HomeMy Public PortalAbout5533 ROSEMEAD BLVD_Mechanical__ 79AMAK - C981E9-1/7e APPLICATION FOR PERMIT
HEATING - VENTILATING • AIR CONDITIONING
BUI�C AND 4J&ETY DIVISIO'R
FOR APPLICANT TO FILL IN BUADDILREDING SS S3 0
(PRINT OR TYPE ONLY)
LOCALITY
No TYPE OF APPLIANCE OR EQUIPMENT REE NEAREST
S
ABSORPTION UNIT, BTU CROSS ST -
OWNER
AIR HANDLING UNIT, CFM I
MA MALL
ADORESS 0" _ Q�
BTU /
CITY ,4,1 TEL NO
COMPRESSOR BTU �
w12 ZA7212 CONTRACTOR
VENTILATION SYSTEM S'O'✓diL ADDRESS�Ly
EVAPORATIVE COOLER CITY TEL NO
FURNACE FAU_GR lNIAFY�, STATE LIC r
FLOOR BTU O� 5 LICENSE NO kM 9F CLASS -ZD
HEATER SUSPENDED_UNI _ DISTRICT NO GROUP ZONE PROCESSED BY
WALL
t�.ays�cE , eO 3 �- o
INSPECTION RECORD
a
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Plan check fee 2S% of abov y' 9
PERMIT ISSUING FEE S
TOTAL FEE jJ9 1,7
PLAN CHE;g APPLICANT
NAME
ADDRESS
CITY i1Y 16A✓ TEL NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IB CORRECT AND AGREE To COMPLY
WITH ALLORDINANCES AND LAWS REGULATING HEATING VENTI-
LATING AIR CONDITIONING
1 HEREBY CERTIFY THAT I AM NOT ACTING IOLATION APPROVAL$ DATE WPECTONI SIGNATURE
OF CHAPTER 9 DIVISION 3 OF THE BUSINESS OFEBSIONIL
CODE Or THE STAT[ or c WA ROUGH
SIGNATURE
OF PERMITTEE FINAL
PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION cK M 0 CASH
. l17lZMAY 542 0 24.94 335 MAY 1641 0 104.25 98
(i v G-2
WORKER have a certificate
DECLARATION 20-00,16DPW9/89 APPLICATION FOR PERMIT LIME GREEN
70A%/C
I hereby affirm that I have a certdmate of consent to Bell insure
or a certificate of Worker a Compensation Insurance or a certified HEATING-VENTILATING-AIR CONDITIONING
copy thereof(sec 3800 Lae cco�mC�n 1
Pal No `J l COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
❑ Certified copy U hxeby turreted
❑ Canffled:PY.flied with thWtheork
but FOR APPLICANT TO FILL IN BUILDING
tlepartmem (PRINT OR TYPE ONLY) ADDRESS "et elf
Date ApplkanLOCALITY
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EKEMNEAREST pr
COMPENSATIOCRDSSST
ABSORPTION UNIT BTU ASSESSOR
(Thisperm Notion need not ed eomps(81d by the MAP BOOK PAGE PARCEL
permit Is for pM hundred dollen(1100)or leu) AI ING UNIT CFM o�Icr rw �.
I cendy that In the performance of the work for which this permit n BN / O
is Issued I shall not employ any arson In any manner so as to 4
become subject to�tlhe Workers Co neetion �I� J
COMPRESSOR BTU
_ IPPNlI18 MTE e19�RFeBgrNTl1�
Applrcenl VENTILATION SYSTEM /� 00
NOTICE TO APPLICANT If alter maks g t e Certmcate of / ROUGH
Exemption you should become subject to theW rivers Compensation EVAPORATIVE COOLER `
provisions of the Labor Code you moat fart h comply with such FINAL
provisions or this permit shell be deemed revoked FURNACE FRU_ !/ Q VALIDA IDN
LICENSED CONTRACTORS DECLARATION FLOOR BTU J
I hereby affirm that I am licensed under provisions of Chapter B HEATER SUSPENDED UNR
(commencing with Section 7000) of Division 3 of the Business and WALL
Professions Code
�and my license is In lull force and effec `
t '7
40
Licensee-Number) 1 0—11 1 Lic Cleve a Ap k d0 L� p 1 ITECII
cS�� Lt�rcd °�L 5 l$�j 35 lAr4 TOTAL 831 . 60IL
>
Dommc, e� _Dme �( , CHECK 831.60 p
❑ I am exempt under Sec Plan Check fee
B aP C for this reason PERMIT ISSUING FEE$ 'r�} O
Data TOTAL FEE Oj[I— j1 5/1O/9Y W
Signature OWNER BUILDER DECLARATION PLAN CHECK APPLICANT 5144 1 PM 5:12 C%
Z
I hereby affirm that I em exempt from the Contractors License Law NAME
for the following reason (Section 7031 5 Business and Professions ► ACCT,i
Code) ADDRESS
❑ I as owner o1 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 1 ITEF
Business and Professions Code) OWNER
F1 as owner of the MAL TOTAL 961 - 95
properly em exclusively contracting �/
with licensed contractors to construct the project (Sec ADDRESS CHE:I<
tion 7044 Business and Professions Code) ,,������
CONSTRUCTION LENDING AGENCY
CITY TEL NO '-HANGE ,I.IJ
I hereby affirm that there is a construction lending agency for COHIA40TOR
the performance of the work for which this permit 4a issued
(Sec 3007 Civ C) 10.ADDRESS *3 DOO7-0001 5/13/5Y
Lender a Name 171249 1 All 9:7-5
c"Y 14 9 L NO a-7a.,01y°l6
Lenders Address _
I certify that I have reed this applrcatlon and state that the above WSE NO 5 t'6_1 GLASS Z2_ ;-0
mlormatlan Is correct I agree to comply with all County ordmanoee
and State laws relating to building construction and hereby euthorlze
esentetivee of thio County to enter upon the above mentioned
pe for In tion a SEE REVERSE FOR EXPLANATORY LANGUAGE
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