HomeMy Public PortalAbout6030 MUSCATEL AVE_Mechanical__ 76A364.-,CE'81e-1/7a .. APPLICATION FOR PERMIT
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HEATING - VENTILATING - AIR CONDITIONING
7
COUNTY OF LOS ANGELES ADDRESS 3 a a Ai(".S e-4 LCL
DEPARTMENT OF COUNTY ENGINEER _
BUILDING AND SAFETY DIVISION LOCALITY t��L L C LL
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING CROSS ST. e��AL
FOR APPLICANT TO FILL IN OWNER ,eS
(PRINT OR TYPE ONLY) MAI L '
No. TYPE OFAPPLIANCE-OR EQUIPMENT FEE
ADDRESS Z = M US6
CITY 5&� 1 CL TEL- NO.
ABSORPTION SYSTEM, BTU
CONTRACTOR,6',LV, �� ��
AIR HANDLING UNIT, CFM n ,
rj
ADDRESS �i AJ/ //1•ij / 4 aE
BOILER, HORSEPOWER CITY (' TEL. NO. q
'STATEnn`
COMPRESSOR, HORSEPOWER LLIC
INO./Z'�� s CLASS I
VENTILATION SYSTEM DISTRICT NO. CLASS GROUP_ ZONE PROCESSED BY
EVAPORATIVE COOLER •^J5' /r/
41 .
/ FURNACE: FAU BTU RA Y/ INSPECTION RECORD
HEATER: SUSPENDED-UNIT-
WALL
USPENDED UNIT_WALL
0
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NEW ADDITION— PERMIT $ 3 00
6
ALTER—REPAIR— TOTAL FEE $ /
PLAN CHECK APPLICANT
NAME �� E!Y—K S U d
ADDRESS O a R S'6A7
CITY N I�� EL TEL.NO 6--0('Z7
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
1 WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE (N PECTOR'S GNATURE
LATIN6, AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL 3 Z�' 7Z
CODE OF THE STATE OF LI RNIA.
SIGNATURE JACK R. ALLEN,SUPERVIS C NIC!AL ENG'R.
OF PERMITTEE
PERMIT VALIDATION CK. M)&-,-- CASH
PLAN CHECK VALIDATION
0
393r NOV 2241 D 1 0.50-
SEE BACK OF APPLICATION FOR COM PLETE FEE SCHEDULE
fA 73
W}RKER'SCOMPENSATION DECLARATION i7BA364 DPW 9/89 APPLICATION FOR PERMIT LIME GREEN
I hereby affirm that I have a certificate of consent to self insure,
or a certificate of Worker's Compensation Insurance,or a certified HEATING-VENTILATING-AIR CONDITIONING
copy thereof(Sec.3800 Lab.C.) A •:,S •, r"
Policy No. P C 9 9 135'lompany R a P U b 1n4ea m COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑ Certified copy is hereby fu ed.
0 Certified copy is filed wit th o nt I Inspection I FOR APPLICANT TO FILL IN BUILDINSG
department. (PRINT OR TYPE ONLY)
Date 1815.19 1 Appl a NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY San Gabriel
NEAREST
CERTIFICATE OF ION FROM KERS' CROSS ST.H e r m o s a
COMPE S KNINSURA ABSORPTION UNIT,BTU NASSESSOR
(This section need not be omploted if the work involved by the , MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO. PROCESSED BY
I certify that in the performance of the work.for which this permit '
is issued, I shall not employ any person in any manner so as to BOILER,BTU
become subject to the Workers'Compensation Laws.
COMPRESSOR,BTU
• APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensation' EVAPORATIVE COOLER
provisions of the Labor Code.,you must forthwith comply with such FINAL 2
provisions or this permit shall be deemed revoked. FURNACE:, FAU GRAVITY
LICENSED CONTRACTORS DECLARATION 1 FLOOR BTU 12 .00 V LI ATION
I hereby affirm that I am licensed under,provisions of Chapter 9 SUSPENDED UNIT
(commencing with Section 7000)of Division 3 of the Business and HEATER: WALL
Professions Code,and my license is in full force and effect.
Licen N m I .Class r_?nn
}
Con Date R�191 1 d
Plan check fee C7
I am exempt undo c. I Q
B.&P.C.for this reason t PERMIT ISSUING FEE$ 13:00 H
Date:' TOTAL FEE6371,00. IL
C
Signature CL
PLAN CHECK APPLICANT Cr
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law NAME
for the following reason(Section 7031.5, Business and Professions
Code):❑ ) ADDRESS + -:-
I, as owner of the property, or my employees with wages. AC I °Y
as,their'sole compensation, will do the work and the CITY TEL.NO. 3307 37°�f 'I
structure is not intended or offered for sale(Section 7044, `r
ITENS
Business and Professions Code). OWNER-Mr . & Mrs . R e i b e r 1 a I ENS
❑ I, as owner of the property, am exclusively contracting MAIL TI3 j AL 37 w OID
with licensed contractors to construct the project (Sec- ADDRESS 6030 Muscate1 I _ _
tion 7044,Business and Professions Code). I JI
) . -HECK �;i.jij..
CONSTRUCTION LENDING AGENCY CITY San G a b r i e 1 TEL'N04 4 0-2113' CHANGE
I hereby affirm that there is a construction lending agency for CONTRACTOR �/ 9 / , °ttil
the performance of the work for which'this ermit Is issued B r. a n t Heating a t i n & A/C I n c .
(Sec.3087,Civ.C.).
ADDRESS 13 5 0 East Las Tunas Drive I I;!}f]I j—I jll] / 6/9 1.
Lender's Name I
CITY San Gabriel TEL "c�86-114'1 8 ': jAM-10:3-F.
Lender's Address STATE LIC.
I certify that I have read this application and state that the above LICENSE NO. Z 217 51 CLASS C-20
information is correct. I agree to comply with all County ordinances
anVntat!
ting t ilding construction,and hereby authorize i
rept • C my to enter upon theabove-mentionedpro rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE I
8/5/91
Ag"T11RE OF AFOPUCANT OR DATE I •.