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HomeMy Public PortalAbout6121 HART AVE_Mechanical__ _ TEMPLE CITY 76 A364- CE 8.18- 5--73 - I - APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONOITIORING COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY.ENGINEER ADDRESS BUILDING AND SAFETY, DIVISION. LOCALITY m le City NEAREST CROSS ST: FOR'APPLICANT TO FILL IN OWNER T 7 (PRINT OR TYPE ONLY) SARUL.LO JAMES - MAIL NO. TYPE'O.FAPPLIANCE OR EQUIPMENT FEE ADDRESS ABSORPTION UNIT, BTU CITY, Temp I I- T L. NO.285_5341 CONTRACTOR - AIR HANDLING.-UNIT, CFM ADDREss 2.034 N. Peck Road BOILER, BTU CITY So El Mont6EL. 110.5 79 279$2 COMPRESSOR, BTU STATE LIC. LICENSE NO. 2655094 CLASS C- 20 VENTILATION SYSTEM DISTRICT No. L�OuPbzoNEC' PRO SS ED.BY EVAPORATIVE COOLER r /� FURNACE: FAU' GRAVITY (/ �. FLOOR BTU INSPECTION RECORD HEATER: ,SUSPENDED IT WALL 0 Cr_ - .O C-3 W L� Z Pian check fee 25% of above. See reverse, PERMIT ISSUING FEE S 3 00 TOTAL FEE PLAN CHECK APPLhCANT 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 WITH ALL ORDINANCES AND .LAWS REGULATING HEATING,, VENT,i- APPROVALS D TE' PEC7 'S SIGNATURE LATING, AIR CONDITIONING. ROUGH I . HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION _. OF CHAPTER 9, DIVISION 3, OF THE BUSIN SS AND PROFESSIONAL -( FINAL CODE OF THE STATE OF CALIFORNIA. SIGNATURE PERMIT VALIDATION CK. M'.0. CASH OF PERMITTEE* PLAN CHECK VALIDATION CK. M.0. CASHo ytij' i�nK % 41 u tU.5 • E SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE ,, ' WORKERS' COMPENSATION DECLARATION fob f�p n ? ©f�fl FOR n 2 j�n�' I hereby affirm that I have a certificate of consent to self , Il"lT L� A..Il m IT Ili If"LSR insure, or a certificate of Workers' Compensation Insurance, HEATING _ VENTILATING,- AIR CONDITIONING or.a,certified.copy-thereof (Sec. 3800, Lab. C.* r ' 76A364C. ,20-0046 DPW`§L88 6 Policy No. Company. EJ tertifiecl,copy ig hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY. ❑ Certified copy is filed with the county building inspec FOR APPLICANT TO FILL IN BUILDING /��� tion department.': ADDRESS 1p�Z�. t 7�1� (PRINT OR iYPE'ONLY) , Date' Applicant LOCALITY p��, ,G NO. TYPE OF APPLIANCE OR EQUIPMENT, FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST. (This section need'not be,completed if the work involved by. ABSORPTION UNIT, BTU DISTRICT NO. PROCES BY the permit is For one hundred'.dollprs ($100) or less.) rtify I cethat-i_n the performance of the work for which this. AIR:HANDLING UNIT, CFM v j permit is-issued, I shall not employ an,y'person in any manner r BOILER;BTU so as to''become subject to'the'WorkersE,COmpenSaTlOn LBWS. - APPROVALS DATE` INSPEG OR'S SiGNA E COMPRESSOR,.BTU ROUGH Date. Applicant a NOTICE TO APPLICANT:'If, after making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should` become subject. io the Workers' Compensation provisions'of the Labor Code;you,must forth- 'EVAPORATIVE COOLER: LID TI with comply with such-provisions orthis'permit shall be deem- ed revoked.: FURNACE: EAU GRAVITY LICENSED.CONTRACTORS DECLARATION FLOOR BTU ' I hereby affirm that`I am licensed-,under provisions of Chapter 9HEATER: SUSPENDED UNIT (commencing with•Section'7000)of Division 3 of the Business*- WALL. 'and.Profe.ssions'Code,and my'license is in full force and effect, o CL ' A 67 r License Number Nbf Lic. Class 0- U C6ntractor.�.(.6y� Date ❑ I'am exempt under Sec,- .. - Q „ Plan check fee W B.&P.C. forthis.reason.' PERMIT ISSUINCs'FEE $ a Date '`^ _ �.. Signature TOTAL FEE OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT 1 hereby.affirm,that l am exempt from the Contractor's License ' Law'for-the•following reason (Section 7031.5, Business and NAME D: Professions Code): .� ADDRESS-..._ 71, as.owner of the property, or my employees with wages as their sole compensation, Will do the work andCIT-Y TEL NO.' Apr the structure is not intended or offered for:sale (Section'_ __ 7044, Business and Professions Code). OWNER ,,a t7 1 E l:I' Ii as owner of the property, am.exclusively contracting ( j with licensed 'contractors to.construct the project (Sec- MAIC tion'7044, Business and Professions Code). -ADDRESS TO l 1TIAt 17, m 00' CONSTRUCTION LENDING AGENCY,, CITY' TEL NO.'. I hereby affirm that there is a construction lending-agency for' the performance of the work for which this permit is issued CONTRACTOR � ('��(�• rv�NS? C�� D_ (Sec. 3097, Civ. C.)_, +•:HANG el�il.:t ADDRESS �O V I C'-roX /-V EI Lender's Name ' ^ ' CITY W GO��A`/T TEL. NO. .C8 11tC3 t^IrI3i I� �f ITL Lender's Address r , . I certifythat I have read this application and state that the STATE ►] ��/ LIC. r, ,1r• t t A 7 i5 RP 'LICENSE NO. l7 � � O CLASS � �•%'�, a r'E3 r i�_a above information is correct. I agree to comply with all County ordinances and State laws relating to building construction, . and hereb authori presentatives of this County to enter up above-m n oned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si azure of Appl' ant or Agent Date ©s