HomeMy Public PortalAbout6130 ROWLAND AVE_Mechanical__ 78A364C (GO8188)-4/77 APPLICATION FOR PERT
• .HEATING - VENTILATING - AIR CONDITIONING
u J
CITY OF TEMPLE CITY
BUILDING AND SAFETY DIVISION TA e% 22ZZ
FOR APPLICANT TO FILL IN BUILDING 610 ROWland Ave. ,
(PRINT OR TYPE ONLY) ADDRESS
Y'
' LOCALITY �
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST �
CROSS ST.
ABSORPTION UNIT.BTU John Sell
OWNER
AIR HANDLING UNIT,CFM MAIL 2023 Bella Vista
ADDRESS
BOILER,BTU
CITY iAreadi�EL.No. /.J_G-2272
1 COMPRESSOR,BTU3 T. 1 O CONTRACTOR J & J Ht & C �+�F J
VENTILATION SYSTEM ADDRESS 2379 First St. ,
EVAPORATIVE COOLER CITY La !7 me TEL.NO.3]A-GOl1
FURNACE: FAU-GRAVITY STATE V S LIC. 7 V
FLOOR BTU 1 n lO OO LICENSE NO 26169-+ CLASS C20
HEATER: SUSPENDED UNIT- DISTRICT NO. GROUP ZONE CESSED BY 0
WALL ^ V
-.5 o '3 9
. o
INSPECTION RECORD V
W
O.
H
'Plan check fee 25%of above.
PERMIT ISSUING PEE$ 7 00
I
TOTAL FEE
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 WITH ALL
ORDINANCES AND LAWS REGULATING HEATING, VENTILATING, AIR
CONDITIONING.
I HEREBY CERTIFY THAT 1 AM ACTING IN VIOLATION OF APPROVALS DATE INSPECTOR'S SIGNATURE
CHAPTER 9, DIVISION 3, OF THE BUST E AND ROFESSIONAL CODE 'ROUGH Z7 �
OF THE STATE ORNIA.
SIGNATUREn FINAL
OFPERMITTE ✓✓✓��y t-'�Ad%"- -AL I
biw -
PLAN CHECK VALIDATI cK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
C.
�y- 78512 RPR... r/ 41 D 217.00 � o
- - -._ 4 0'Z/-3l
SATION
WORKERS'CI have q cerci ficate Of n DECLARATION APPLICATION FOR PERMIT
insurer hereby a
rafcertif certificate of Workers' Compensat oInsurancent e,
or a certified copy thereof (Sec. 3800, Lab. C.) 76A364C HEATING - VENTILATING - AIR CONDITIONING
20-0046 DPW 9/88
Policy No. Company
❑ Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY
❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING f
tion d part enc. ADDRESS ��?f 6
� ��J (PRINT OR TYPE ONLY) G
Date l Applicant LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' I NEAREST
COMPENSATION INSURANCE CROSS ST.
(This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. PROCESSED BY
the permit is for one hundred dollars($100)or less.)
I certify that in the performance of the work for which this AIR HANDLING UNIT, CFM ��O ✓�� J /_
permit is issued, I shall not employ any person in any manner BOILER, BTU
so as to become subject to the Workers'Compensation Laws. APPROVALS DATE SIGNATURE
Date Applicant COMPRESSOR, BTU /a' DO ROUGH
r
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL i
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER V ID TI
withcomp with such provisions or this permit shall be deem-
ed revoked. FURNACE: FAU
LICENSED CONTRACTORS DECLARATION 4— FLOOR BTU /;L. D
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 WALL
and Professions Code,and my license is in full force and effect. _
License Number Lic. Class , C
AC Tov V
Contractor Date ,� x
❑ I am exempt under Sec. r FF--
fi
Plan check fee i ITEMS W
e.&P.C. for this reason CL
PERMIT ISSUING FEE $ TOTAL 37 o
Date: I
qP
Signature TOTAL FEE QO 'HELD; 37.11
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT CHANGE .1313
1 hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and NAME
Prof sions Code):
ADDRESS I I II—�ILIL!i 'i' 14/91
I, as owner of the property, or my employees with l Q /`+Ow�d`'l�xx -e _
wagest as their sole compensation,will do the work and CITY �/- �' �rTft.�O. 2E78 1 AM 8:38
the structyre is not intended or offered for sale(Section /�",r 74
7044, Business and Professions Code). OWNER filly((C��/ _� 47/0-ZI, as owner of the property, am exclusively contracting j
with licensed contractors to construct the project (Sec- MAIL
ADDRESS 461;10
tion 7044, Business and Professions Code). _
CONSTRUCTION LENDING AGENCY CITY TEL. NO.gl ?3j.
I hereby affirm that there is a construction lending agency for ,
the performance of the work for which this permit is issued CONTRACTOR
(Sec. 3097, Civ. C.).
ADDRESS
Lender's Name
CITY TEL. NO.
Lender's Address
I certifythat I have read this application and state that the STATE LIC.
above iformation is correct. I agree to comply with all County LICENSE NO. CLASS
ordinances and State laws relating to building construction,
and hereby authorize representatives of this County to enter
upon.the rbove-mentioned propgrty f Zption purposes.
/ A SEE REVERSE FOR EXPLANATORY LANGUAGE
Signatu a of Applicant or Agent Date