Loading...
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