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Home My Public Portal About5410 PERSIMMON AVE_Mechanical__ 76 A364- CE 818-1/75 APPLICA ION FOR PE IT • HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES ADDRESS .�✓ DEPARTMENT OF COUNTY ENGINEER P BUILDING AND SAFETY DIVISION LOCALITY NEAREST CROSS ST. FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) MAIL �" �� •' NO. TYPE&SIZE OF EQUIPMENT FEE ADDRESS SEE BACK OF APPLICATION •C`� FORCE AIR FURNACE, BTU CITY TEL. NO. CONTRACTOR / COMPRESSOR, BTU ADDRESS VENTILATION FAN CITY N u TEL. NO. 6 LIST ALL OTHERS BELOW STATE LIC. -- r ( LICENSE NO. CLASS DC7 �,®-� DISTRICT N0. GROUP ZONE IPROCESS 0ED BY G � L J INSPECTION RECORD I } 0_ O O ` O F- U W 0- Pian check fee. See reverse. Z I PE.11NI11, I55rl.Nc F1-:1-: g PLAN CHECK APPLICANT t. 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 SIGNATURE LATING, AIR CONDITIONING. ROUGH � �; �/' :�- •._r I HEREBY CERTIFY THAT AM&�� N VIOLAT IO '• OF CHAPTER 9, DIVISION 3, TH OFESSION FINAL 1]'�3 CODE OF THE STATE OFC FO A. J•'-"-'�'^P SIGNATURE PERMIT VALIDATION cK. r M.O. CASH OF PERMITTEE PLAN CHECK VALIDA ON CK. M. CASH 1 7 1 yPR 6 4 1 01 2.0 0 I ., Cry ION WORKER have a certificate of consent to 7BM46DPW9189 APPLICATION FOR PERMIT LIME GREEN: ' 76A3fi4C I hbgeby affl?m 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.) Policy No. PC946069companyREPUBLIC INDEMNIT&LINTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ Certified copy is hereby furnished. Np E i Certified copy is filed with the county building ins actio FOR APPLICANT TO FILL IN ADDRBUILDEs�410 PERSIMMON AVE. department. , (PRINT OR TYPE ONLY) Date 8/31/92 Applic NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ow LAA NEAREST EMPLE CITY CERTIFICATE OF EXEM ION FROM WORKERS' NEAREST CROSS ST. COMPENSATION INSURANCE ABSORPTION UNIT,BTU (This section need not be completed if the work Involved by the ASSESSOR PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM MAP BOOK PAGE DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU [ ` 1 become subject to the Workers'Compensation Laws. cam- 1 COMPRESSOR,BTU 60,000 2 3 25 Date Applicant NSA VENTILATION SYSTEM APPROVALS DATE INSPECTOR'S SIGNATURE NOTICE TO APPLICANT: If, after making this Certificate of ROUGH ff6:_14 Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU V TY LICENSED CONTRACTORS DECLARATION FLOOR BTU �� 23 25 VALIDATION 1 hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business and HEATER: WALL Professions Code,and my license is in full force and effect. License Number 4 6 8 6 0 9 Lic.Class C 2 0 /� fl , CL CL Contra to 8431492 C ` Plan check fee r_1 am exempt under Sec. BAP.C.for this reason PERMIT ISSUING FEE$ 24 75 O Date: TOTAL FEE d Signature N/A 171125 — co OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT Z I hereby affirm that I am exempt from the Contractor's License Law NAME I , for the following reason(Section 7031.5, Business and Professions Code): ADDRESS ACCT p0 ❑ 1, as owner of the property, or my employees with wages .