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HomeMy Public PortalAbout10667 HALLWOOD DR_Mechanical__ r 76 A$F4 - CE 818 - 9-71 • , pPPLICAT16H FOR PERMIT HEATING - VENTILATIN-G - AIR CONDITIONING ,D3 - COUNTY OF LOS ANGELES BAUILDINs 10667 East Hallwood DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY Temple Cit NEAREST CROSS ST. FOR APPLICANT TO FILL IN OWNER William Park r (PRINT OR TYPE ONLY) MAIL NO. TYPEOFAPPLIANCEOR EQUIPMENT FEE ADDRESS 10667 East Hallwood CITY Temple City TEL. NO. 443-6641 1 ABSORPTION UNIT, BTU 3-ton-- 5 OO AIR HANDLING UNIT, CFM CONTRACTOR Bryant Heat. & Air Cond. ADDRESS 1350 E. Las Tunas Drive BOILER, BTU CITY TQUQUbQC*(%fS. G STEL. NO. 286- 1141 Y COMPRESSOR, BTU STATE LIC. LICENSE NO. 221751 CLASS C-20 VENTILATION SYSTEM }DISTRICT NO. GROUP ^ ZONE PROCIISSED BY EVAPORATIVE COOLER � 0 � u` �. � 0 FURNACE: FAU X GRQa(IATY FLOOR BTU rSl11Vl INSPCTI CORD v 5 OO E HEATER: SUSPENDED UNIT_ O E- WALL U LU a • z Plan check fee 25% of above. See reverse. PERA,IIT ISSUING FEE. S 3 00 TOTAL FEE 1 13100 PLAN CHECK APPLICANT NAME ADDRESS CITY TEL.NO. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 1f" WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS A EI ) I CT 'S SIGNATURE LATING, AIR COND NTNG ROUGH I I , C Y TH I NOT ACTING IN VIOLATION OF CHAPTER 9 IV 0 BUSINESS AND PROFESSIONAL FINAL CODE OF THE TA / TT SIGNAT UR G/`//' PERMIT VALIDATION K. M.O. CASH OF PER PLAN CK VALI TI N CK. M.O. CASH .4 0 AUG 15 4.1 D 1 3.&0 0�8 SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE (� ION DECLARATI WORKER'Shave/MPENSATate of consent to 76A34fiDPW9/89 APPLICATION FOR PERMIT LI E GREEN. 76A364C I hereby affirm that I have a certificate of consent to self insure, • or a certificate,of,Worker's Compensation Insurance, or a certified" HEATING-VENTILATING-AIR CONDITIONING cop,y,theiaof f$ec.3800 Lab. C.) Policy'No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS. BUILDING AND SAFETY DIV. ❑ Certified copy is hereby furnished. ❑ - - - Certified copy'is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING W O O department. � � � (PRINT OR TYPE ONLY) A LOCALITY Date Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT. FEE Lt 4 CERTIFICATE OF.EXEMPTION FROM WORKERS' NEAREST CROSS ST. COMPENSATION INSURANCE ABSORPTION UNIT,BTU (This section need not,be completed if the work involved by the ASSESSOR MAP BOOK PAGE PARCEL permit is for one hundred dollars or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED'BY I certify that in the performanc of the or for which Is permi / is issued, I shall not employ ny person i any m n so as, BOILER,BTU V U become subject to the Work s'Corn ensa' n LawS7 IQ _04/ COMPRESSOR,BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date pplicant VENTILATION SYSTEM NOTICE TO APPLICAN If, after making this Cert, ' to of ROUGH - — —` Exemption,.you should beco a subject to the Workers'Co nsation - EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. FURNACE: FAU - GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU VAL'� TION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT mHEATER: .(com encing with Section 7000) of Division 3 of the Business and WALL Professions Code and my license is in full force and effect. i .j— Number i I License umber ��•� L c Cass �I '� n^; a Contractor "^ON m o ��dte �' ^ 0 .._ J _ - f , - QPld am'exemptunder Sec. B.&P.C.for this reason PERMIT ISSUING FEE.$ Q Date: . TOTAL FEE W Signature PLAN CHECK APPLICANT - 0- OWNER-BUILDER DECLARATION Z Z I hereby affirm that I am exempt from the Contractor's License Law NAME 5116A , for the following reason (Section 7031.5, Business and Professions Code): - -, ADDRESS /� � ❑ I, as owner of the property, or my employees with wages C'r as their sole compensation, will do the work and the CITY e '� TEL NO. �f 86�t� structure is not intended or offered for sale (Section 7044, Business and ).Code). OWNER ❑ " r.�/.� =• Y• t i-- I, as owner of the property, am exclusively contracting CJ' �� � MAIL . .`f'sit_ 4 2 - 00 with licensed contractors to construct the project (Sec- ADDRESS e " © . tion 7044, Business and Professions Code). Cur_11- CITY _<Z TEL.NO. CONSTRUCTION LENDING AGENCY �`JJ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued CONTRACTOR by-,K_-r �Od (Sec.3097,Civ. C.). ADDRESS Lender's Name CITYY/ (' ` ` TEL.NO. ., (�C�� Q // �:�"-_,` Lender's Address STATE lJ �1 certify hat I have read this application and state that the above LICENSE NO. SG Z C ASS 'z ormati n is correc a ree to comply with all County ordinances n Sta laws tplati g uilding cc tr tion,and hereby authorize epr s tatives of t is unty toe r pon the above-mentioned p for inspec io urposes a SEE REVERSE FOR EXPLANATORY LANGUAGE SIGNAT OF APPMCANTIOR AGENT DATE //