HomeMy Public PortalAbout5595 ROSEMEAD BLVD_Mechanical__ 76 A364-- CE 818- 5-73
APPLICATION FOR PERMIT
• HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADDRESS LAS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.///s
FOR APPLICANT TO FILL IN
OWNER
(PRINT OR TYPE ONLY) MAIL
✓ �� �� c
No. TVPEOF APPLIANCE OR EQUIPMENT FEE
ADDRESS
CITY Rd IS /J�H TEL. NO.
ABSORPTION UNIT, BTU
CONTRACTOR C. O
L� r
AIR HANDLING UNIT, CFM n e
ADDRESS ll .r
BOILER, BTU CI TYZLR IV .` .: TEL. NO. 2
COMPRESSOR, BTU STATE w // LIG G`',LICENSE NO. 91t7� 615- CLASSC - jg-
VENTILATION SYSTEM DISTRICT NO. GRDUP ZONE PRO27SED Br 1
EVAPORATIVE COOLER G//FURNACE: FAU GRAVITY INSPECTION RECORDFLOOR BTUHEATER: SUSPENDED—UNIT_WALL
7 2 !Plan check fee 25 of above. See reversePERMIT ISSUING FEETOTAL FEF. R
PLAN CHECK APPLICANT
NAME #ZLL
ADDRESSf' 05APPLICATION
/�/(l,f�CITY�O ry '_'4 ;' ' TELIHEREBY ACKNOWLEDGETHAT I HAVE REALICATIONAND STATE THAT THE ABOVE IS CORRECT ANCOMPLYWITHALL ORDINANCES AND LAWS REGULATI , VENTI- APPROVALS DAATE INSPECTQR'S SIGLATING, AIR CONDITION INO. ROUGHI HEREBY CERTIF 14T qM NOT AIOLATIONOF CHAPTER 9, DIVISI N OF THEBUSINESSSIONAL FINALCODE OF THE STATE LIFORJIIA.SIGNATURE PERMIT VALIDATION cK. MOF PERMITTE ✓-� '�-
PLAN CHECK VALIDATION CK. M.0. CASH
7 3 7 sura 1 4 1 0 1 4.5 U
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
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]p A36 - CEO1 B- 5-73
APPLICATION FOR PERMIT
NEATING - V�ENTIILATTINNG� - AIR.CONOITIONING
COUNTY OF LOS ANGELES
DEPARTMENT ADDRESS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY G
NEAREST
CROSS ST ((s
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) G
MAIL / e
NO YPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS (p +,may r
CITY F30 T TEL —
ABSORPTION UNIT, BTU
CONTRACTORMa (son
N
I AIR HANDLING UNIT CFM 1,5ygoR ' a0l
ADDRESS I G C
Ile—
BOILER, BTU CIT V S TEL NO 'f"�/A/EO�
COMPRESSOR BTU TJX 1000 -4 STATE LIC LICENSE NO /LK7(p 0'� 1 CLASS G'�ZO
VENTILATION SYSTEM PO DISTRICT NO GROUP ZONE I PROCE eo er
EVAPORATIVE COOLER 300 ✓ GR
Oa / c2- C -3
REFURNACE FAU ✓ GRAVITY
h FLOOR BTU I _ 0.ploy_ INSPECTION RECORD
HEATER SUSPENDED—
UNIT-WALL
Y
d
O
/ O
1--
U
W
L
S
PhD check fee 25" of abo,c See rcrene z
PER\II I IS91ANG M F F S
FOl Al I,FF -50
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY , TEL NO
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP/LIGATION
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING VENTI APPROVALS DATE INSPECTOR! IG RE
LATING AIR CORD ITIOXIXG
ROUGH
1 HEREBY CERTIFY THAT NOT ACTING IN VIOLATION
OF CH
APTER 9 DIVISION 3 OF THE
pUSINE3S AND PROFESSIONAL FINAL �
CODE OF THE !TATE OIIFORNIA 2L I
SIGNATURE PERMIT VALIDATION CK M 0 CASH
OF PERMITTEE arantluz
PLAN CHECK VALIDATION CN M o ASH
6 4 6nvinp 10 42 0 1 5_.19 °
9 18 4 1 u cl52 5 °
,7 1'-
SEE SACK OF APPLICATION PON MMPLRTF rrF Nrumiu r
WORKERS COMPENSATION DEClA4TION APPLICATION FOR PERMIT
I herebyff'arm that I have a cerlikate of consent to self
insure or a certificate of Workers Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
or a certified co thereof (Sec 3800 Lab C 76A364C
Polity Certified copy is hereby furnished Company �'' 20-OD4e DPW 9/98
F-1 CerCOUNTY OF LOS ANGELES BUILDING AND SAFETY
to Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING /j s,E1
hon de rtmenI /L - ADDRESS S L7iod
l/(•�A~eIAA'/CJ. (PRINT OR TYPE ONLY)
Date Apphcan^
110 TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST
COMPENSATION INSURANCE CROSS ST r It Irl
(This section need not be ctimplortod if the work Involved by ABSORPTION UNIT BTU DISTRICT No/ PRaassEo BE
I c parish Is for one hundred dollar ($IBo)or Ins) I g�
certify that in the performance of the work for which 1h4 AIR HANDLING UNIT CFM \
permit is issued 1 shall not employ any person in any manner BOILER BTU J
so as to become subject to the Workers Compensation Laws ���rs/-s APPROVALS DATE S SIGNATU
Date Applicant COMPRESSOR BTU /VQ zROUGH
NOTICE TO APPLICANT If, after making this Certificate of VENTILATION SYSTEM - n/l FINAL 1
Exemption, you should become subject to the Workers' VLA
Compensation provisions of the Labor Code, you must forth EVAPORATIVE GOOIER 1 VALID
with comply with such provisions or this permit shall be deem I \
ed revoked FURNACE FAU_GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby off Irm that I am licensed under provmlom of Chapter 9 HEATER SUSPENDED UNIT
(commencing with Section 7000)of Division 3 of the Business WALL
and Professions Code,and my li ense min full force and effect
Class (__M '
License Nu e r Uc I M , V
Controcf .AM, OL
❑ I am exempt under Sec
Plan check fee
B 8P C for this reason
O N
Date PERMIT ISSUING FEES =
Signature TOTAL FEE
OWNER BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Controcto/s License '
Law for the following reason (Section 7031 5, Business and NAME
Professions Code) rm�
Fj I, as owner of the property, or my employees with ADDRESS - t "' `g'�tF - 86.50
wagesas their sole compensation,will do the work and Gln, TEL NO
..a 1 ITEMS
the structure is not intended or offered for sale(Section
7044 Business and Professions Code) _ _ _ _ TOTAL 86.50
❑ I, as owner of the OWNER CJ t-
property, am exclusively project
(SecCIECK:
with licensed contractors to construct the project (Sec =LRE B T "�
hon 7044, Business and Professions Code) SS 1180 s�
CONSTRUCTION LENDING AGENCY CITY TEL N 114) J-/- [e ,
I hereby affirm that there is a construction lending agency for J 1N
the performance of the work for which this permit is issued CONTRACTOR
(Sea 3D97, Civ C ) ELWA/ O 0000-0001 7/17/89
Lender's Name ADDRESSgn 4503 1 AM 9003
Lenders Address CITY UTY Or UlDvWRYTEL NO 'C7 561-
certify that I have read this application and state that the IrATEt40 UC Ly O
above information m correct I agree to comply with all County ENSE
ordinances and State laws relating to building construction,
and hereby authorize representatives of this County to enter
��u n the above-mentioned property for inspection purposes
IIJ)M Y2Ip SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date ell