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Home My Public Portal About5116 ROSEMEAD BLVD_Mechanical__ 7 P A 3154Z-CE 818-§-68 APPLICATION FOR PERMIT ,1Y HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ya 5116 Rosemead Boulevard COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY Temple City NEAREST FOR APPLICANT TO FILL IN CROSS ST. (Print or type only) OWNER Ad. hurt No.. TYPEJOF APPLIANCE OR EQUIPMENT FEE apish even a MAIL ADDRESS 5116 Rosemead Boulevard TEmple city ABSORPTION SYSTEM, BTU CITY TEL. NO. u AIR HANDLING UNIT, CFM CONTRACTOR Owen Bros. Plumbing, Inc. BOILER, HORSEPOWER ADDRESS 4265 No. Baldwin Ave. 5 COMPRESSOR, HORSEPOWER CITY El Monte qq TEL. No. 443-0078 STATE LIC. C VENTILATION SYSTEM LICENSE NO. 231 7`t1 CLASS 36 DISTRICT NO. GROUP I ZONE PROCESSED BY EVAPORATIVE COOLER !j FURNACE: FAU GRAVITYcJ FLOOR—BTU INSPECTION RECORD HEATER:.$USPENDED UNIT WALL �/} } o_ O U O F-- U W D_ N Z NEW—ADDITION— PERMIT $ 3 00 ALTER—REPAIR— TOTAL FEE $ - 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 LAWS REGULATING HEATING, VENTI- APPROVALS TE I CTOR'S URE LATING, AIR CONDITIONING. ROUGH � I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF CHAPTER 9, DIVISION 3, OF E BUSINESS AND PROFESSIONAL FINAL �� p CODE OF THE STATE OF CALIFO JACK R. ALLEN,SUPERVISIN CHANICAL ENG'R. SIGNATUREf. PERMIT VALIDATION CK. M.0. CASH OF PERMITTE PLAN CHECK VALIDATION ^ 2 :6 1 b NOV 5 41 D 1 9.00 SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE 76 A3W- "_ "'B - 9-" APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER 31 BUILDING AND SAFETY DIVISION LOCALITY ,c NEAREST _ CROSS ST. FOR APPLICANT TO FILL IN OWNERf� (PRINT OR TYPE ONLY) MAIL / /7 NO. TYPE OF APPLIANCE OR EQUIPMENT EEADDRESS J> f� ABSORPTION UNIT, BTU/6 �N CITY �' fvy�f^� TEL. NO. CONTRACTOR AIR HANDLING UNIT, CFM ADDRESS BOILER, BTU .> CIT � � TEL. NO. �F62 COMPRESSOR, BTU STATEi LIC. LICENSE NO. 1114 6 07 CLA VENTILATION SYSTEM DISTRICT NO. GROUP ZONE I ocessE EVAPORATIVE COOLER a FURNACE: FAUGRAVITY FLOOR BTU INSPECTION RECORD v HEATER: SUSPENDED UNIT_-—77o WALL v W a N Z Plan check fee 25% of above. See reverse. PERMIT ISSUING FEE S 3 00 TOTAL FEE 6�7 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 LAWS REGULATING HEATING, VENTI- APPROVALS f4i1T INSPECTO SIGNATURE iw LATING, AIR CONDITIONIN . ROUGH C � CHAPTER CERTIF THAT I AM OT ACTING IN VIOLATION OF HAPTER 9, DIVISI N 3„OF THE SINESS'AND PROFESSIONAL FINAL11/ 1 CODE OF THE STATE CA�IFORNI SIGNATURE ,� ' 6 '� PERMIT VA ATION CK. M.O. CASH OF PERMITTEE 1 PLAN CHECK VALIDATIO M.O. CASH f err, 2 84 77 3- fur' 2� 1 A 1 8,U0b SEE BACK OF APPLICATION FOR COM PLETE_FEE SCHEDULE WORKER'S COMPENSATION DECLARATION zo-D04f3DPW 9,89' APPLICATION FOR PERMIT LIME GREEN 70.00 4C 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. EJB UILDING Certified copy is filed with the county building inspection (PRINT OR TYPE ONLY) ADDRESS department. , LOCALITY /l� Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE c_"� NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. d •. COMPENSATION INSURANCE ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed if the work involved by the MAP BOOK- � PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit (49 is issued,.) shalt not employ any person in any manner so as to BOILER,BTU become subject to the Workers'Compensation Laws. At/, COMPRESSOR,BTU `J I/ • APPROVALS DATE '^INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM �a �C�•� G. .3 0 NOTICE TO APPLICANT: If, after making this Certificate of ROUGH _ 1 Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COO iR FINAL provisions of the Labor Code, you must forthwith comply with such V provisions or this permit shall be deemed revoked. FURNACE: FA GR VITY LICENSED CONTRACTORS DECLARATION FLOOR BTU !J VALIDATIOf1 1 hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED- UNIT-(commencing with'Section 7000) of Division 3 of the Business and HEATER: WALL 2 ITEMS Professions Code,and my license is in full force and effect. TOTALS 1073.701 License Number Lic.Class CHECK 1073°70 � CHANGE °00 p Contractor Date V ❑ Plan check fee „ y� I am exempt under Sec. v Z C. _, n B.&P.C.for this reason PERMIT ISSUING FEE$ D 0000-0(301 3/1ll'— O Date: TOTAL FEE' 3 285 1 AM 9:34 CL Signature (1)PLAN CHECK APPLICANT � OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law NAME Pol.for the following reason (Section 7031.5, Business and Professions dCode): ADDRESS IYJ I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the CITY TEL.NO. structure is not intended or offered for sale (Section 7044, Business and Professions Code). OWNE �v ❑ I, as owner of the property, am exclusively contracting MAIL with licensed contractors to construct the project (Sec- ADDRESS' /.6 tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITEL.NOV. TY /• �/ I hereby affirm that there is a construction lending agency for CONTRACTOR the performance of the work for which this permit Is issued (Sec.3097,Civ.C.). ADDRESS Lender's Name CITY TEL.NO. 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 propM ect purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 3 13 SIGNATURE OF APPLICANT OR A DATE