HomeMy Public PortalAbout5312TEMPLE CITY BLVD_Mechanical (2) AOR KCRS COMPI-NSAI ION DLC LARATION 1 76A CE
fir; file,I re, a "rtifleete of consent to self CE BIB (280) APPLICATION FOR PERMIT
_srnllcate of Worker,; Compensation Insurance or 1 HEATING•V TILATING-/ R CONDITIOM1443
a Ip) thereof(See 3800, Lab C) // �,,�/ CUCCL/
Pal¢, No Com pony _ _ _ _ —e�7�'' /� _
COUNTY OF LOS ANGELLDINSAND SAFETY
0 Lerrllled Cup, n hels
rLb) furnnetl 1
rlerr 111 ed cop) a bled w11h I' ouni) hu d In rsPutu'n BUILDING
Ua4%(Jrr� v FOR APPLICANT TO FILL IN 1�
1#) Applmint (PRINT OR TYPE ONLY) ADDRESS
v I LOCALITY
CLlil[I I(A 11 OI LN LII PI ION PROM NORISLRS NO TYPE OF APPLIANCE OA EOUIPM ENT FEE
COMPENSATION INSUR ANCI NEAREST }
CROSS ST
(11115 SWIUU ncLd not he completed If the work-m,Ol,ed - - ABSORPTION UNITBTU-
6% (lle knroi is for one hundred dollars ($100) or less) DISTRICT NO PROCESSE aY �7
I Lut1LL that u1 the performance of the work for whish this AIR HANDLING UNIT CFM
p.nnd I- isSued I shall not emplo, an% person In an) manner i S�� O
No a, to bccomL sub),,ct to the Workers Comptroition Laws . BOILER BTU
�J (/ APPROVALS DAT INSPECTOR SSIGNATURE V
Data Applicant I / COMPRESSOR BTU_s_J/ �� N
III ROUGH LU
NOTICL IO 1PPI1CAN I It aftW making this Ccrtlffcxtt of VENTILATION SYSTEM FINAL 2
FSemptton you Should becnmL subJLL( to thL WorkLr,'
(ompurwbun p,o,nrons of the Labor Code you mus forth EVAPORATIVE COOLER VALIDATION
vnh cmlPly with such proSmone or this permit shall be ,
deeme 1 rL,"Led
FURNACE EAU_ GRAVI
L7C1 ftiSLDfON iK ACTOI(S D}CLARAiION / FLOGR BTU—
�
1 hLrcb, ifflrm th n 1 am licensed under provisions of Chapter HEATER SUSPENDED UNIT
9 (LommLncmg with Section 7000) of Dosion 3 of the Bus, WALL
n,ss ani' Pmtessvins (.udc °nJ my ImensL 1s In full fore, and
Uffr,t ///''' — V
LtLcme Nurr r d� � � LIC Class�r
CunfraLte _ Date
Lj 1 am exempt from the licensing regwrtmenls as I am a
t,owd rr,lut,ct or a r,glstervd professional engmLer ) Plan check tee 25°h of above
fell
ole
q m h
my prasslocaDu (v (Section 7051 Bus
me
ts and Pm fLavuns Code)
ePERMIT ISSUING FEE $
) sf'
I IC ur RLg' No Date TOTAL FEE D (
HO\II 01ANLR BUILDiR DECLARATION PLAN CHECK APPLICANT V J
1 IlLrehy affirm thal 1 am Lx,mpt from the Contractors NAME \}
1aLu1n Law for thL following rLuson (Section 7031 5 Bus, t I� J �' —4 1 3 2 4 A
m S,and i4uft,tons Cod) ADDRESS V—
#'o • • • • 8
I as owner of the ,n,I,dprnptrty will do the fo wird and the TEL NO
7044tun. n nut mnndss or offered for sale (SLcgon ` CITY 2
7044 Business and Pnrtessmns Code) - -27.00
OWNER
Lae mLncr of On rio-10 [} ton nstruslvLly Conte aLimqg o 'A �� - 27005
will, Imen sLJ coni mL(ors to construct rhe prvgeci f MAIL
(SLLttun 7044 Bu,mL,s and Professions Code) ADOR !eq __ _
0924-81
(ONSI ItUCTION LLNDING A(,LNCY CITY T' r. NO
1,h,rehy.affirm that then rs a LonstruLtiun lending agene)
for the performance of thL work for wh,Lh this permit ,s CONTRACT .R
I$WLII(.Slt 3091 Cit C)
LLndcr',N on, ADDRESSAA/
Lender s Addr, , CITY TEL NO -
I certify that I hese read this application Ind SIML (hilt I STATE / LIC
abu,L Information IS t(ofLLi 1 ag,LL to urmpl) with all Coil I, LICENSE NO CLASS -
oalm,nLLs and Stute laws mgulatmg Heaonb Ven tilal,nb and
Air Conditioning and Iemb) uuthor,eL reprrsentatn L, of this S!E REVI-RS} I OR I YPLANA TORY LANC,UAGE
Cuuln, to enter upon IhL ubo,L menti IoLd propLri, for
m n p 1r r rs
9_�od-p -
op"Dater, I'LTm1tIlL OWL