�- as their sole compensation, will do the work and the CITY TEL.NO. �7�7V� 71.25 structure is not intended or offered for sale (Section 7044, 4 T7i•Mt+ Business and Professions Code). OWNER CALVIN NGUYEN i i�G11,7 ❑ 1, as owner of the property, am exclusively contracting MAIL TOTAL 71.25 with licensed contractors to construct the project (Sec- ADDRESS S410 PP.RsTmmoN AViFOEM tion 7044,Business and Professions Code). CITY TEMPLE CITY TEL.NC818-444—$0 8 �y.4iEM 71.25 CONSTRUCTION LENDING AGENCY CHANE s00 I hereby affirm that there is a construction lending agency for CONTRACTOR , the performance of the work for which this permit Is issued IRVINEWEST HTG. & A/C (Sec.3097,Civ.C.). Lender's Name N/A ADDRESS 638 SOUTHERN AVE. O=—WOI g/ ¢/92 CITY ORANGE TEL.NO. 714-921-0800 1 AN 9:21 Lender's Address I certify that I have read this application and state that the above STATE E NO. 4 6 8 6 0 9 LIC. C20 C2 0 information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon the above-mentioned pro rty for in action purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE I 4 EOF APPLICANT O NT �� ATE?2 I WORKER'S COMPENSATION DECLARATION �66MrC 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.) Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ Certified copy is,hereby furnished. // Certified copy is filed with the county building inspec ibn , FOR APPLICANT TO FILL IN ADDRESS `f( (J '�C��1�9/t•V y�2v 1J-f,� department. (PRINT OR TYPE ONLY) Date Applicant1f NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY �, TIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS ST. COMPENSATION INSURANGE ABSORPTION UNIT,BTU This seead not be completed if the/work Involved b the ASSESSOR ( P Y MAP BOOK PAGE PARCEL permit ion hundred dollars($7001%or less.) AIR HANDLING UNIT,CFM // DISTRICT NO. PROCESS I certify in th performance of t e work for which this permit is issuehall n employ any person in any manner so as to BOILER BTU �.0b become ct to the orkers'Compensatio�Ls . e-11LCOMPRESSOR,BTU �� _ APPROVALS DATE INSPECTOR'S 3IGNATURE `MOicant VENTILATION SYSTEM NOT \fk'liengg—this Certificate of• ROUGH Exemptiu should b omo the W ORATIVE COOLER provisiothe Lab Codet forthwith comply with such FINALprovisiothis pe it shall d revoked. FURNACE: FAU GRAVITY LICE ED CONTDECLARATION FLOOR BTU VALIDATIONIherebyrm at I am licer provisions of Chapter 9 SUSPENDED UNIT (6ommencing ith Section 70ion 3 of the Business and HEATER: WALL Professions ode,and my licefu force and effect. x-�el A e .. 4eK, 2 �icense Number Lic. lass ontractor Date Q 1 am exempt under Bec. Plan check fee U BAP.C.for this reason i PERMIT ISSUING FEE$ 0 O Date: TOTAL FEE (p W Signature OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I (a/) I hereby affirm that I am exempt from the Contractor's License Law NAME , e following reason(Section 7031.5, Business and Professions Co ADDRESS ACCT.T I, as owner of the property, or my employees with wages t n their sole compensation, will do the work and the CITY TEL.NO. 3303 Q�-30 structure is not Intended or offered for sale(Section 7044, 1 ITEM • Business and Professions Code). � OWNER ❑ I, as owner of the property, am exclusively contracting MAIL r /"� / TOTAL 'o � with licensed contractors to construct the project (Sec- ADDRESS (� 1 � �rt7E4K bu�O tion 7044,Business and Professions Code). If CONSTRUCTION LENDING AGENCY CITY TEL.NO. CHANGE o00 I hereby affirm that there is a construction leing agency f CONTRACTOR , the erformance of the work for which this permit Is issued i /02 (Sec.3097,Civ.C.). '�y �-t t I t ADDRESS 0000-0001 10/.198/95 Lender's Name CITY TEL.NO. 2881 1 Ah 90°27 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 representatives of this County to enter upon the above-mentioned pro rt+�ffoor' spection purposes. ,I SEE REVERSE FOR EXPLANATORY LANGUAGE ' DATE SIGNATURE OF APPLICANT OFJJM3 T .I