HomeMy Public PortalAbout6446 LIVIA AVE_Mechanical__ 76A364„�c�'..E818 •- 3-69 _ APPLICATION FOR- PERMIT l qq
�` HEATING - VENTILATING - AIR CONDITIONING !U
COUNTY OF LOS ANGELES BUILDING, 6446 Livia
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY.DIVISION•
JOHN A LAMBIE, COUNTY ENGINEER LOCALITY Temple City
COLEMAN W JENKINS,SUPERINTENDENT OF BUILDING NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER J. T. Prochaska
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS 6446 Livia
ABSORPTION SYSTEM, BTU CITY Temple City TEL. NO. 286-8332
CONTRACTOR Bryant Htg. & Air Cond. Inc.
AIR HANDLING UNIT, CFM
ADDRESS 1350 E. Las Tunas
BOILER, HORSEPOWER
CITY San Gabriel � 7 . No. 286-1141
1' COMPRESSOR, HORSEPOWER-3 13—t�n3 4 00 STATE LIC
LICENSE NO. 221751 CLASS C20
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE P OCESSED BY
EVAPORATIVE COOLER D
1 FURNACE' FAU G1R}1xIT600 5 00 y
FLOOR BTU 1((JJ -INSPECTION PECORD
HEATER* SUSPENDED UNIT �' dl
WALL }
rs
���11 1ti.C� ✓/ C
/ C
L:
' LL
2
NEW—ADDITION— PERMIT $ 3 00
3 oyt
ALTER_REPAIR_ TOTAL FEE $ 12 00
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL. NO. 2
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A (CATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO:COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATINGVENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CO ONING. l
IHEREBY RTIF T I M T CTING IN VIOLATION ROUGH
CHAPTER 9, IVISIO OF H B NESS AND PROFESSI L FINAL
CODE OF THE STAT 1` FO
SIGNATURE JACK R. ALLEN, SUPERVISING MECHANICAL ENG-R.
OF PERMITT
PERMIT VALIDATION cK. M.O. CASH
.
PLA"CK CK VALID I N
t ±;nom 0 5 ^ y ti JJIJ 3 4 1 D 1 2.0 0
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE /
WORKER'S COMPENSATION DECLARATION 20-0046 DPW.9/89 fr���yy/fr��,y�llll I�f�4 S�I(I� I� (� I�1f�f�I��I I�
PhereE 76A364C ALR_ ���� 9 ®HCl '0^®II ll •If LSlfllltlll� 8 '(•L�7�nt
l
hereby that I have �'certrficate of consent to self Insure, •,
ora certificate of Worke'r's Compensation Insurance, or a certified HEATING-VENTILATING -AIR'CONDITIONING
copy thereof(Sec 3800 Lab C
Policy No Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS I BUILDING AND SAFETY DIV.',-
Certified
IV.'Certified copy Is hereby furnished
❑ Certified copy is filed with the county budding inspection`, FOR APPLICANT TO FILL IN , BUIL SS
UILDING
department (PRINT OR TYPE ONLY) .
y
LOCALITY,'
Date Applicant'
NO TYPE OF APPLIANCE OR EQUIPMENT � 'FEE -
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
CROSS ST
COMPENSATION INSURANCE ABSORPTION UNIT,BTU
i• ASSESSOR. /�
(This section need not be completed If the work Involved by the MAP BOOK3?G, PAGE'elPARCEL
,permit Is for one hundred dollars($100)or.less.)• AIR HANDLING UNIT,CFMr
DISTRICT NO PROCESSED BY ,
I certify that-in the performance of the work for which this permit i
Is issued, I shall not employ any person in ahy manner so'as to BOILER,BTU
C91 op
become subject to the Workers'Compensation Laws I I ,
COMPRESSOR,BTU �/ &zry '
APPROVALS• DATE INSPEC S SIGNATURE
Date Applicant t VENTILATION SYSTEM ,w
NOTICE TO APPLICANT If, after making this Certificate of ROUGH, .
Exemption,you should become subject'to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code,-you must forthwith comply with such + - FINAL -
provisions or this permit shall be deemed revoked _ FURNACE FAU G VITY //
LICENSED CONTRACTORS DECLARATION FLOOR• BTU ,�' !� t ''VALIDATION'
I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT
(commencing with Section-7000] Of Division`3 of the Business and HEATER WALL
Professions Code,and my license is in full,force and effect / • _ ;
- , ' � •
License Number tic,Class :73303 -9
126' 3
;•'Ft T■a
Contractor Date
/� La o D „ a
❑ I Plan check fee , '3�f''5
I am exempt under Sec ,, "•• 3
B&P C for this reason _. ,PERMIT ISSUING FEE$ /�SGp ` 0
Date TOTAL FEE.' 1 ITEMS - LOU
Signature r w "1 I{'tA•.{. _ "1'26® 30 co
PLAN CHECK APPLICANT Z
OWNER-BUILDER DECLARATION - F - r.• �,UU >z it f 31, ':
I hereby affirm that I am exempt from the Contractor's License Law NAME GH 'k 1��.a
for the following reason (Section 7031.5, Business and Professions
Code 3'•
) ADDRESS ,r ` +. �) -.• t
❑ -I, as owner of the property,'or,my employees with wages
as their sole compensation, will do the work and the CITY, TEL NO 0�`0�`0�Ir i r ``
structure is not Intended or offered for sale (Section 7044, V3JVL�- 1 7/26/9
Business and Professions Code) OWNER A u -' `—' L925 s I ` Aid 9;I]`'
I; as owner of the property, am exclusively contracting MAIL
with licensed contractors to construct'the,project (Sec- ADDRESS
tion 7044, Business and Professions Code) ,
CONSTRUCTION LENDING AGENCY CITY TEL NO 2'I
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) _L -
ADDRESS '-
Lender's Name
CITY _ TEL,NO
Lender's Address STATE LIC
I certify that I have read this application and•state that the above LICENSE NO CLASS
information Is correct I agree to,comply with all County ordinances
and State laws relating to building construction,and hereby authorize - -
e sentatives of this County to enter upon the above-mentioned
p p ty�ol
SEE REVERSE FOR EXPLANATORY LANGUAGEATURE NT O AGENT 0 E