HomeMy Public PortalAbout5541 ROSEMEAD BLVD_Mechanical__ iBAlW�eBi R—! e! APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONOITIONIN
Y
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING 7�7
BUILDING AND SAFETY DIVISION ADDRESS .gyJOHN A LAMBIE COUNTY ENGINEERCOLEMAN W JENKINS, SUPERINTENDENT OF BUILDING LOCALITY �� �jFOR APPLICANT TO FILL IN CROSS sT J(Pant or type only) ��p OWNER vFEE NO TVPEIOF APPLIANCE OR EQUIPMENT MAILADDRESS Q tsM/ S
ABSORPTION SYSTEM BTU CITY TEL NO
AIR HANDLING UNIT, CFM CONTRACTOR C ^CJ
BOILER, HORSEPOWER y ADDRESS/t6 ,Blkhe oT
COMPRESSOR, HEPOWER p CITY /.,r TEL N0666-
3�
u A> ORSSTATE LIC
VENTILATION SYSTEM 3 LICENSE NO 6 3 CLASS
/ EVAPORATIVE CO�LER DISTRICT NyON RRO UP RZONE PROCESSED B
FURNACE FAU_6`015G VITYO F �.er �. D V b ` C�
FLOOR—BTU W INSPECTION RECORD
HEATER SUSPENDED—UNIT_
WALL YY
0 000 µsl- v
6YA�JT FrF✓ 6" CRH
0
U
/ '• " /1s'- CFM � H
z
NEW ADDITIONPERMIT S 3 00
ALTER—REPAIR TOTAL FEE S
Plan check applicant d 4,06
Name /
Address psi.4.42,Q
City Fel No f p2o0
I HEREBY ACKNOWLEDGE THAT I HAVE MCAD THIS APPLICATION
AND !TATE THAT THE ABOVE I! CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCE! AND LAW! REGULATING HEATING VENTI- APPROVALS DATE INEOR!SIGNATURE
LATING AIR CONDITIONING
ROUGH
HEREBY CERT IFT AT 1 AM NOT At
IN VIOLATION FINAL
Of CNAPTER B DIVIBIO 3 OF THE SVSI MCl3 PROFE I SI ONAL
CODE OF THE STAT[ ALIFORNI11♦
//y� JACK R ALLEN,SUPERVISI CHANICAL ENG'R
SIGNAOF PE URE P PERMIT VALIDATION CK M O CASH
OF PE RMITTE
PLAN CHECK VALIDA nON
I_Af Ar- .9 7 5 4� APR19 4 1 D 3 (,00-
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
APPLICATION FOR PERMIT {�
HEATING - VENTILATING - AIR CONOITIONING u
p5c7Y
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING /�
(PRINT OR TYPE ONLY) ADDRESS {/
LOCALITY
NO YPEOF APPLIANCE OR EQUIPMENT FEE CIL Y
NEAREST
CROSS ST
ABSORPTION UNIT, BTU
OWNER
AIR HANDLING UNIT CFM MAIL
ADDRESS
BOILER, BTU CITY cfry TEL NO
COMPRESSOR BTU 5 O CONTRACTOR ROMAJ 6V
VENTILATION SYSTEM ADDRESS /
EVAPORATIVE CO LER CITY TEL NO 3
FURNACE FAU_GR I Y STATE //�'� LIC
FLOOR BTU LICENSE NO W CLASS —W
HEATER SUSPENDED- NIT_ DISTRICT NO GROt ZONE ESSED BY
WA I
w _ `j 0� �' N1 $
INSPECTION RECORD
UC i Z y
x
Plan check fee 25% of above
PERMIT ISSUING FEE S
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
I HEREBY ACKNOWL GE AT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE IS
! CORRECT AND AO7IN
C TO COMPLY
WITH ALL OROINANC AND AWS REOULATIMTING VENTI
LATINO AIR CONDITI ING
I HEREBY CERTI Y T I AM 0 VIOLATION APPROVAL! DATE INSPECTORS SIGNATURE
OC CHAPTER G OIVI ON THE 9 ESS 0 PROCESSIONAL
CODE GF THE STATE AVIA ROUGH
SIGNA J/����
OF PERMI E NAL
PLAN C7 VALIDA7 CK M 0 CASH PERMIT VALIDATION cK NO CASH
51 7 rFEB 7 4 1 U 5 '7,0 0 eoa
0 �
76 A394 - CE 010 -t/75
• APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONOIIIOWNGG
COUNTY OF LOS ANGELES UILDIN gL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST Ala,FOR APPLICANT TO FILL IN OWNER(PRINT OR TYPE ONLY) '✓MAIL NO TYPE&SIZE OF EQUIPMENT FEE ADDRESSY&SEE BACK OF APPLICATION
CITY��f_FORCE AIR FURNACE BTUN'CONTRACTOR
COMPRESSOR BTU o NADDRESSVENTILATION FANCITYLIST ALL OTHERS BELOW STATELIC `LICENSE NO CLASS 0 iT NO I PROCE pY
i A� fr , INSPECTION RECOR
a
0
V
K
O
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W
a
Plan check fee See reverse
PI Rql I h"l I\( hi F S
OI 11 III6017160
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING VENTI APPROVALS DATE INSPECTOR S SIGNATURE
