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Home My Public Portal About4819 TEMPLE CITY BLVD_Mechanical__ T �'9os&4eJAXinaAl-T�4V*0 !91790 78 J368 - CE 818• 573 APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BLDING V DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY 110'OIL NEAREST CROSS ST �4!5 FOR APPLICANT TO FILL IN OWNER Yo (PRINT OR TYPE ONLY) MAIL NO YPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS CITY TEL NO ABSORPTION UNIT, BTU CONTRALTO AIR HAND ING UNIT, CFM ADDRES CITY 061&gTNO _ COMPRESSOR, BTU STATE LIC LICENSE NO CLASS VENTILATION SYSTEM DISTRICT No GaouP zoNE oc spo By EVAPORATIVE COOLER �F O FURNACE FAU_GRAVITY FLOOR BTU INSPECTION RECORD HEATER SUSPENDED- UNIT-WALL Y _ d O U CC O H V W d H PhD rheck fee 25', of Ibc,, See re%cr,e z PFNNIII ISSUING FEt S o 101 \L FFF AIL PLAN CHECK APPLICANT NAME ADDRESS CITY TEL NO I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCE! AND LAWS REGULATING HEATINO VENTI- APPROVALS DATE INSPECTOR!SIGNATURE LATING Ala CONDITIONING ROUGH I NE REIY CERTIFY THAT NOT ACTING IN VIOLATION OF CHAPTER G DIVISION 3 OF THEE BUSINESS AND PROFESSIONAL FINAL CODE OF THE !TATE 0 LI FOR NIA SIGNATURE PERMIT, VALIDATION CK MO CASH OF PERMITTEE PLAN CHECK VALIDATION CK M 0 CASH S 5"�F aiJ 2p 4 1 49,5o ezz n/f t ro A 36- CE 811-1/TS APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES UILDIN5Yw LlJ� DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY /_ NEAREST CROSS Sr Lp 6, Zv VA FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) tfJ MAIL .�jj NO TYPE&SIZE OF EQUIPMENT FEE ADDRES`/-7 (�j -4a 400, SEE BACK OF APPLICATION FORCE AIR FURNACE BTU CITY �-/O TEL NO CONTRACTOR COMPRESSOR BTU ADDRESS ; _ LC VENTILATION FAN CITY ✓ 1 TEL NO ` LIST ALL OTHERS BELOW STATE LIC LICENSE NO Z O Z CLASS GZ p 1 DiSTRICT O GROUP ZONE PROCESSED BY 15 F - G INSPECTION RECORD (L a 0 U (C O r + U W EL Plan check fee See reverse PI 10111 IS�LIAf, FI 4 S D 1111 I I I PLAN CHECK APPLICANT ' NAME ADDRESS CITY TEL NO I XEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING HEATING VEKTI APPROVALS DATE INSPECTOR!SIGNATURE LAT ING AIA CONDITIONING ' ROUGH I HEREBY CERTIFY THAT AM NOT ACTING IN PROFESSIONAL OF CHAPTER 9 ATE Oi THE BUSINES! AND PROFEl910NAL FINAL CODE OF THE STATE C LIFOR NIA SIGNATURE I PERMIT VALIDATION cK M o CASH OF PERMITTEE ./ PLAN CHECK VALIDATION cK M o CASH I � 9746;lrrT 341 0 5Q,o0A9a WORKERS COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to ,elf APPLICATION FOR PERMIT Insure or a certificate of Workers Compensation Insurance or a certified copy thereof (Sec 3800 Lab C eA1e4C , HEATING - VENTILATING - AIR CONDITIONING ) CE 818(REV 10%81) , - 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 non department (PRINT OR TYPE ONLY) ADDRESS s Date Applicant LOCALITY L ,, NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST (This secilon need not be completed If the work Involved by ABSORPTION UNIT BTU DISTRICT W PROQ D BY the psmilt Is for one hundred dollars ($100)or less) AIR HANDLING UNIT CFM I certify that In the performance of the work for which this 16. Q permit is Issued I shall not employ any pe in any manner so as to become subject to the Worker% or enao ors BOILER BTU AV ItOVALS DATE INSRECYOR S SIGNATURE �O Oct, d-76 crAo _� Dote Ilea COMPRESSOR BTU J ROUGH NOTI TO PLICANT after making this Certlhc a of VENTILATION SYSTEM FINAL 1.2 Exemption you should become subject to the Workers _ Compensattoh provisions of the Labor Code, you must forth EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deemed revokedI FURNACE FAU LICENSED CONTRACTORS DECLARATION FLOOR N � Oy j hereby affirm that I am licensed under provisions of Chapter 9 HEATER SUSPENDED UNIT_ (Commencing with Section 700D) of Division 3 of the Business WALL and Profess ons Code and my license Is In full force arid effect - 1 ,conseL/�ryy/yymb��r Llc Classy:—Z/� , V raCMnf c(6r-' ❑ I am exempt under Sec _ _ W I ' Plan check fee - B 8P C for This reason PERMIT ISSUING FEE $ p Dare Signature _TOTAL FEE OWNER-BUILDER DECLARATION PIAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor s