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HomeMy Public PortalAbout6340 ROSEMEAD BLVD_Mechanical__ 1/7 74j'1364CCE,-8,t8(REV.6/78) ©s APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS G o C (PRINT OR TYPE ONLY) LOCALITY NO. TYPE OF APPLIANCE-OR EQUIPMENT FEE NEAREST - CROSS ST. ABSORPTION UNIT;.BTU " OWNER AIR HANDLING UNIT,CFM MAIL' _ ADDRESS . i BOILER,BTU CITY TEL.NO. -/.. �6--r ��^ } COMPRESSOR,BTU 3 CONTRACTOR • /T VENTILATION SYSTEM ADDRESS EVAPORATIVE COOLER / CITY - TEL.NO. '^ C' • FURNACE: FAU GR VITY STATE LIC. /I J FLOOR BTU LICENSENO.2- •6 CLASS C-ZZ0 HEATER: SUSPENDED UNIT_ APPROVALS DATE - INSPECTOR'S SIGNATURE WALL ROUGH " q� FINAL �",�dy''�� ����r'J�-•.-�4 ®. INSPECTION RECORD IIN Plan check fee 25% of above. 6 dQ JO,;-- VI5 A107 PERMIT ISSUING FEE$ TOTAL FEE PLAN CHECK APPLICANT PLAN CHECK VALIDATION NAME ADDRESS CITY. TEL.NO. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND 21 1 4,2 A LCHAPTER T THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ES AND LAWS REGULATING HEATING, VENTILATING, AIR NING. PERMIT VALIDATION # 0 0 0 0 [�REBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF 2 ,� o (�.!�' O0 9, DIVISION 3, THE BUSINESS AND PRO ESSIONAL CODEATE OFC RNIA.`M , 0 0 097000TTEE DISTRICT NO. il ESS Y 11,03-78 POLICY HOLDEN: ,'_ POLICY NIJFVIRI°P• - 7.-_ --sem WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, 76A364C HEATING - VENTILATING - AIR CONDITIONING or a certified c6py thereof (Sec. 3800, ab. 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 insp(ic- FOR APPLICANT TO FILL IN BUILDING tion department. (PRINT OR TYPE ONLY) ADDRESS nan Date Applicant LOCALITY t NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTIO ry FROM WOR R ' NEAREST COMPENSATION INSURANCE ABSORPTION UNIT,.BTU CROSS ST. �({1�tSj• C,)' (This section need not be completed if the work'involved by DISTRICT NO. PROLE BY the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this AIR HANDLING UNIT, CFM , permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. BOILER, BTU APPROVALS DATE INSPEC R'S SIGNATURE ('•� Date. ' d Applicant .dates�+�, "7u"Ly o///11///11 COMPRESSOR, BTU ROUGH NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM 100 FINAL Exemption, you should become subject to the Workers' 5 /,t,�///��� Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER V V AL ATI iv tl with comply with such provisions or this permit shall be deem- v v ed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT (commencing with Section 7000)of Division 3 of the Business WALL- and Professions Code,and my license is in full force and effect. Ab h� cS1"i5��L �— tJJ(J r License Number Lic. Class �� , CL Contractor Date O 0 El : I am exempt under Sec. Plan check fee B.&P.C. for this reason. H Date: PERMIT ISSUING FEE $ _ Z Signature TOTAL FEE Za b6. 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 PA"E S Professions Code): I, as owner of the property, or my employees with ADDRESS fJOo/4AC F'i U wages as their sole compensation, will do the work and CC• CITY TEL. NO the structure is not intended or offered for sale(Section �'� 'P � J�• �` ��. •_� L;7 223.007044, Business and Professions Code). OWNER L I, as owner of the property, am exclusively contracting I ITEM with licensed contractors to construct the project (Sec- MAIL tion 7044, Business and Professions Code). ADDRESS TOTAL 223 m CIO CONSTRUCTION LENDING AGENCY CITY TEL. NO. CHECK 2223-5.j 10 I hereby affirm that there is a construction lending agency for the performance of The work for which this permit is issued CONTRACTOR loop. �;l{¢t3 ° l!I (Sec. 3097, Civ. C.). ADDRESS Lender's Name n ® _i 1 8/' CITY / TEL. NO. "Zl� {JI.300-108/10/9101Lender's Address u � STATE C LIC. 2480 t `r` I certifythat I have read this application and state that the LICENSE PP LICENSE NO. rJ V CLASS 6640 J above information is correct. I agree to comply with all County ordinances and State laws relating to building construction, and hereby uthorize repres ntatives of this County to enter Upon a :vin/tion operty for inspection purposes. 9n SEE REVERSE FOR EXPLANATORY LANGUAGE q9 -ature of Applican gent Date ©s ION DECLARAT WORKER'S I have a certificate of consent to 76A346DPW9/89 APPLICATION FOR PERMIT LIME GREEN 76A364C I I�ereby affirm that I have a certificate of consent to self insure, ora certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec. 3800 Lab. C.) �. a� I Policy No. Company - COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUDRE83 department. (PRINT OR TYPE ONLY) DateZ LOCALITY Applicant � NO. TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS ST. COMPENSATION INSURANCE ABSORPTION UNIT,BTU (This section need not be completed if the work involved by the ASSESSOR MAP BOOK PAGE PARCEL . permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU /� Q become subject to the Workers'Compensation Laws. J !