HomeMy Public PortalAbout5607 ROSEMEAD BLVD_Mechanical__ TB A]aa - CE $18 -I/TS
APPLICATI FOR PERMI
HEATING - VENTILATING • AIR CO DITIONING ?O�
COUNTY OF LOS ANGELEJRA LDING ^ �l
DEPARTMENT OF COUNTY ENGDRESS L/
BUILDING AND SAFETY DIVISALITY
REST Ir n I
SS ST J
FOR APPLICANT TO FILER
(PRINT OR TYPE ONLY)
IL
NO TYPE&SIZE OF EQUIPMENTDRESS ovel 1)
SEE BACK OF APPLICATIO
Y TEL NO
FORCE AIR FURNACE BTU
TRACTO%A AY HEATING SERV(
COMPRESSOR BTU
DRESS 13609 E IMPERIAL HIGHWAY
5P M
VENTILATION FANY A/D � ITELNO i-LIST ALL OTHERS BELOWTE Gi LIC
ENSE NO 32�� CLASS G —a O
nISTR,Cl NO GROVP LONE CESSED BY
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INSPECTION RECORD
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Plan check fee See reverse
PI'li 111 l 1�4 IA( FII $
IDI 11 III02 0a
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL NO
I HEREBY ACMVOWLEDOE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCESAND LAWS REGULATING HEATING VENTI APPROVALS DATE INSPECTORS SIGNATURE
LATING AIR CONOITIO NI NO
ROUGH J6
1 HEREBY CERTIFY 1 M NOT IND IN LATION
OF CHAPTER 9 OIVI9 3 F HE BU SS AN FESSIONAL FINAL '/.
CODE Or THE B6ia
SIGNATURE PERMIT VALIDATIO cN M o CASH
OF PERMITT
PLAN CHECK VALIDATION cN cn BH
6 8 3;!,MN 30 A 1- R 2 7A 0 �a
Ove
R100
RSCOMPENSATION DECLARATION 9lea APPLICATION FOR PERMITLIME GREEN
i have aertlficete of consent toself Insure
rkCompensation Insurance or a certified HEATING-VENTILATING-AIR CONDITIONING
y1. Lab C)
Policy No Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
❑ Cemhed copy le hereby furnished
❑ Certifiedcolpy Is hied with the county building inspection FOR APPLICANT TO FILL IN B,yppR� O E•Mt t (y�
(PRINT OR TYPE ONLY)
Dela Applicant anl NO TYPE OF APPLIANCE OR EQUIPMENT FEE -Tell
1
CERTIFICATE OF EXEMPTION FROM WORKERS C�NEAREST J K 1
COMPENSATION INSURANCE ABSORPTION UNITBTU '
(Thin section need not be completed If the work Involved by the MAP BOON PAGE PARCEL
permit In for a"hundred dollars($100)or less) NR HANDLING UNIT CFM
oisrwcrrio rsoc�mer
I candy,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 5• Q 8
become subject to the Workers Compensation Laws �y
COMPRESSOR BTU 104"D
✓ Q
xrrviovua wn eexv«Tu�
Date QApplcam VENTILATION SYSTEM
NOTICE T AP LICANT If at king ihia Certificate of ROUGH f
Exemption you should become subject to the Workers Compensation EVAPORATIVE COOLER
provisions of the Labor Code you must forthwith comply with such FINAL 2
provisions or this permit shell be deemed revoked FURNACE FAU GRAVfTV
LICENSED CONTRACTORS DECLARATION bl FLOOR BTU GO ID ION':+
I hereby affirm that I em licensed under provisions of Chapter 9 HFA7FA SUSPENDED—UNIT—
(commencing
USPENDED UNIT_(commencing with Section 7000) of Division 3 of the Business and WALL $4 X A
Professions Code and my license Is in full force and effect f
1L req M*
License Number
diona LIc Gass G-JD U '
^yv y � a
cont ,.l., d le 1 .3 1 ~ ' 8
Plan check fee r
❑ I am exempt under Sec �•• Cl b0' 43 f cc
B aP C for this reason PERMIT ISSUING FEE i 24 — !n } V
DateTOTAL FEE 60 -75 ,ti d
Signature
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT Z
I hereby affirm that I em exempt from the Contractor's License Lew NAME !f
for the following reason (Section 7031 5 Business end Professions sL
Code) ADDRESS ' 1t=.s �...1C w 11•, i$vrlJ! j f lU.!J
❑ I an owner of the properly or my employees with wages FJ- WRQ c-
c �
as their sole compensation will do the work and the CITY �� TEL NO -'9 _ y
sEL KW
tructure is not intended or offered for sale (Section 7044, % ', t '`� •i •TVs v v
Business end Professions Code) OWNER liTletir SAV 4$.�s -
❑ I as owner of the property am exclusively contracting (✓f _
MAIL •.,�}�
with licensed contractors to construct the project (Sec ADDRESS O �L'�+�'sc./�/
tion 7014 Business and Profeseione Code) CITYTEL NO _
CONSTRUCTION LENDING AGENCY C+1T 0:11- •c'r 1.•Tfu
I hereby affirm that there is a construction lending agency for CONTRACTOR
the performance of the Work for which this permit ra issuedC2 01
(Sec 3097 Civ C) ADDRESSt�l.- r r•� 10
-
Lenders Name R`- t 210 -75
CITY \AADKM TEL NO
Lender•Address STATE LIC
I damn that I have reed this application and state that the above LICENSE NO o CLASS
information to correct I agree to comply With all County ordinances
and State laws relating to building construction,and hereby aulhonze W u"`
representatives of this County to enter upon the above mentioned n
arty for map Gi n purpos SEE REVERSE FOR EXPLANATORY LANGUAGE
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NA iK AYPl1CAMr O A FJm re