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76 A36OL Z E b' — 9-71
APPS TION FOR PIT
HEATING - NEN ILATING - AI CONDITIONING
COUNTY OF LOS ANGELES ADDRESS 9659 Las Tunas Drive
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY Aemple Cit
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER Mrs . Glenn Harris
(PRINT OR TYPE ONLY)
MAIL 9659 Tas Tunas Drive
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDRESS
CITY Temple City TEL. NO. 286-6592
ABSORPTION UNIT, BTU
CONTRACTOR Bryant Heat. & Air Cond. Inc.
AIR HANDLING UNIT, CFM
ADDRESS 1350 E/ Las Tunas Drive
BOILER, BTU CITYTEL. NO.
COMPRESSOR, BTU 36.000 5100 STATESan Gabriel LIC 86-1141
LICENSE NO. 221751 CLASS C20
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROLE SED BY
EVAPORATIVE COOLER 1 , �8 L C Z p}
0
FURNACE: FAU_GRAVITY INSPECTION RECORD U
FLOOR BTU
HEATER: SUSPENDED UNIT_ v
WALL w
o..
• Z
Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE S 3 00
TOTAL FEE 8 00
PLAN CHECK APPLICANT
NAME
ADDRESS
S CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING,AIR CONDITIO NG.
ROUGH
I HEREBY CERT F AT OT ACTING IN VIOLATION /�
OF CHAPTER 9, DTVI N 0 T NESS AND PROFESSIONAL 'FINAL ���/
CODE OF THE STAT 0 1
SIGNATURE PERMIT VALIDATION CK. M.O. CASH
OF PERMIT E
PLAN CHeYOVALIDAT CK. M.O. CASH
3 7 G 673 OCT 2 3 4 1 D 8('}OA.
SEE BACK OF APPLICATION F0. COM PLETFEE SCHEDULE
W,bRKER'S COMPENSATION DECLARATION 200046 DPW 9/89 ������A ®� ��RMIT
I hereby affirm that I havw`a'certificate of consent to self insure, 76A964C �1 `� E GREEN
or a certificate of Worker's Compensation Insurance, or a certified HEATING-AWILATING-AIR CONDITIONING
copy thereof(Sec.3800 Lab.C.) - d
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 � s E Zit
department. (PRINT OR TYPE ONLY)
Date ApplicantL06ALITY ,l
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE .
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($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU p
become subject to the Workers`CompensatioILa s.�/
ti �, d0
COMPRESSOR,BTU (1�
Date � A IlCent APPROVALS DATE INSPECTOR'S SIGNATURE
PP VENTILATION SYSTEM
NOTICE TO APPL CANT: If, after ma ng this Certifi o ROUGH
Exemption,you should become subject to t e Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code,you must forthwith comply with such FINAL
provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION
I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT
(commencing with Section 7000)of Division 3 of the Business and HEATER: WALL
' Professions Code,and my license is in full force and effect. _
�I
(/,(,� Jnr 7�
License.Number Lie.Class
Contractor Date
❑ I am axe pt under sec. Plan check fee ; C:
AUCT. a
B.&P.C.for this reason PERMIT ISSUING FEE$ �� (70u C
Date: TOTAL FEE O r 1 1�'U - u
Signature PLAN CHECK APPLICANT V
OWNER-BUILDER DECLARATION TOTAL AL 98 m 30 L
1 hereby affirm that I am exempt from the Contractor's License Law NAMEI'+V 1:
for the following reason(Section 7031.5, Business and Professions � 3=LI� '°10
e)' ! ADDRESS
CHANGEa 1J1)
I, as owner of the property, or my employees with wages
as their sole,compensation, will do the work and the CITY TEL.NO.
structure is not intended or offered for sale(Section 7044, I fl_ ( ;
Business and Professions Code). OWNER 0010"'r 1.1f-1111'-1 L if 3/94
❑. 1, as owner of the property, am exclusively contracting MAIL IF 3254 1 AM11:413
'with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code).
CITY TEL.NO.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for , CONTRACTOR
the performance of the work for which this permit Is issued
(Sec.3097,Civ.C.). I
ADDRESS 7 -cu/{f6
Lender's Name " '
CITY fav TEL.NO. i
Lender's Address STATE LIC.
I certify that 1 have read this application and state that the above LICENSE NO. CLASS �Zt�
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
[Q\]Ser• spe tion rposes. / C/ _i SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATI E OF gppLICANT OR AG 1 DATE !