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Home My Public Portal About5561-5563-5573 ROSEMEAD BLVD_Mechanical__ 1 I r 1 Q ^- 76A364 - CE8I8 - 3-69 -TEMPLc CITY (I APPLICATION FOR PERMIT U HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING L DEPARTMENT OF COUNTY ENGINEER ADDRESS 5S BUILDING AND SAFETY DIVISION JOHN A LAMBIE COUNTY ENGINEER LOCALITY Temp e-- ilsc COLEMAN W JENKINS SUPERINTENDENT OF BUILDING NEAREST CROSS ST FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) MAIL NO TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS ABSORPTION SYSTEM BTU CITY TEL NO AIR HANDLING UNIT CFM CONTRACTOR 1,51 9— 90 HORSEPOWER T s '� ADDRESS A 1 in 9L sp CITY TEL NO COMPRESSOR HORSEPOWER STATELIC /� LICENSE NO 27&p0 CLASS G-2O 8 VENTILATION SYSTEM DISTRICT NO GROUP ZONE ESSEO BY EVAPORATIVE COOLER O 8 F 0-3 FURNACE FAU W GRAVITY_ FLOOR BTU loopcoo IR25� IS INSPECTION RECORD HEA ER SUSPENDED—UNIT— Hq�- WALL FL;ap&c6: FAU I to,00O 78 r5 O v iX NEW_ADDITION_ PERMIT $ Z ALTER--REPAIR— TOTAL FEE $ 7il 23 PLAN CHECK APPLICANT NAME NB coryl. ADDRESS ' , 8 CITY E TEL NO IHEREBY 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- LATING AIR CONDITIONING APPROVALS DATE INSPECTOR 5 SIGNATURE I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH CHAPTER 9 DIVISION 3 OF THE BUSINESS AND PROFESSIONAL FINAL CODE OF THE STATE OF ALIFORNIA -;w)a SIGNATURE JACK R ALLEN, SUPERVISING MECHANICAL ENG'R OF PERMITTEE PERMIT VALIDATION � M o CASH PLAN CHECK VALIDATION 5 9 4�sW 2 4-1 9 3 1 72 5 tAA BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE m� TION WORKER I have a cNSAcateDECLARATION �OPkVeI$9 APPLICATION FOR PERMIT LIME GREEN I hereby affirm Uel I have a cemhcete of consent to sell Insure or a certih a of Worker a Compensation Insurance or a certified / HEATING-VENTILATING-AIR CONDITIONING 0 Copfihere1o�'(^9ec_3^80r0 Lab C ' �J,l,�y/W copy is hereby furnsuhmil +1' « N�n1l�J�L�4om �� r�1 COUNTY O ANGELES DEPT OF PUBLIC WORKS �BUILDING AND SAFETY DIV ❑ ��9 a7�i�with tiro wunry Ing I FOR APPLICANT TO FILL IN BUILDINGADSS (PRINT OR TYPE ONLY) Dat App L NO TYPE OF APPLIANCE OR EOUIPMEN7 FEE CER FICATE OF EXEMPTION WORKERS NEAREST COMPENSATION INSURANCE CROSS ST ABSORPTION UNIT,BTU (This section need not be tompletetl If the rock Involved by the ASSESSOR IJAP BOOK PAGE PARCEL permit In for one hundred dollen($100)or to" AIR HANDLING UNIT CFM I certify that In the performance of the work for which this permit _ is issued I shell not employ any person In any manner so as to BOILER BTU— become O GL become subject to the Workers Compeneatwn Laws V U COMPRES60R BTU Data Applicant �vHloaua ogre aexawnre VENTILATION SYSTEM NOTICE 70 APPLICANT 11 alter making this Certificate of ROIIO/f Exemption you should become subject to the Workers Compensation EVAPORATIVE COOLER provisions of the Labor Code you must forthwith comply with such RIVAL provislons or this permit shall be deemed revoked FURNACE FAU_GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION I hereby affirm that I em licensed under provisions of Chapter 9 HEATER SUSPENDED—UNIT— WALL USPENDED UNR_ t (commencing with Section 7000)of Division 3 of the Business and WALL Professions Code and my license w In full force and effect �(/��jNumbs // Lk: Cfaa � 3 efl le ❑ I am exempt under Sec Plan Check fee Q B sP C for this mason PERMIT ISSUING FEE S —1 50 O Date TOTAL FEE 01W Sgnmuro OWNER BUILDER DECLARATION PLAN CH Z I hereby affirm that I am exempt from the Contractor• License Lew NAME ► 8 for the following reason (Section 7031 S Business and Professions A//+� Code) ADDRESS 1'1441.A ❑ I as owner of the property or my employees with wages as their sole compensation will do the work and the CITY TEL �y,u c3.90 structure is not intended or offered for sale (Section 7044 1 ITCH'' Business and Professions Code) OWNER ❑ I as owner of the property am exclusively contracting MAIL TOTAL53.90 with licensed contractor@ to construct the project (Sec ADDRESS CHECKM 53.90 non 7044 Business and Professions Code) iyiAu2 .00CONSTRUCTION LENDING AGENCY CITY TEL �TW47�K I hereby affirm that there Is a construction lending ap ency fCONTRACT the performance of the work for which this permit Is Issue'd' _ — (Sec 3087 Cav C) ADDRESS .001�p0�0-0001 10/18/95 Lender a Name q. L.L-q.s 1 AM11:32 Lender a Address NO,�/ �f�i G g . TE I candy that I have read this application and state that the above LICENSE NO CUSS C p / mformatwn iscorrect I agree to comply with all Countyordmanoes and Stale 18wa relating to building c nSimuchon,arid hereby authorize reprasenta)9res of this County to enter upon the ahnvat ntloned py n r Inape n purposes SEE REVERSE FOR EXPLANATORY LANGUAGE