HomeMy Public PortalAbout9484 OLEMA ST_Mechanical__ SA36v .4—CEt61)1.1.88.� ; _ APPLICATION FOR PERMIT (v
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS 9484 Olema
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY Temple City
FOR APPLICANT TO FILL IN
NEAREST T .
(Print or type only)
OWNER Frank Owen
No. TYPE,OF APPLIANCE OR EQUIPMENT FEEMAIL
ADDRESS 9484 Olema
ABSORPTION SYSTEM, BTU CITY Temple CltgEL. NO.
AIR HANDLING UNIT, CFM CONTRACTOR Bryant Htg. & Air Cond.
BOILER, HORSEPOWER ADDRESS 1350 E. Las Tunas Drive
1 COMPRESSOR, HORSEPOWER 7 50CITY San Gabriel TEL. No.286-1141
STATE
VENTILATION SYSTEM LICENSE NO. 221751 CLASS C)20
DISTRICT NO. GROUPO�E ESSED BY
EVAPORATIVE COOLER
FURNACE: FAU A GRAVITY • g_eCLCL
1 FLOOR—BTU 137,000 5 PO _,,kNSPF.CTION RECORD
HEATER: SUSPENDED UNIT
WALL J F
c
u
n
NEW—ADDITION PERMIT $ 3 00
ALTER—REPAIR— TOTAL FEE $ 15150
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT T ROVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNT 0 DIN S AND TE LAWS REGULATING
HEATING, VENTI TING CORD 1 ING
I HEREBY ERT AT M ACTING IN VIOLATION
OF CHAPTER 9, 1 S, N SI ESS AND P OFESSI AL
CODE OF THE ST E F 1 APPROVALS D TE IN ECTOR'S§IGNATURE
SIGNATURE ROUGH
OF PERMIT EE
V- EMOSE
_ FINAL LL
LIDATION JACK R. ALLEN
CK M.O. CASH SUPERVISING MECHANICAL ENG'R.
Pr_ 3u43o uLC1p4 D 1. 5.50
EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORKERS'COMPENSATION DECLARATION CEA366 8C(2-80) APPLICATION FOR PER USA T
I hereby affirm that I have a7 certificate of consent to self
insure,or a certificate of Workers'Compensation Insurance,or I I-IE:ATING-V ENT IL.ATING-A112 CONDITIONING
a certified copy thereof(Sec.3800,Lab.C.)
Policy No. Company COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy Whereby furnished.
Certified copy is filed with the county building inspection BUILDING
department. FOR APPLICANT TO FILL IN
Date Applicant ' (PRINT OR TYPE ONLY) ADDRESS
LOCALITY CIT
CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
COMPENSATION INSURANCE NEAREST }
CL
(This section need not•be completed if the work involved ABSORPTION UNIT, BTU caoss ST. p
by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. PR D BY V
I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM �` f�
permit is issued, I.shall not employ any person in any manner �/ �C/ 00
so as to become subject to the kers'Com ensJLawF, BOILER, BTU.
J P
'z-,So /ye APPROVALS DATE INSPECTOR'S sl TORE WDate pplicant v.o �C COMPRESSOR,BTUROUGH df it
!nNOTICE TO APPLICANT: If, after making this CeVENTILATION SYSTEM FINAL01
Exemption, you should become subject to th 'Compensation provisions of tate Labor Code, you EVAPORATIVE COOLER VALIDATION
with comply with such provisions or this perm
deemed revoked.
CE: FAUGRAVITY
LICENSED CONTRACTORS DECLARATION
� FLOORBTU
I hereby affirm that I am licensed under provisions of Chapter I HEATER: SUSPENDED UNIT
9 (commencing with Section 7000)of Division 3 of the Busi- WALL
ness and Professions Code, and my license is in full force and
effect. G Q45 /% W/q;t5pL c+2G
License Number Lie.Class 1J/ ,J
Contract Date
/Z 30: M .1 y�A fes•�S A
I am a empt from the licensing requirements as I am a
licensed architect or a registered professional engineer Plan check fee 25%of above.
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). PERMIT ISSUING FEE$
Lie.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
I, as owner of the property, will do the work and the CITY TEL.NO.
structure is not intended or offered for sale (Section
7044,Business and Professions Code).
OWNER
I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project MAIL
(Section 7044,Business and Professions Code). ADDRESS
CONSTRUCTION LENDING AGENCY CITY TEL.NO. 9 3 5 6 9 A
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is CONTRACTOR # o 0.01b 4 1
issued(Sec.3097,Civ.C.).
Lender's Name ADDRESS - - 27.00
Lender's Address ESTATE
TEL.NO. 0 0 0
I certify that I have read this application and state that the LIC.
above information is.correct.I agree to comply with all County O. CLASS 1230-80
ordinances and State laws regulating Heating,Ventilating and
Air Conditioning,and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County to enter upon the ab ve-mentioned property for
$Js{�a, _purpose
Signature of Permittee Date