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Home My Public Portal About4343 TEMPLE CITY BLVD_Mechanical__ -6A364 -CE918 - 3-69 APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUI LO ING /J/Y� DEPARTMENT OF COUNTY ENGINEER ADDRESS vf/ BUILDING AND SAFETY DIVISION JOHN A LAMBIE COUNTY ENGINEER LOCALITY G/ COLEMAN W JENKINS,SUPERINTENDENT OF BUILDING NEAREST CROSS ST FOR APPLICANT TO FILL IN OWNER C - H .Y (PRINT OR TYPE ONLY) MAIL nAn NO .TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS JY1 ABSORPTION SYSTEM BTU CITY TEL NO CONTRACTOR / o AY�' AIR HANDLING UNIT CFM _ es 09 ADDRESS O /0 4e1- BOILER HORSEPOWER n �� 9�/q CITY TEL NO EO /` J COMPRESSOR, HORSEPOWER- Oln STATE LIC LICENSE NO CLASS - VENTILATION SYSTEM DISTRICT NO GROUP ZONE PROCESSED BY EVAPORATIVE COOLER 0 97_ / FURNACE FAU GRAVITY FLOOR BTU p INSPECTION RECORD HEATER SUSPENDED—UNIT— WALL US ENDED_UNIT_WALL 0. O U oe O Q NEW_ADDITION_ PERMIT $ 3 00 'Z— ALTER--REPAIR— PLAN TOTAL FEE $ p 0 PLAN CHECK APPLICANT NAME I ' ADDRESS CITY 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- APPROVALS 7E IWOR 9 SIGNATURE LATING AIR CONDITIONING I HEREBY CERTIFY T T I AM NO ACTING IN VIOLATION OF ROUGH CHAPTER 9 DIVISION OF THE B INE SCS A PROFESSIONAL FINAL CODE OF THE STATE ALI FOR SIGNATURErL JACK R ALLEN, SUPERVISI MECHANICAL ENG'R OF PERMITTEE PERMIT VALIDATION CK M 0 CASH PLAN CHECK VALI A ON [.Ar, 3 1 -a a� DEC 22 a 1 D 1 5.00- 'EE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE aB18(REV 11 h78) , m+ APPLIC N PERMIT HEATING - VENT ATI AIR CONDI ZONING COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL INI ING TPc� !Ty ES V IPflINT OR TYPE ONLYI LOCALITY_ NO TYPE OF APPLIANCE OR EQUIPMENT FE EST S ST OWGF ABSORPTION UNIT BTU ER PIT wct� / AIR HANDLING UNIT CFM 6ff U P2p j?VV �C. V ,r ESS G�ll'3 L,cz" �j O BOILER BTU_ CITYL 1 /0AO& TEL NO ) COMPRESSOR BTU CONTRALTO VENTILATION SYSTEM ADDRESS !Y 1 EVAPORATIVE COOLER CITY )TATE J+ p6 1` TEL NO �/�&�4Z hY LIC FLOORFURNACE F A U_BTU GRAY RV LICENSE NO /(i Z O a 7 CLASS C.+ ZD HEATER SUSPENDED-UNIT AppnovAlS DATE INSPECTORSSIOnAN WALL ROUGH r 6 FINAL 16firl. O V INSPEC ION RECORD m 160 Plan check fee 259'P of above PERMIT ISSUING FEE$ TOTAL FEE 7 D PLAN CHECK APPLICANT P GH VALE NAME / ADDRESS CITY S TEL NO 2j(0r-42,7f I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND 19 1 4 6 A STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING VENTILATING AIR CONDITIONING PERMIT VALIDATION # 4 1 1 HEREBY CERTIFY THAT I AM NOT ACTING IN IOLATION OF CHAPTER 9 DIVISION 3 OF THE BUSINESS AND P F I NAL CODE 2,• • 3 7.0 0 OF THE STATE OF IFO SIGNATURE 0 0 3 7 0 0 6 OFPERMI E DISTRICT NO I PR S D BY 0226-80 /off WORKERS COMPENSATION DECLARATIONaffirm APPLICATION FOR PERMIT d'cenifimtte of Workers Compensation oe of n Insuran ent to lf '" �' HEATING - VENTILATING - AIR CONDITIONING mace r fled o y thereof Lab C ) 76A3AIC f,'� �,�\a 2D 0046 DWI 9/BB Policy o mpan}� eC - COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy a hereby furmahed i ❑ Certified copy is filed with the county building nsp c- FOR APPLICANT TO FILL IN BUIL04NG 34 hon department ADDRESS 3 LyTV ��5 we. (PRINT OR TYPE ONLY) / r Dot (�(/ ApplicantLOCALITY Lt_- C NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST COMPENSATION INSURANCE CROSS ST ' ABSORPTION UNIT BTU (This aaxflon need not M completed R the work Imolvod 6T __715`109 astTacr nq the permit b for ono hurdrod ddFon (SI00)or Iwo) - /'—J a - I certify that in the performance of the work for which this AIR HANDLING UNIT CFM a.