HomeMy Public PortalAbout8734 WENDON ST_Mechanical__ 6A364-CEBI8-+-68APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS 8734 Wendon
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY San Gabriel
FOR APPLICANT TO FILL IN CROSSS ST. -
(Print or type only)
OWNER Leland Stephens
NO.. TYPEIOFAP.PLIANCE OR EQUIPMENT FEE
ADDRESS . 8734 Wendon
ABSORPTION SYSTEM, BTU CITY San Gabriel TEL. N0287-6905
AIR HANDLING UNIT, CFM CONTRACTOR Bryant Heat & Air Cond. Inc.
BOILER, HORSEPOWER ADDRESS 1350 E. Las Tunas Drive
1 COMPRESSOR, HORSEPOWER 22-1/2 4 OO CITY San Gabriel 9'/774TEL. N0?86-1191
STATE LIC.
VENTILATION SYSTEM LICENSE NO. 221751 CLASS C20
DISTRICT NO. GROUP ZONE PROCESSED B
EVAPORATIVE COOLER ��
FURNACE: FAU GRAVITY a r }�
FLOOR—BTU INSPECTI R ORD CD
HEATER: SUSPENDED UNIT
WALL CD
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NEW—ADDITION PERMIT $ 3 00
ALTER—REPAIR— TOTAL FEE $ 7 00
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY DINA NCES AND STATE LAWS 'REGULATING
HEATING. VENTILAT 0, AIR CONDITIONING.
1 HEREBY CE IF AT N ACTING IN VIOL ON
OF CHAPTER 9, DI , 0 E SU NESS AND PRO FES NAL
CODE OF THE ST O APPROVALS DATE PE 'S SIGNATURE
SIGNATURE ROUGH
OF PERMI EE
FI NAL
/�LIDA.TION JACK R. ALLEN
CKyf/I M.O. CASH SUPERVISING MECHANICAL ENG'R:
'4 2; 3 9,R2 t-MR 2 6 4 1 D 7.0 0 04
3EEBACK-OF APPLICATION_FOR COM PLETEFEE SCHEDULE `��/Y"!_7/I/I7!
WORKERS'COMPENSATION DECLARATION 78A 818 VA lid lid p C 6� `��O N FO§ PERMIT
1 hereby affirm that I have a' certificate of consent to self
CE 818 (2 80) Ir II— L� 6`� U �I If�C
insure,or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONING
Cc�ified copy thereof(Sec.3800,Lab.C.)
Policy i � Company RAL CO►Yl �� I
Certified copy is hereby furnished.
COUNTY OF LOS ANGELES / / I BUILDING AND SAFETY
000 I
Certified copy is filed with th ounty lding inspection BUILDING `1t/ee WOOA`+
e �r rp FOR APPLICANT TO FILL IN ADDRESS I 3�
Date F Applicant (PRINT OR TYPE ONLY)
CERTIFICATE OF EXEMPTI FROM WORKERS'
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY'
CERTIFICATE OF EXEMPTIZFROM WORKER
COMPENSATION INSURANCE NEAREST CROSS STI A\/�� >
.
(This section need not be completed if the work involved ABSORPTION UNIT, BTU CLO
by the permit is for one hundred dollars (5100) or less.) DISTRICT NO. PROCESSW BY — 0
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 .-ov
U
so as to become subject to the Workers'Compensation Laws. BOILER,BTU
APPROVALS DATE INSPECT R'S SIGNATURE
Date Applicant COMPRESSOR,BTU W
ROUGH ). r'� N
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM
Exemption, you should become subject to the Workers' FINAL
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION
with comply with such provisions or this. permit shall be
deemed revoked. FURNACE: FAU X GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU Q
I hereby affirm that 1 am licensed under provisions of Chapter HEATER: SUSPENDED UNIT
9 (commencing with Section 7000)of Division 3 of the Busi- WALL
ness and Professions Code, and my license is in full force and
effect. ! E t id
I
License Number Lic.Class-
Contract Date
I am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer Plan check fee 25%of above.
acting in my professional capacity (Section 7051, Bus- t
iness and Professions Code). PERMIT ISSUING FEE$ U
r _
Lic.or Reg.No. Date TOTAL FEE S
HOME OWNER-BUILDER DECLARATIONPLAN CHECK APPLICANT
I hereby affirm that I am exempt from- the Contractor's NAME
License Law for the following reason (Section 7031.5, Busi-
ness and Professions Code): ADDRESS 0,0
0 I, as owner of the property, will do the work and the CITY v 7 U p
structure is not intended or offered for sale (Section S,�a l TEL.NQe7�`rL
7044, Business and Professions Code). L �o J 0 0 0 0 0
El 1,
�� • I I '
I, as owner of the property, am exclusively contracting 0 0 -45 ,9 C
with licensed contractors to construct the project MAIL `
(Section 7044,Business and Professions Code). ADDRESS � -5 \q E Oor
' z
CONSTRUCTION LENDING AGENCY CITY456i Id &I Ae IL.NO. pLE 7 1l— 71
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is CONTRACTO
issued(Sec. 3097,Civ.C.).
Lender's Name . ADDRESS
Lender's Address CITY TEL.nA
NO
I certify that I have read this application and state that theSTATE �Z ._5 CLASS
above information is correct.I agree to comply with all County LICENSE NO.
ordinances and State laws regulating Heating,Ventilating and
Air Conditioning,and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County to enter upon a obo mentioned property for
puliioses. +
'E
Signature of Permittee Date