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��n�tr:�:��s•co��rrres,�Tio�nrc�.,�is.anoti CEA818(260) APPLICATION FOR PERMIT 1 hrrah}' :iffirr.� th:it I ha�c a'crrti(icate nf cnn�ent tn self � in�ure,nr a cenific�tenf 1Sor'ers'Cmnpensation lozurance,or HEATING-VENTILATING-AIR CONDITIONING a certiCied cnpp Iherenf(�ec.,.90q,l.:ih.G) . r,�r�Y.�>._F 04329�,,,,,,.,,,,�Fairmont I ❑ Crrtiticd cnpy a�ierc��y furni<!:��. COUNTY OF LOS ANGELES BUILDING AND SAFETY � Ccrtified c!ipy is filcd�cith ihr county buildinq inspretinn dep::nmrn�. FOR APPLICANT TO FI LL IN OUIIDING Dstr Ap;licant (PRINT OR TVPE ONLY) AD�RE55 980 N. Gol den Springs Dr. -NO. TVPE QF APPLIANCE OR EQUIPM1IENT FEE LOCALITv Diamond 3ar Bldg, 6 CI;ILTII7C:\TL OI�1:SIC.11'TIO[i 1�H0.`415'OILICl:I2S' — ' CO`.II'1'.VS:\TIO�I\c111i:\\CI; NEAREST . } (T�1iS S.cti�)n ncc� n0� t`�' c�ln[+�:tC�j if Ihe ��'oI}; in�0��'C� AF3SORPTION UNIT,6TU CROSS ST. O �/}' [f1C (ICiRiI� IG �f1( f1�C I�undrcd Jnilacs (S��n� O[�CSS.� - OISTRICTNO. PPOCESSFDP.' V 1 c�rtify'tti.it in [he ��e�f<�r:n�n�'e r�f tl:e��'urF:f��r«I�ich thit AIR HAN�LING UNIT,CFA1 l0 rc/ � permit i;issucd,I sh�ll nnt employ;�n��person in an.�m�nner 0 so as�o become nihject tn Ihe�Sorkrrs'Compensation L:i�+'s. BOILEF,eTU MPROVALS DATE 14�PECiOF'SSiGNATU�E �U ��"� `�;�'�''°i 7 COh7PRESSOR,BTU�Qp00_0_�] QO a NpTICl>TU APYI.ICAY7=IG afirr m�king Ihis Crrlilic�te oF � � ROUGH y I�:xem�tinn, }'nu th�iilri i•ecnme�:�hject tn Ihe 11'nrkerc' 2� IVENTI�ATIONSYSTEM 8Q_00 f�NAL z ('mm�en�:�tinn �rni�ictnn<<�I'tlie I.nl•iir!'n;i�,vnii muct f�irth-� �.'ith cnnt��ly ���ith cuch �«��•i�inns i�r Ihis ��:tmit �h�ll bc EVnYOHATIVECOOLeR vF�L��r�i�L•i� decmcA revnked. FURNACE: FAU�GRAVITV_ i.icr.r:seo�•o�;.^.:�crr�resntci.:va,�rio�; FIOORr ATU_6O_�OU0�7 _DQ f h^re!�y affi�m Ih:�t I;u.^.licensed um!er provisionsofChapter - IHEATER: SUSPENDED UNIT � (cnmmencinK ailh Crc�ion^,000)nl'Di.isinn 3 ot th,•Ilu�i� LVALL � ness and Prnf�uiuns C��dr._nd m5'lic_nxr ic in�full fnrce anJ �rre�,. 53 Re i sters @ 1.75 9 75 �����s�Vumhcr_3SOrJ43_ Lic.Cl�ss_C-ZO <<��,«�<«��_Rancho_Air �i:����_8-31-85 � 1 am e�empt fmm thr liccnsin�rcyuiremen�s as I am a �� .� �.�A licrnsed :rchilrct nr � r�zistercd profession�l eneinerr P�an eheek fee 25°0 of above. acti�g in mv profe=•iumei c�p:icily (Scction 7051. ❑us- #�'�����'�$ ine�s and rrnte«i��ns c��dr). PERMIT ISSUING FEE S 1� 5� ' I.ic.or Itr..w�. l�ite TOTAL FEE 32�25 ��'3 2 3 2 5 I{O�tIS O`•�'NF:f:-f3Uli.U172 UI'CLAIiATIO\ PLAN CHECK APP�ICANT •��3 2�2 5 c=a I herehy affirm that t -�n etempt fr��r.r thr Cnntr:�ctnr's NAA9E 0���'2(��8(1 I.iccnvz La�c fnr thr fallo�cine rr�cun (Sertiun 7031.5,l;usi- . necs unJ Prufr��iun.('nd,�): . l�DORESS G1. ;�s o�cner ui thc prnprnp.�ciil dn the ir�rk and the atru[ture is not intcndrd or nffere:t (nr sale (Srctiun CITY TEL.NO. � 703.M1,ilu.inr.s anJ 1'rnfe�,innc CnJe). ❑ �,�S���,�,�•���r��,�• S., y j OWNER TNE_ANDEN_GROUP propert :nn redusierl�eon[rncfin� ���iih Iicen.�J cnnlractr�rs 1�� cnn�truct Ih� 4,mjcrl M11AIL ts��n�����n:.a,is���;�,;�.�:����r«r,•<<��,�.[�nee�, aooness 629 COV7►18_B_�Vd, COVSTI4DCTIOti I,I;.":UNC AGIiNCY CITY TEL.NO. San Dimas.,_CA 599_686_4 1 her?6p affirni tha� Ihrre is ;� cunstruction li�ndinp; �4ence - far 1hc per(urcisnrr ot ihr ���urA fnr «hich Ihis pcnnit is CONT(iACTOR Rancha_Air_ T icaue�.l(Sec.J097.Civ.C.). 7- n�. . Lcroirrs n��»� AODRE55 8880 Benson Ave. Sui te 118 - LrnAer's:lddren ��T� MOI1tC1 di Y'� CA TEL.NO, 981-4HO1 [Ccr[ify th�t I ha��c n•��t tl�is;il��iic�li��n ind ststc [h�l lhr �TATE p LIC. ,t,�>,r��r�,��,,:������,�s���r�r�i.i ei rec tU ctnnpl)'a'ith all C��Unt)' LICENSE NO.300543 c�ass C-20 ordin�n• s snd St^- ���s rc{�ul:�!in!c Hr:�linp.Vrntilefing and ' :1ir Co d:iuni•� ..inJ .:rel�y nuthnri�e represcnt�ti��e+uf this SGI;RI:V1iRSE I'Oli IiXPL.4NATORY L.4NGUAGIi Cuun y : rr u• he ahmr�mrntinnrJ ruPcnv fur insr �ir��� �n<. _ .� ,a��� . S�7nature nf Pcrmittcc D�ir. �. .,, �„ -'- - _ ~ • �,, t �,; ' "' .. � .. � ` . '" . - t ' , ��� � - . . '" � � `,, � .' �. ` � � Y � � � � • � • 0 , 7? N . 2 O� N • N4 m _ �� 0 - s� N � O a • . . 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