HomeMy Public PortalAbout6237 RENO AVE_Mechanical__ 96-A364 4e48tN II70 `
• �PPLICATI'o FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADDRESSl��•
DEPARTMENT OF COUNTY ENGINEER 6237 N.
BUILDING AND SAFETY DIVISION LOCALITY Temple City
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING CROSS ST.
FOR APPLICANT TO FILL IN OWNER
Ed Roney
(PRINT OR TYPE ONLY)
MAIL
�. NO. TYPE OFAPPLIANCE•OR EQUIPMENT FEE
ADDRESS 2723 E. Lashbrook
CITY l Monte TEL. NO.h43-0078
ABSORPTION SYSTEM, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM Owen Bros, Plumbings INc®
ADDRESS 1,265N Baldwin Ave.
BOILER, HORSEPOWER CITY El Monte TEL. No. _00.78
COMPRESSOR, HORSEPOWER STATE LIC.
LICENSE NO. 2 ;gyp CLASS
VENTILATION SYSTEM DISTRICT NO. CLASS GROUP ZONE PROFESSED BY
EVAPORATIVE COOLER
FURNACE: FAU_GRAVITY
FLOOR BTU INSPECTION RECORD
HEATER: SUSPEN UNIT_
1 WALL pp
0
C
c
o
C
C.
C.
NEW—ADDITION— PERMIT $ 3 00 v
c
ALTER—REPAIR— TOTAL FEE S 00
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE PECTOR'S S NA RE
LATINAICONDITIONIN .,
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING MVIOLATION
OF CHAPTER 9, DIVISIO y.OF T SUSINE AND OFItSSIONAL FINAL /
CODE OF THE STATE 0 CAL
SIGNATURE , 1 JACK R. ALLEN,SUPERVISINGECHANICAL ENG°R.
'! OF PERMITTE ?
PERMIT VALIDATION C I M.O. CASH
PLAN CHECK VALIDATI
,;iiL �. 4 1 D 8.0 Q- n,
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
ION
DECLARATI
WORKER'S I have
a certificate
of consent to 7SA364DPW 9,a9 APPLICATION FOR PERMIT LIME • GREEN
'thereby affirm that I have a certificate of consent to self Insure,
or a cOtiflcate of Worker's Compensation Insurance,or a certified HEATING-VENTILATING-AIR CONDITIONING
copy thereof(Sec.3800 Lab. i
Policy No. �mpanY COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑ Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN BUILDING
Certified copy is filed with the coupty building inspe n p (PRINT OR TYPE ONLY) ADDRESS
d /
t.
1%7
Date pa 1A Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY
NEAREST
ERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST.
COMPENSATION INSURANCE ABSORPTION UNIT,BTU
(This section need not be completed if the work Involved by the ASSESSOR
MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit L
Is issued, I shall not employ any person In any manner so as to BOILER,BTU
become subject to the Workers'Compensation Laws.
1 COMPRESSOR,BTU Z
APPROVALS DATE INSPECTOR'S SIGNATURE '
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER _ /
provisions of the Labor Code, you must forthwith comply with such FINAL
provisions or this permit shall be deemed revoked. ` FURNACE: FAU GRAVITY SeVALIDATION
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
(commencing with Section 7000)of Division 3 of the Business and WALL
Professions Code,and my license is in full force and effect.
jyLicense Number Lic.Class
Contractor Date
m� AW1111 C
Jr
❑ I am exempt under Sec. Plan check fee
BAP.C.for this reason PERMIT ISSUING FEE$ l° p� C
F
Date: TOTAL FEE
Signature U
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I 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 fyCt_14 a
I, as owner of the property, or my employees with wages �_ z
as their sole compensation, will do the work and the CITY TEL.NO. . 30* 57.NO
structure is not intended or offered for sale(Section 7044,
Business and Professions Code). OWNER
❑ l,'as owner of the property, am exclusively contracting MAIL Cf TOTAL AL 5 7 .00
with licensed contractors to construct the project (Sec- I ADDRESS t{
tion 7044,Business and Professions Code). CITY TEL.NO. CHECK ~f.130
CONSTRUCTION LENDING AGENCYlog �v 1V CHANGE f:I
I hereby affirm that there is a construction lending agency for ® C�`T+�t otjt
the performance of the work for which this permit Is Issued CONTRACTOR
(Sec.3097,Civ.C.). I
ADDRESS 0 • I jlRjU—i II4�1 i 3/25/91
Lender's Name i[ }
CITY TEL.NO 011921 7 i 1 AN 111:_'1I
Lender's AddressSTATE d LIC.
I certify that I have read this application and state that the above ' LICENSE NO. CLASS
information is correct. I agree t mply with all County ordinances
and State laws relatin to buil ' g construction,and hereby authorize
repr entatives of t i Cou o enter upon the above-mentioned
pr e t or ns actio p o SEE REVERSE FOR EXPLANATORY LANGUAGE
IGNATURE OF P A r