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Home My Public Portal About6322 ROSEMEAD BLVD_Mechanical__ 76AA364C CE-818(REV.6/78) os APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING (PRINT OR TYPE ONLY) ADDRESS 6322 N. Rosemead NO, TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY 'Temple Cit NEAREST l CROSS ST. Longden ABSORPTION UNIT,BTU OWNER AIR HANDLING UNIT,CFM MAIL _ ADDRESS Same as. above. BOILER,BTU CITY TEL.NO. COMPRESSOR,BTU 10 00- CONTRACTOR ' McAfee Engineering VENTILATION SYSTEM ADDRESS 22010 'S.• Wilmington Ave. , ��1.. EVAPORATIVE COOLER CITY Carson TEL.N0518-1800 FURNACE: FAU GRAVITY STATE LIC. FLOOR BTU LICENSE NO. 287684 CLASS C-20 HEATER: SUSPENDED UNIT_ APPROVALS DATE INSPECTOR'S SIGNATURE WALL ROUGH � Remodel - Remove existin FINAL unit and add new roof-t0 INSPECTION RECORD 09 heat pump Plan check fee 25% of above. PERMIT ISSUING FEE$ 7 00 TOTAL FEE 17 00 PLAN CHECK APPLICANT P AN CHECK VALIDATION ^ NAME ADDRESS /' O 0.4 A CITY TEL.NO. #'o o'o o LI IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION-AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL 2 o o 1 7.0 0 ORDINANCES AND LAWS REGULATING HEATING, VENTILATING. AIR �y CONDITIONING. .O o o 1 (y O 0 V PERMIT VALIDATION I HEREBY, CER AT I A NOT ACTING IN VIOLATION OF CHAPTER 9, DIVISI THE NESS AND PROFESSIONAL CODE '10.02-79 , OF(LIF2011A. " LOF�THE �STATE DISTRICT NO. PRO SED BY WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certific;:;p of Workers' Compensation Insurance, 76A364C HEATING - VENTILATING - AIR CONDITIONING or a certified'zopy thereof (Sec. 3800, Lab. C.) .20-0046 DPW 9/88 Policy No. Company Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING tion department. ADDRESS 2Z (PRINT OR TYPE ONLY) Date Applicant LOCALITY -re ln T" CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. '(This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. PROCESSE the permit is for one hundred dollars ($100) or less.) ` J 'I certify that in the performance of the work for which this AIR HANDLING UNIT, CFM (/ permit is issued, I shall not employ an rson in any manner so as to become subject to the War'- rs' 0mpensatio L s. BOILER, BTU APPROVALS DATE SPECTO ' SIGNATURE 0 Date Applicant ( COMPRESSOR, BTU EXE 0 ROUGH NOTICE TO APPLICANT: If, after aking this C rtificate of VENTILATION SYSTEM FINAL �� Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deem- ed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT- (commencing with Section 7000)of.Division 3 of the Business HEATER: WALL. and Professions Code,and my license is in full force and effect. . License Number 4 9 ov Lic. Class 2c�) CL} O Contractor a'k��urhD"ate /7' ZZ-10 U oG ❑ I am exempt under Sec. 0 Plan check fee B.&P.C. for this reason. W Date: PERMIT ISSUING FEE $ Z Signature TOTAL FEE OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License ' Law 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 ACC .J' the structure is not intended or offered for sole.(Section CITY TEL. NO. 7044, Business and Professions Code). OWNER 33-17 •-_-- � ❑ I, as owner of the property, am exclusively contracting } ITEMS with licensed contractors to construct the project (Sec- MAIL tion 7044, Business and Professions Code). ADDRESS 01,AL 25 - 00 CONSTRUCTION LENDING AGENCY CITY TEL. NO. :--., c I hereby affirm that there is a construction lending agency for CHUX -� },Cj_t the performance of the work for which this permit is issued CONTRACTOR 1` C , F. H�(3E vial._°• (Sec. 3097, Civ. C.). ADDRESS �y Lender's Name `' f ® TEL. �r CITY ✓j'' TEL. NO. 6Z,5-CJp3J �I 00-01001 if/ 14/9 l Lender's Address STATE LIC. if f' Lac I certify that I have read this application and state that the LICENSE NO. 5-1 C)Q ItCLASS l2,0 # Al t1U'''L' above information is correct. I agree to comply with all County ordinances and State laws relating to building construction, andher uthorize representat' es of this County to enter upo a ab ve-mentione "pr9orty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE d�z,:z-w Signature of Applicant o Agent• Date ©s