/O Ca /LZF�—fit-tom o COMPRESSOR,BTU /'9V'b" ��• O� APPROVALS DATE INSP OR'S SIGNATURE Date Applicant3 VENTILATION SYSTEM �3 3` J NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER p L)/ P provisions of the Labor Code, you must forthwith comply with such FINAL $'�i0 '%GO G provisions or this permit shall be deemed revoked. FURNAC AU LICENSED CONTRACTORS DECLARATION y.s-O -SOD o0O �, DD VALIDATIQW I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: Fi SUSPENDED UNIT A! 8 (commencing with Section 7000) of Division 3 of the Business and WALL 4CT.a Professions Code,and my license is in full force and effect. 3303 390.25 \License Number626+7 3 2- Lic.Class `—�— ✓ ,3 J?0 1 ITEMS 1t�� ci , � L �j 3 0y' 6 o Tr_�TAL390 - 25 a. Contractor ) Date 7 0 CHECK 390.25 0 ❑ Plan check fee t'r eQo 0 I am exempt under Sec. WANGE B.&P.C.for this reason PERMIT ISSUING FEE$ Ft O Date: TOTAL FEE (d U LU Signature � � o lef 'l 1 J� �� O- 9 OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT 1 Rpt.}{ (n I hereby affirm that I am exempt from the Contractor's License Law NAME ITE[�S tii' 7 "VV for the following reason (Section 7031.5, Business and Professions Code): ADDRESS TOTAL 807 -810 CHECK n t ❑ I, as owner of the property, or my employees with wages CHECK 307.80 as their sole compensation, will do the work and the CITY TEL.NO. u ■fir structure is not intended or offered for sale (Section 7044, CHANGE .00 Business and Professions Code). OWNER ❑ I, as owner of the property, am exclusively contracting MAIL with licensed contractors to construct the project (Sec- ADDRESS 0000-0001 7/ 2/96 tion 7044, Business and Professions Code). �1 CONSTRUCTION LENDING AGENCY CITY TEL.NO. 7?a9 1 AM 1V w I hereby affirm that there is a construction lending agency f.,\. CONTRACTOR the performance of the work for which this permit Is issue - (Sec.3097,Civ.C.). p � Lender's Name \ ADDRESS � ZG� l 2 f�s f/ J -+ CITY r e Ig4�_,7 TEL.NOIJg 709 Lender's Address STATEr7 e LIC. / I certify that I have read this application and state that the above LICENSE NO. / 2 CLASS ,2-a information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon the above-mentioned Zprerty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �O APPLI GENT DATE WORKER'S.GOMPE=iSATIONDECLARATION DPW 76A364APPLICATION FOR PERMIT LIME GREEN 76A364C I herebyeffirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified HEATING -VENTILATING-AIR CONDITIONING copy thereof(Sec. 3800 Lab. C.) Policy Nn (':)IOqC/S"t�7Co'pang C.j/Yf C,I1ZL'- COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished. ❑ Certified copy is filed with the count buildinginspection FOR APPLICANT TO FILL IN BUILDING department., mNf^r�y p (PRINT OR TYPE ONLY) ADDRESS �f/Y"q A Ilcant/n�fW UI L l� LOCALITY e Date PP i NO. TYPE OF APPLIANCE OR EQUIPMENT FEE - CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS COMPENSATION INSURANCE ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed if the work involved.by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU O� become subject to the Workers'Compensation Laws. COMPRESSOR,BTU I. ' U0 APPROVALS DATE I E 'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of I ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions ofthe Labor Code, you must forthwith comply with such FINAL 28� provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY VALIDATION LICENSED CONTRACTORS DECLARATION FLOOR BTU hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and .WALL Professions Code,and my license is in full force and effect. Lr Colo. 0v ��ZS�tYe-L��3sr License Number� Lia Class Contractor 6 V'r/La Q• Date S - V ❑ I am exempt under Sec. Plan check fee B.&P.C.for this reason PERMIT ISSUING FEE $ 2-10 0 U Date: TOTAL FEE 1'1 Q d Signature fA OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT Z I hereby affirm that I am exempt from the Contractor's License Law NAME for the following reason (Section 7031.5, Business and Professions Code): ADDRESS rP(' ❑ I, as owner of the property, or my employees with wages Al•4•ToF as their sole compensation, will do the work and the CITY TEL.NO. 3303 41•f7 .80 structure is not intended or offered for sale (Section 7044, ITEMS 7 Business and Professions Code). OWNER 1 1TEi I ❑ 1, as owner of the property, am exclusively contracting MAIL TOTAL 41 e`-�F m 80 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CITY TEL.NO. CHECK 417080 CONSTRUCTION LENDING AGENCY t� Nrc 00 I hereby affirm that there is a construction lending agency for CONTRACTOR s , CHANGE a the performance of the work for which this permit Is issue (Sec. 3097,Civ.C.). _ ADDRESS //C �• I� UUVO-� t11 JJ 1 / Lender's Name O!J I� O CITY IANC&.//� TEL.NO. 1-y7 x)v 6382 1 A!i 7 n 11 Lender's Address STATE LIC. J V I certify that I have read this application and state that the abov LICENSE NO. � CLASS C information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon the above-mentioned (�roperty for ins ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE y/ 5--ly-2� SIG URE OF APPLICANT OR AGENT DATE