HomeMy Public PortalAbout9010 HERMOSA DR_Mechanical__ ,GA l�_B.GB UAPFLICAT1V11 FOR PER T ' TEMPLE CITY
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
9010 E H emlosa
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING LOCALITY Tempi e City pg ®6 38 B-2
FOR APPLICANT TO FILL IN NEACRROSSST. Rosemead 8r Encinita
(Print or type only)
OWNER M etr o
NO. TY PEIOF APPLIANCE OR EQUIPMENT FEE
MAIL
ADDRESS p
ABSORPTION SYSTEM, BTU— , CITY TEL. NO-287 3894
AIR HANDLING UNIT, CFM CONTRACTOR
Normco Service
BOILER, HORSEPOWER ADDRESS 3141 San Fernando Rd
COMPRESSOR, HORSEPOWER CITY Los Angeles TEL. No. 254-2211
STATE - LIC.
VENTILATION SYSTEM LICENSE NO. 249647 CLASS C 36-20
DISTRICT NO. GROUP �O NEjl�rEDBY
EVAPORATIVE COOLER D8 r1/A��
FURNACE: FAU_GRAVITY
FLOOR—BTU INSPECTION RE OR
HEATER: SUSPE'Np UNIT_
WALL 35MDFBbO— 10 00
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N EW_ADDI TION PERMIT $ 73
ALTER—REPAIR— TOTAL FEE S 17 00
Plan check applicant
vane Norm co Appliance Service
Address 3 141 San Fernando Road
City Los Angeles Tel. No. 254-2211
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WIT ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS pATE IN ECTOR'S SIGNATURE
LATING, AIR COND ITHONING. rFINAL
GH 3 7
HEREBY CERTIFY -HAT I AM NOT ACTING IN VIOLATI
OF CHAPTER 9, OIVIS 3, OF THE BUSINE S AND PflO FE5510
CODE OF THE STAT CA IFORNIA.
JACK pR. ALLEN,SUPERVISING MECHANICAL ENG-R.
SIGN,OF PERMRITTE.. rE{A,IIT VALIDAPION CK. M.O. CASH
PLAN CHE ' VALIDATION ° 3°L
O D p CA
tc�'ti -F—C.tn7 a� P v c �
v
'O O 0 Oa
CM
SEE BACK OFAPPLICATION FOR COMPLETE FEE SCHEDULE
A WORKER'S COMPENSATION DECLARATION 6 MCDPW91Ba AnnICATION FOR PERMIT LANE GREEN
I hereby affirm that I have a certificate of consent to self-insure,
os a certificaie of Works I'S Compensation urance, or a Certified HEJATING-VENTILATING-AIR CONDITIONING
copy Cher Sec. 3800 Lab C.) j
P❑ollcy 9/3S Compan COUNTY OF LOS ANGELI?!"I DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
Certified copy is hereby furnished.
CXJ Certified co is tiled with the to`o t b " in 'n ection FOR APPLICANT TO FILL IN BUILDING
PY Y P ADDRESS
apartment. � (PRINT OR TYPE ONLY)
3 ( LOCALITY
Date—
! pelican �' N0. TYPE OF APPLIANCE OR EQUIPMENT FEE '
CERTIFICATE OF EXEMPfIGNS.FROM WOR6E S' NEAREST
CROSS ST.
COMPENSATION INSURANCE ABSORPTION UNIT,BTU -
(This sectiASS
on need not be completed If the work involved by the MAPESSORBOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU _
become subject to the Workers' Compensation Laws. v 0 O O
COMPRESSOR,BTU l�
'
APPROVALS BATE INSPECiOfl'S SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption, you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL -Z
provisions or this permit shall be deemed revoked. FURNACE: FAU GRA
LICENSED CONTRACTORS DECLARATION FLOOR BTU ��� VALIDATION
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT_
(commencing with Section 7000) of Division 3 of the Business and WALL
Professions Code,and my license is in full force and eff1�1ect.
License N bar Lic'Class `
a
Con L Date _ o
El PF_ cc
am exempt andPlan check fee� Be.ec. cc
B.BP.C.for this reason PERMIT ISSUING FEE$ ACC_T.a O
Date: fI'rl•1'IW
Signature I iTENS - (-
- -
NAME
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT CO
I ITAL iio'- lbZ
I hereby affirm that I am exempt from the Contractor's License Law ,
for the following reason (Section 7031.5, Business and Professions CHECK !If'.Iii
Code): ADDRESS _
I, as owner of the property, or my employees with wages
• ,ANtiE ,hill
as their sole compensation, will do the work and the CITY TEL.NO.
structure is not intended or offered for sale (Section 7044, (^/
Business and Professions Code). OWNER `l LI[h]:J-1 IQ14i `x,(24�3'
I, as owner of the property, am exclusively contracting MAIL
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code). .3 U /
CONSTRUCTION LENDING AGENCY Cm 0.
TEL.N
I hereby affirm that there is a construction lending agency for '. /I,O, �. L
the performance at the work for which this permit Is issued CONTRACTOR -ss�y
(Sec.3097, Civ.C.).
ADDRESS 13 _c7 �(
Lender's Name
CITY EL.NO.
Lender's Address STATE r ^ ` LIC. _ /
I certify that I have read this application and state that the above LICENSE NO. .�OL �J CLASS
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 _
pr p My fo ins eglion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
URE OF A11U.AvV AGENT DATE ,