HomeMy Public PortalAbout8909 HERMOSA DR_Mechanical__ WORKER'S have
a certificate at
76A36C 9/89 APPLICATION FOR PERMIT LIME GREEN,
I hgiebY affirlA that I have a certificate Of consent to self insure, 7fiA36aC
or a certificate of Worker's Compensation Insurance, or a certified HEATING •VENTILATING•AIR CONDITIONING I'
copy thereof(Sec.3800 Lab.C.) _ d
Policy Ne. PC943677 Company Reoub 1 i c I ndemn i ty COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑ Certified.copy is hereby furnis
® Certified co Ib tiled with t e co b In Ins ection FOR APPLICANT TO FILL IN euaolNG
department. p (PRINT OR TYPE ONLY) ADDRESS. 8909 East Hermosa Drive
Date 6/17 91
n LOCALITY Temple City
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CEflTIFICccE OF E TION FROM q KERS' CROSS ST.
COMP BION INSURAe ABSORPTION UNIT,BTU
(This Section need not be completed if the work Involved by the MAPBSSOR
OOKPAGE PARCEL
permit f9 for one hundred dollars($100)Or less.) AIR HANDLING UNIT,CFM
nATTPILi NO. PROCESSED BY
I certify that in the performance of the work for which this permit
is comes I shall not employ any person in any manner so as to BOILER,BTU od
become subject to the Workers' Compensation any
m
1 COMPRESSOR,BTU 36 000 23 25
MPFOVALS DATE INSPECTOR'S SIGNATURE
Date Applicant VENTILATION SYSTEM -
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensation 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_ v wr
LICENSED CONTRACTORS DECLARATION 1 FLOOR BTU 23 25 VALIDATION
I hereby affirm that I 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. LJII
7 air register outlets 26 81
License Number 221751 Lic.Class C-20 1 return air intake 3 �83
Contractor Bryant Htg. & A/CDate 6/17/92 _ , 1 0
yr ,•707 U
❑ I am exempt under Sec. Plan Check fee ' t Sf ! • rrr
B.&P.C.for this reason PERMIT ISSUING FEE $ •`• O
24 75 i 'TOTAL 10 1 - 35� v
Date:
Signature TOTAL FEE 101 89 i,, ECP, - IOfi d
PLAN CHECK APPLICANT CHAME °11=1 Z
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law NAME Poo.for the following reason (Section 7031.5, Business and Professions nl:' _T 1
Cade): I_„_113—Njil_.i _•%l2/>:
❑ ADDRESS '-
I, as owner of the property, or my employees with wages
as their sole compensation, will do the work and the CITY TEL.NO. ..+Y'•� 1 rllil1`t'(i
structure is not intended or offered for sale (Section 7044,
Business and Professions Code). ' OWNER Mr. & Mrs. David Lan
❑ I, as owner of the property, am exclusively contracting MAIL
with licensed contractors to construct the project (Sec- ADDRESS 8909 East Hermosa Drive
tion 7044.Business and Professions Code).
CONSTRUCTION LENDING AGENCY CITY Temple City TEL.NO. 285-0098
hereby affirm that there is a construction lending agency for CONTRACTOR ,
the performance of the work for which this permit Is issued Bryant Heating & A/C Inc. -
(Sec.3097, Civ.C.).
ADDRESS 1350 East Las Tunas Drive
Lender's Name
CITY San Gabriel TEL No 286-1141
Lender's Address TATE LIC.
I certify that I have read this application and state that the she LICENSE NO. 221 751 CLASS C-20
information is correct. I agree to comply with all County ordinances
and State laws relating to building construction,and hereby authorize
representatives of this County to enter upon the above-mentioned
property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
6/17/92
SIGNATURE OF APPLICANT OR AGENT DATE