� 1 ®0 permit is Issued I shall not employ any person in any manner JJJ sa as to become subject to the Workers'Compensation Laws BOILER BTU AFPgOVALS DATE INSPECTOR S SIGNATURE Dote Applicant - COMPRESSOR BTU ROUGH i T NOTICE TO APPLICANT If, after`making this Certificate 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 co=with such provisions or this permit shall be deem- ^ ed revoked I I FURNACE FAU__GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I I hereby off irm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED UNIT c (commencing with Section 7000)of Division,3 of the Business WALL _ and Professions Code,and my license Is in full force and (effffeectt Y 1 License NumberV�Z LIc Class -C-V-3 , d Contractor d/ J/A,•Date ❑ O I am exempt under Sec - Plan check fee 8 SP C fat this reason w Dote PERMIT ISSUING FEE $ 2 Signature I TOTAL FEE Or)r3 OWNER-BUILDER DECLARATION - RAN CHECK APPLICANT ' I hereby affirm that I am exempt from the Contractor's License i Poo.Low for the following reason (Section 7031 5 Business and NAME - - Professions Code) I, as owner of the property or my employees with ADDRESS 8 wages as their sole compensation, will do the work and ANT3 the structure is not intended or offered for sale(Section CITY - TEL NO 7044 Business and Professions Code) OWNER &kV So=G 7 � I, as owner of the property, am exclusively contracting - 00 L ITEMS with licensed contractors to construct the project (Sec- MAIL I/� /fie' S tion 7044, Business and Professions Code) ADDRESS /i' `.r TOTAL "� .OO CONSTRUCTION LENDING AGENCY crry TEL No I hereby affirm that there ISO construction lending agency for s.TTGf.It 25•00 y the performance of the work for which this permit is issued CONTRACTOR / (Sec 3097, Civ C ) CHANE ' ,(KI , ADDRESS - _ - Lender's Name , .. .-__ _ •�J� � _ clT, /r y TEL No' 0000-0001 5/ 1/90 Lenders Address _ 1 certify that I hove read this application and state that the LICE hip UC 0427 1 AM 9: above information is correct I agree to comply with all County i ordinances and State jaws relating to building construction and hereby authorize repipsentahves of this County to enter upon the eve-mento 6s'pr for inspection purposes - E REVERSE FOR EXPLANATORY LANGUAGE �1S-9d Signaxxe of Apphoan w Agent Dote ®s r , WORKERS COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby affirm that 1 have a certificate of consent to self insure or a certificate of Workers'Compensation Insurance, or a certified copy thereof (Sec 3600 Lab C7AA364C HEATING) - VENTILATING - AIR CONDITIONING / CE 818 IREV 10/81) Policy No Compony 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 - BUILDIW, tion—deppartmeen�tt (PRINT OR TYPE ONLY) ADDRESS ,Q o'��L� DaleApplicant LOCALITY FEE NO TYPE OF APPLIANCE OR EQUIPMENT CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST COMPENSATION INSURANCE _ CROSS ST (This section need not be completed If the work Involved by ABSORPTION UNIT BTU olsrPicr 1,10 PROCESSED ry the permit is for one hundred dollars ($100)or less) Q I certify that in the performance of the work for which this AIR HANDLING UNIT CFM permit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws BOILER BTU APPROVALS ATE INBPPCTOR s SK3"TU Date Applicant COMPRESSOR BTU ROUGH NOTICE TO APPLICANT If after making this Certificate of VENTILATION SYSTEM a' FINAL - Exemption you should become subject to the Workers' CompensatioIT n provisions of the Labor Code, you must forth EVAPORATIVE COOLER V LID TIO with comply with such provisions or this permit shall be deemed revoked FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED UNIT_ (commencing with Section 7000) of Division 3 of the Business WALL and Professions Code, and my license is in full forced affect > d License Number is Class - - , V Contra cto Date] ' ❑ I am exempt under Sec {� 1 a G Plan check-fee LLL U J B 8P C for this reason us Date PERMIT ISSUING FEE$ e e e 2 Q 5 0 6 Z Signature TOTAL FEE 1206-88 OWNER BUILDER DECLARATION PLAN CHECK APPLICANT 1 hereby affirm that I am exempt from the Contractors License oil.Low for the following reason (Section 7031 5 Business and NAME /"" Professions Code) ❑ 1 as owner of the property or my employees with ADDRESS wages as their sole compensation will do the work and CITY TEL NO structure n not intended or offered for sale(Section 7044 Business and Professions Code) OWNER ❑ I as owner of the property am exclusively contracting MAIL with licensed contractors to construct the project (Sec ADDRESS hon 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCYCITY TEL'NO 1 hereby affirm that there is a construction lending agency for _ the performance of the work for which this permit is issued CONTRACTOR - ► - (Sec 3097 Civ C ) . _ ' ADDRESS Lender's Name CITY r TEL NO Lender's Address - I certify that I hove read this application and state that the STATE NO LIC q orr5g _ above information is cect I agree to comply with all County - ordinances and State jaws relating to building construction and hereby authorize representatives of this County to enter ' upon the above a on proper inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Sigrwlure of Applicant or Agent Dote ` - - WORKCOMPENSATION DECLARATION � nfe DPW 9/89APPLICATION FOR PERMIT LIME GREEN I hereby affirm thatt I have have a certificate of consent to aeli•Ineure 7sA384C or a certificate of Worker a Compensation Insurance or a certified HEATING-VENTILATING-AIR CONDITIONING copy thereof(Sec 3900 Lab C) Sl L. i Policy No Id aqj Comparq - �"�+ rsf. d' COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV ElCem9ed copy is hereby furnished L=1 �xi=py is filed with the county building inspecion FOR APPLICANT TO FILL IN AD�pq q ZE , (PRINT OR TYPE ONLY) Date 7 ' Applwam �/�—✓ LOCALITY NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEM h FROM WORKERS NEAREST COMPENSA I URANCE CROSS ST (Thle tm action need not be cople d If the work Involved by the ' ABSORPTION UNIT 9N AA SS SSj PAQE PARCEL - permit Is for one hundred dollera(11100)or leas) AIR HANDLING UNIT CFM oarxr so wiocaasm ar I certify that m the to employ of the work for which this permit C•a�L>w'�"w"'— le leaned I shell not employ any person In any manner so as to BOILER RTU p become sublect to the Workers Compensation Lewy ' Q Q COMPRESSOR BTU AFPra�vras Dore Mose aonAn.ns Data Appllcem VENTILATION SYSTEM NOTICE TO APPLICANT 11 alter making this Certificate of ROUGH Exemption you should become sublect to the Workers Compensation EVAPORATIVE COOLER provisions of the Labor Code YOU must forthwith comply with Such FINAL provisions or this permit shell be deemed revoked FURNACE FAU_GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION 1 hereby affirm that 1 em licensed under provisions of Chapter 9 HEATER SUSPENDED UNIT_ r n; (commencing with Section 7000) of Division 3 of the Business and WALLr"�` Professions Code and my license is In full force and effect 0 License Number4+-2 DO % Lic Clam ��,, �p� _ ► ACCT.: > Contract« / c Date J.1L2L1J_. y H v dhWS aD I17 17 7IJ0 El I am exempt under Sec Plan Check fee Q 1 B sP C for this reason PERMIT ISSUING FEE$ 0 Dae p 1 ITEMS v 9pneNre TOTAL FEE OQ VITAL 132 � S0 d 05 N BUILDER DECLARATION PLAN CHECK APPLICANT CHECK T 132.8-.1Z ,I hereby affirm I t I e exempt from the Contractor a License Lew �E , ,_Hr11�JG .IJU for the following res (Section 7031 5 Business and Professions Code) ADDRESS ❑ 1 as owner of the property or my employees with wages as their sole compensation will do the work and the CT' TEL NO O:IpCI—;ulu1 i�i7/Yi structure is not intended or offered for sale (Section 7044 Business and Professions Code) OWNER ❑ I as owner of the property em exclusively contracting MAL /_ with licensed contractors to construct the project (Sec ADDRESS T-�p ,lion 7014 Business and Professions Code) CONSTRUCTION LENDING AGENCY GMM , I hereby affirm that there is a construction lending agency for CONTRACTOR r , the performance of the work for which this permit ?I ieeuetl / f v L (Sec 3097 Cr, C) _ ADDRESS ,E. Lenders Nesse � CITY {)�— I Ila— C109NO Lender a Address _ I certify that I have read this application and state that the above ME NO 4e{—ZOk9 7 CLASS information is correct I agree to comply with all County«dmancee _ and State lawn relating to building conalruclwn and hereby emhonze representatives of this County to enter upon the above mentioned _ property for inspection purposes _ SEE REVERSE FOR EXPLANATORY LANGUAGE , /9/ ' TU RE OF APPIJGV/T ORAOEKT DATE