LATING AIR CONDITIONING
RO LIG H
NEPEpY CERTIFY T T AM NOT ACTINO IN VIOLATION
OI CHIP TER 9 DIVISION OF THE BUSIxC55 ROIESS IOWA FINAL Z�
CODE OF THE STATE OI LFOR NI♦
SIGNATURE _ PERMIT VALIDATION cK M 0 CASH
OF PERMITTEE
PLAN CHECK VALIDATION ER M 0 CASH
3 7i:JAN 51 4 1 0 2 7.0 0 At,13
WORKERS COMPENSATION DECLARATION r L r
5-131/e r
_ I hereby affem that I have a certificate of consent to self APPLICATION FOR PERMIT
Insure, or a certificate of Workers'Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
or a certified copy thereof(Sec 3800 Lab C ) 76A364C
CE 018(REV 10/81)
Pollcy No/OYA2QJ Company STr4TE. F✓A Zt
❑
Certified copy Is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY
❑ Certified copy is filed with the county building insW- FOR APPLICANT TO FILL IN BUILDING
hon department (PRINT OR TYPE ONLY) ADDRESS at 31
Date /-3-/- k7 Appl¢c LOCALITY
NO TYPE OF APPLIANCE OR EQUIPMENTFEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST
(This section Mad not he completed If the work Involved by ABSORPTION UNIT BTU OISTRK'r NO *C)CE&MD BY
the permit Is for aria hundred dollars ($100)or lass ) y
CFM
I certify that in the Performance of the work for which this K 0
permit Is issued I shall not employ any person in any manner AIR HANDLING UNIT
so as to become subject to the Workers'Compensation Laws BOILER BTU APPROVALS DAIS OR s Sx1NAT yRE
Date Applicant COMPRESSOR BTU ROUGH
NOTICE TO APPLICANT If after making this Certificate of VENTILATION SYSTEM FINAL
Exemption you should become subject to the Workers
Compensation provisions of the Labor Code you must forth EVAPORATIVE COOLER VALIDATI
with comply with such provisions or this permit shall be
deemed revoked FURNACE FAU LGRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 NEATER SUSPENDED UNIT_
(commencing with Section 7000) of Divmlon 3 of the Business WALL
and Professions Code and my license is in full force and effect d
License Number 171q.2 y0a LIc Class G'�0 , V
OC
Contractor 4�8VIEVEfL40 Date /2- If 7 O
❑ I am exempt under Sec W
Plan check fee d
N
B 8P C for this reason Z
PERMIT ISSUING FEE$
Date
Signature TOTAL FEE
OWNER BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor s License ►
Low for the following reason (Section 7031 5 Business and NAME
Professions Code)
❑ I as owner of the property or my employees with ADDRESS
wages as their sole compensation will do the work and TEL NO
CITY
the structure is not Intended or offered for sole(Section S 8 4 9 4 A
7044 Business and Professions Code)
OWNER #la a a 0,0 8
❑ I as owner of the property am exclusively contracting
with licensed contractors to construct the project (Sec MAIL ( • • 2 Q Jr
hon 7044 Business and Professions Code) ADDRE55 CL Ra t FJ A • •i• 2 Q cJ O 5S
CONSTRUCTION LENDING AGENCY CITY -� _ TEL NO - 1.1 SS
I hereby affirm that there a a construction lending agency for , 12-03-87
the performance of the work for which this permit Is Issued CONTRACTOR L`AN t_6Y �owE2 G O
(Sec 3097 Civ C ) ,
ADDRESS OS hl l'FERN'�O SW �v
Lender s Name
Lender s Address ❑TYsr£fLpA mliybo,E_ TEL NO 5-1149
STATE LIC
I certify that I have read this application and state that the LICENSE NO 4 '14 Oa CLASS tip
above Information Is correct I agree to comply with all County
ordinances and State laws relating to building construction
and hareb nand a uthoriz�presentahves of this County to enter
upon t m d property for imwl,.n purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Apphcont or Age Dale