HomeMy Public PortalAbout9855 MILOANN ST_Mechanical__ 76 A364- CE B 16-1/75
APPL�ICATIGOR RMIT
HEATI'NG - VENTILATING - AIR CONDITIONING �.
COUNTY OF LOS ANGELES BUILDING
98'55 Miloann
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY Temple City
' NEAREST Anes st .
CROSS ST. g
FOR APPLICANT TO.FILL IN OWNER W. Vi -Graham
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE&SIZE OF EQUIPMENT FEE ADDRESS 9855 Miloann
SEE BACK OF APPLICATION
1.
FORCE AIR FURNACE, BTU 80, 00 CITY Temple City TEL. NO. 287 1.280
CONTRACTOR Valley Heating Co,
COMPRESSOR, BTU �_� nom- ADDRESS 305 E Valley Blvd.
VENTILATION FAN CITY San Gabriel TEL. N0288 6812'
LIST ALL OTHERS BELOW STATE 14 FT99 LIC' C20
LICENSE NO. CLASS
80 Duo ' -- Ori —0o DISTRICT N0. GROUP ONE OCESSED BY
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INSPECTION RECORD
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Plan check fee. See reverse. ?
PERMIT ISSI+IVC Fh:F; S o
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 LAWSREGULATING •VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING. AIR'CONDITIONING.
ROUGH
I HEREBY ,CERTIFY AT I AM NO ACTING IN Y OLA FI AL f�r�D)+;
OF CHAPTER 9, DIVI OF THE B ESS AND PROFESS N
CODE OF THE STAT ALIFORNIA. _ '
SIGNATURE RMIT VALIDATION . M.O. CASH
OF PERMITTE
PLAN CHEQK VALIDATION CK. M.O. CASH
68111-DEC • '.9 4-1 u 1 9.50
76A364C pp �a p p ®�y®
WORKERS'FObI have
DECLARAI cn ION CE-818(2-80) b�r-P L IC AT I O � FOR P E R tl�78 T
[, hereby affirm.titgt I have a certificate of con,ant to self
inslt re or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONING
a certified cony thereof(Sec.3800,Lab.C.
Policy 7�j,,._-ftJ'q37Company53T12 &fJ
❑ Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy is filed wit �e count• WON,.inspection BUILDING
epar n�� FOR APPLICANT TO FILL IN ADDRESS 9855 Ml1.tJl'3Y1T1
Dated` 1=LlL Applican (PRINT OR TYPE ONLY)
CERTIFICATE OF EXEMPTION FROM IYORKFRS'
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY TeWle Cit
COMPENSATION INSURANCE NEAREST }
(This Section need not be completed if the work involved ABSORPTION UNIT, BTU cRoss ST.
Agnes Ave. a0
by the permit is for one hundred dollars (SILO) or less.) DISTRICT NO. PRO 5ED BY U
I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM �D a X
permit is issued, I shall not employ any person in any manner A O
so as to become subject to the Workers'Compensation Laws. BOILER,BTU t;�i APPROVALS DATE INSPECTOR'S SIGNATURE LL
Date Applicant COMPRESSOR,BTU T�E�� /p� a
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 VALIDATION
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU '4_ GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU f
I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT
9 (commencing with Section 7000)of Di%ision 3 of the Busi- WALL
ness and Professions Code, and my license is in full force and
effect.
License u bee Lic.Class- ^ 010 1
Contra or . tom' ^ ��
❑ I am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer Plan check fee 25%of above. @�
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). dO
Lic.or Reg.No. Date TOTAL FEE
HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from- the Contractor's NAME
License Law for the following reason (Section 7031.5, Busi-
ness and Professions Code): ADDRESS
❑ 1, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section CITY TEL.NO. -
7044, Business and Professions Code).
❑ OWNER r
1, as owner of the property, am exclusively contracting
with licensed contractors to construct the project MAIL
(Section 7044,Business and Professions Code). ADDRESS
i
CONSTRUCTION LENDING AGENCY CITY TEL.NO. �1 7
I hereby affirm that there is a construction lending agency _
for the performance of the work for which this permit is CONTRACTORr�I ;
issued(Sec.3 civ.C.>. 5937 IT. Oink Able.
Lender's Namee ADDRESS
Lender's Address CITY 1 818-285-121
Tie Cit TEL.NO
I certify that I have read this application and state that the STATE 2'7488.0 LIC.
above information is correct.I agree to comply with all County LENSE NO. CLASS
IC
ordinances and State laws regulating Heating. Ventilating and
Air Conditioning,and hereby authorize representatives of this I SEE RI'VERSE FOR FXPLANATORY LANGUAGE
County to enter upon the above-mentioned property for i
inspection purposes.
Signature of Permittee Date