby affirm that there is a construction lending agency for = , the performance of the work for which this permit is issued CONTRACTOR (Sec. 3097, Civ. C.). • ' d' Lender's Name ADDRESS w 'Tw CITY LU TEL. NO. 7_ Lender's Address ' TATE LIC. certify that S have read this application and state that the LICENSE NO. �p� CLASS if�Z.. above 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 uIft the above- entioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE !D.2a 8'7 Signature of Appl item or Agent Date ' `� VVORKER�%COMPENSATION DECLARATION f I hereat' affirm that I hove a certificate of consent to self APPLICATION FOR PERMIT insure', or a certificate of Workers' Compensation Insurance, 7b436aC HEATING - VENTILATING - AIR CONDITIONING or a certified coppy7 thereof (Sec. 3800, Lab. C. CE-818(REV. 10/81) Policy No.�(�t �ompaS \A2 Vv.,N� 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 bJ 1 q p tion department. ADDRESS L 1� 0 (PRINT OR TYPE ONLY)' Date�F-21'T� 1 Applicant QNY LOCALITY T2 YY, �� C 1.\}`. NO. TYPE OF APPLIANCE OR EQUIPMENT FEE \ CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST C-\ COMPENSATION INSURANCE CROSS ST. (This section need not be completed if the work Involved by ABSORPTION UNIT, BTU DISTRICT NO. PRo ESSED BY the permit is for one hundred dollars ($100)or less.) I certify that in the performance of the work for which this AIR HANDLING UNIT, CFM G� permit is issued, I shall not employ any person in any monner BTU v so as to become subject to the Workers'Compensation Laws. BOILER, APPROVALS DATE IN PE DR'S SIGNATU Date Applicant COMPRESSOR, BTU ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL i Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATIO with comply with such provisions or this permit shall be deemed revoked. FURNACE: FAU I GRAVITY `1Q LICENSED CONTRACTORS DECLARATION I FLOOR BTU -15 100D U (l I hereby affirm that I am licensed under provisions of Chapter 9HEATER: SUSPENDED UNIT_ L (commencing with Section 7000) of Division 3 of the Business WAL ' and Professions Code,and my license is in full force and effect. } nn++ Q d License Number s7tl f� /' y,Lic Class l0/ `s�`OhS\ �. �rl ► 7 7 9.6 A W Contractor�QV`��a'V` Dote �\ 0 I am exempt under Sec. W Plan check fee 'l e'e 2 0.5 0 a B.BP.C. for this reason' PERMIT ISSUING FEES SU s Z v Date: �• e,e 'Z0,505 Signature - I TOTAL FEE S OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT O 3 .� 8 7 I hereby affirm that I am exempt from the Contractors License , Low for the following reason (Section 7031.5, Business and NAME Professions Code): ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section CITY TEL, NO. 7044, Business and Professions Code). OWNER � e U V ❑ I, as owner of the property, am exclusively contracting 1 with licensed contractors to construct the project (Sec- MAIL tion 7044, Business and Professions Code). ADDRESS 165` III— CONSTRUCTION CONSTRUCTION LENDING AGENCY CITY \ TEL. NO. 0 �L 1� I hereby affirm that there is a construction lending agency for �Em \� ��"C 2'" .- the performance of the work for which this permit is issued CONTRACTOR �Qr C C ► (Sec. 3097, Civ. C.). ADDRESS , O \Q 6\vJ Lender's Name Q�L 1 Q�ry Q CITY Lender's Address 1 p(� v STATE Z b O D . I certify that I have read this application and state that the LICENSE NO CILICAvo— above 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 u n the above-m m,a ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Z1-2\` 11 I Sigt re of Ap scant or Agen Date