License ' Law for the fallowing reason (Section 7031 5 Business and Professions Code) - 8 ) 2 N I as owner of the property or my employees with 1-1ADDRESS ^ o wages as their sale compensation will do the work and the structure is not Intended or offered for sale(Section CITY TEL NO1 _ to c 7044 Business and Professions Code) 0 OWNER ❑ I as owner of the property co exclusively project (Sec MAIL o o • Tj p 5 (�` with licensed contractor to construct the project (Sec ADDRESS tion 7044 Business and Professions Code) 0 ) ) ) -8 (( CONSTRUCTION LENDING AGENCY CITY I hereby affirm that there is a construction lending agency for , the performance of the work for which this permit is Issued CONTRACTOR - - (Sec 3097, Gv C ) r ADORE55 Lender s Nome CITY TEL NO - Lenders Address SLIC I certify that I have read this application and state that the LICENICEN SE NO CLA55 above Information Is correct I agree to comply with.I1 County ordinances and State laws relating to building construction _ and re by authorize resarnol ves of Thu County to enter ` Apo t e above tion pr ty for inspection urposes SEE REVERSE FOR EXPLANATORY LANGUAGE ri 1/ Signature of Applicon,or ret Da WORKERS COMPENSATION DECLARATION APPLICATION FOR PERMIT I hereby off Km that I have a certificate of consent to self Insure or a certificate of Workers Compensation Insurance, � � , zHEATING - VENTILATING - AIR CONDITIONING or o ceridied pt' there f ($Dc 800 ab C ) / TG -31 RI v J CE BIB(RLN 10/61) ' — ty No Company •""+i co Certified copy Is hereby furnished If COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy Is filed with the county budding inspec FOR APPLICANT TO FILL IN - - BUILDING Z111 �{ �f � tion��{{{{,,ee��partmenl , TINT OR TYPE ONLY) ADDRESS Date � ApApplicantc NO TYPE OF APPLIANCECEOR EQUIPMENT FEE LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS =`T ' COMPENSATION INSURANCE CROSS S7 W 4.I' ZLLSa (This section need not be completed H fM work Involved by ABSORPTION UNIT BTU DISTRICT NO RROCESSED BY the permit is fat"a hundred dollop ($100)or Itis ) I certify that in the performance of the work for which this AIR HANDLING UNIT CFM .0 permit Is issued, 1 shall not employ any person in any manner ✓ So as to become subject to the Workers Compensation Laws BOILER BTU AWJ?OVALS DATE INSPECTOR S SIGNATURE Date Applicant COMPRESSOR BTU t ROUGH NOTICE TO APPLICANT If after making this Certificate of VENTILATION SYSTEM FINAL 1-7-204V 4= 1 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 4 deemed revoked FURNACE FAU_GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU I hereby affirm that I am licensed under provisions of Chapter 9SUSPENDED—UNIT— (commencing USPENDED UNIT=(commencing with Section 70DD) of Division 3 of the Business HEALER WALL and Professions Code, nd my license a In full force and effect ,Q' O License Number 9r J � LIc Class �J ► U Contractor�•��Date JJ�'L__J_ - I O ❑ I am exempt under Sec r W Plan check fee H B 8P C for this reason PERMIT ISSUING FEE ; Z Dote 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 $9,1 1 6 A wages as their sole compensation,will do the work and CCTV TEL NO � ' • • • • 8 the structure is not Intended or offered for sole(Section I ' 7044 Business and Professions Code) OWNER �.^ • 4 3 S 0 Elas owner of the property am exclusively contracting with licensed contractors to construct the project (Sec .DORE55 Q �. • • • 4� 5 �rc�i tion 7044 Business and Professions Code) .�^ r CONSTRUCTION LENDING AGENCY CITY C- TEL NO �66'9`/E(� r 0222-84 1 hereby affirm that there Is a construction lending agency for , , the performance of the work for which this permit is issued CONTRACTOR C• s,.,� (SBC 3097 CIV C ) ADDRESS ENO (/l.I r✓LY Lender s Name Lenders Address CITY L, A . TEL NO - TATE rJ (� LIC p 3 I certify that I have read This application and stole that the LICENSE 0 6 (0 S CLA55 L— 7 above Information Is correct I agree to comply with all Count' - ordinances and State jaws relating to budding construction, and herey au horde representatives of this County to enter '- upon the bo mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date