HomeMy Public PortalAbout10112 LYNROSE ST_Mechanical__ `-76 A364 - CE 81,8-1/75
AhPLICAYION FOR PERMIT F
HEATING -- VIENTILATING - AIR CONDITIONING
COUNTY OF LOS•ANGELES ADDRESS 10112 L nrose St
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY Temple City
NEAREST
CROSSST G1 ickman '
FOR APPLICANT TO FILL IN
(PRINT OR TYPE ONLY) OWNER Mr, and Mrs, D.+'Bechelder
MAI L
No TYPE&SIZE OF EQUIPMENT FEE ADDRESS 10112 L nrose St. "
SEE BACK OF APPLICATION
CITY Temp 1 e City TEL. NO. 4.47-1 797
1 FORCE AIR FURNACE, BTU 80-0-00 10 00
, CONTRACTOR E. L. PAYNE COMPANY
COMPRESSOR, BTU __1O,0_a0 10 00
ADDRESS 166 W— Live Oak
VENTILATION FAN
CITY _ Arcad la TEL. NO 446-6118
LIST ALL OTHERS BELOW STATE LICENSE NO. 120228 LIC C-20
CLASS
-, QI T NO" GROUP ZONE, PROCESSEDAY
INSPECTION RECO
d
O
U
O
H
U
W
Plan check fee. See reverse.
HNll1'_I1_S111\G VEI $' ]3 JRA
° TOTAI, F LI 27 00
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 SIGN URE Y
LATING, AIR CONDITIONING
ROUGH '
I HEREBY CERTIFY THAT I AM NOT ACTIN G• IN WA '
OF CHAPTER 9, DIVISION OF THE BUSINESS AND PRO SIGNAL FINAL
CODE OF THE STATE OF OOFORNIA '
SIGNATUREPERMIT VALIDATION CK M O CASH
OF PERMIT E
�&;
PLAN CH KwALIDATION CK-'' M 0 CASH
' �a-'e'��• � a4 ., �+-�.c�y✓''t • �j,CT-�Lf�►'� " G t:U C:J ego
)
erJy
1WORKERS'COMPENSATION DECLARATION APPUCAT ON FOR PERMPT
I-herdf'Plrm that I have a GertfSicoteafrconsent to self
Insure, or a certificate of Workers' Compensation Insurance,
or a certified copy thereof (Sec 3800, Lab C 76A364C HEATING - VENTILATING - AIS CONDITIONING)
CE-818(REV 10/81)
,Policy No Company
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 (PRINT OR TYPE ONLY) ADDRESS I D S
Date Applicant LOCALITY L /�
NO TYPE OF APPLIANCE OR EQUIPMENT FEE �_ C
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST I LJ
(This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO P OCESSE BV
the permit is for one hundred dollars (Sl or less:) AIR HANDLING UNIT, CFM
I certify that m the performance of ih wo for i this )
permit is issued,'I shall not employ an pe m a y anner
so as to become
subject to the Work r5 a p a n Laws BOILER, BTU AP ROV LS DATE INSPECTOR SIGNATURE
Date ?'-A a•-I1`� 'Applicant COMPRESSOR,"BTU ROUGH
NOTICE TO 'APPLICANT If, after kl C r i to of VENTILATION SYSTEM FINAL
Exemption, you should becom subject t t rkers' LJ
Compensation provisions of the Labor Code, y u st forth- EVAPORATIVE COOLER V LI I IV
with,comply with such provisions or this mit shall be
deemed revoked FURNACE FAU GRAVITY
-'LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED'' ' _ 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
(J o.
0
License Number Lic'Class D V
OC
Contractor % Date :1 WAC/ V
F] ,I am exempt under Sec LU
Plan check The N
B 8P C for this reason PERMIT ISSUING FEE $ Z
Date
Signature TOTAL FEE ;9 0 7&O A
OWNER-BUILDER DECLARATION P 1—
I hereby affirm that I am exempt from the Contractor's License D # e 'o o e 08
Law for the following reason (Section 7031 5, Business and NAME Z '
Professions Code) s a e'a
El 1, 8
I, as owner of the property, or my employees with ADDRESS C) �,
wages as their sole compensation,will do the work and / 9.2 8-8 8
the structure is not Intended or offered for sale(Section CITY P TEL N fr 6
7044, Business•and Professions Code) v
OWNER
El1, as owner of the property, am exclusively'contracting
with licensed contractors to construct the project (Sec- MAIL
tion 7044, Business and Professions Code) ADDRESS
CONSTRUCTION LENDING AGENCY CITY TEL NO
I hereby affirm that there Is a construction lending agency for
the performance of the work for which this permit Is issued CONTRACTOR t
(Sec 3097, Civ C )
ADDRESS•
Lender's Name
CITY TEL NO _
' Lender's Address '
I cer t t l have ihis-a lication and state that the STATE LIC -
y pp LICENSE NO -CLASS
ob a Info matron __Tc
o ect I agree to comply with all County
or no a and at s relating to building construction,
d h re au
t e rep sentatives of this County to enter
pon he bo entl d property for Inspection purposes - SEE REVERSE FOR,EXPLANATORY LANGUAGE
SI e of Ap hcd t gent Date