HomeMy Public PortalAbout9416 BROADWAY_Mechanical__ 15 ABB< - `E BIB - G',I APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDD' ESS (p
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO.FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
CITY TEL. NO.
ABSORPTION UNIT, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BT CITY EL. NO� ��
COMPRESSOR, BTU STATE /J) VLIC.
LICENSE NO. [/ CLASS J
VENTILATION SYSTEM DISTRICT No. c�eoup zorvE r;aE 5:5:E 01:0 r
EVAPORATIVE COOLER
FURNACE: FAUGRAVITY
FLOOR-BTU- INSPECTION RECORD
s
HEATER: SUSPENDED-
UNIT-WALL U
W
d
h
Z
Plan check fee 25T of Bhovc. Sce reverse.
PERMIT ISSUING FEE S 3 00
"I'OTAL FEE `
PLAN CHECK APPLICANT
NAM
ADDRESS C�(p �(�et,
Cl TV T.E L.NO..-7,Vj�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE N PECTOR'S SIGNATURE
LATING, AIR C DITIONING.
ROUGH
HEREBY E T rF 1 AM NINESS AND SIN VIOLATION
OF CHAPTER 9, NNE BUSINESS AND PROFESSIONAL FINAL
CODE OF THE S' TE CALIFOFZY14 :d
NIA.
SIGNATURE PERMIT VALIDATION K. M.O. CASH
OF PERMIT .E
PLAN CHECK VALIDATION CK. M.O. CASH
F� 2 7 5 973 AUG 16 1 0 1 0.504IN
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE LJ f
WORKER'S COMPENSATION DECLARATION 20-0046 DPW 9/69, APPLICATIONTOR,
(({{ q (((��5000 �il�f�r +
I hereby,atfirm that'1 htive'a certificate of consent to self insure, 76A364C r.' r` �••S PER U�k±1 E'. 'GR
'd... IL3 L1.13,
J
a c_ertificat§ of Worker's Compensation Insurance, or a certified '' AIR CONDITIONING !NRNJGNH f1��1T716J1F.CtllL+raIIB�—
copy thereof(Sec.3800 Lab. C.) - a.HEATING-VENTILATING - - ., .�
.Policy No. `WQ S l'7 l'�Q®I nyCj.►L. CAMP , COUNTY OF LOS ANGELES " - ' DEPT OF.�UBLIC WORKS BUILDING AND SAFETY DIV
❑ .,.CertifiedcoPY is hereby furnished. -
[R FOR-APPLICANT -FILL.IN BUILDINGr ��; -
Certified copy is Iiled wit the c o ui n nspection_ ADDRESS 9 416 BROADWAY
department. ' / (PRINT OR TYPE ONLY) - '
Date7/31/95 'Appli n ! NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY TEMPLE CITY -
.. .. - ,
CERTIFICATE OF PTION FROM WO RS' - - NEAREST
COMP jNSATION.INSURANC CROSS ST: CLOVERLY +
ABSORPTION UNIT,BTU ASSESSOR
(This section need not becompleted if the work Involved by the .. MAP BOOK PAGE. - I
CEL -
-.permit Is for one.hundred dollars($100)or less.) � _ � AIR HANDLING UNIT;CFM
DISTRICT... PRCCESSED.1
I certify that in the performance'of the work for which this permit
is issued, I shall not employ any person in any manner so as.to .BOILER,BTU
become subject to the Workers'Compensation Laws.
COMPRESSOR,BTU o M25 - _
"Pr ALS DATE INSPELTOe:s SIGNATURE
'.Dale Applicant VENTILATION SYSTEM - T -
MOTICE TO APPLICANT: If, after making this;Certificate of .. _ _ - _ ROUG ��
- ExemptioA,.you should become subject to the Workers'Compensation - EVAPORATIVE•COOLER
'provisions of the Labor Code, you must forthwith comply FINAL with such - - +
provisions orthis.permit shall be deemed revoked.•!::_ - FURNACE: -R. FAU GRAVITY -
LICENSED CONTRACTORS DECLARATION 1 FLOOR BTU :VALIDATION . -
:1 hereby affirm that,l'am licensed under provisions-of Chapter 9 - SUSPENDED -UNIT_
(commencing with Section 7000) of Division 3 of the Business and HEATER: WALL ,.
Professions Code, and my license is in full force and'effect,
. 4
Liced a Numb r . c.Class
�/. ACCT a
Contra . Date i' >, T O
❑" am exempt untler _ PIBR Check fee; - - -1 33 122.50()
2
B.BP.C.for this reason PERMIT.ISSUING FEE$ - O
Date: - _ TOTAL'FEE - 1"ITEMq8 W
Signature - - r j�jp�� 1CEL
PLAN CHECK APPLICANTG/�HCAG`T'tr,[�� UI
- OWNER-BUILDER DECLARATION Z,
- - - MtV,GE ,.
I hereby affirm that I am exempt'from the AN
Contractor's License Law NAME NE
for the following reason (Section•7031.5, Business•and Professions - oOMt—owl- +S/ 7/95
Code): - ADDRESS _ W
❑ I, as owner of the property, or my employees with wages - - A
as their sole compensation, will do the work and the CITY r TEL.NO. 1707 ,•1 AMIM43
I structurer is not'intended or offered for sale (Section 7044, - _ -
- Business and Professions Code).: OWNER 'G. FISCHER *'�
`❑ - I, as owner of the properly, am,exclusively contracting
with licensed contractors-to'construct the project (sac- ADDRESS 94-16 BROADWAY - - - -
• tion 7044, Business and Professions Code).
- CONSTRUCTION LENDINGAGENCY - CITY'TEMPLE CITY TEL.N0.285-7959
ihereby.affirm that there is.a construction'lending:agency for CONTRACTOR. _ s
he performance of the work for which this permit Is issued BRYANT HTG 6 A/C INC. , - -a , ,.•1
(Sec. 3097 Civ. C.)::•
ADDRESS1350 E. I.AS TUNAS DRIVE
v. Lender's Name -
CITYSAN GABRIEL TEL NO. 286-1141
Lender's Address
I certify that I have read this application and state that the above LICENSE NO' 221751 ' CLASS C-20
information is correct. I agree to comply with all County ordinances
antl Slate lArelab.uilding constructionand hereby auttiorizeantsuntytorpoesSEE REVERSE FOR EXPLANATORY LANGUAGE.MATURE Oi