HomeMy Public PortalAbout4947 TEMPLE CITY BLVD_Mechanical__ V 'Kl? DMIENSATIONDICIARATION 'BAag4G APPLICATION FOR PERMIT
j CE 918 12 80)
>�c^) lffirm that I havr, a cvrnfleatn of consent to sJf
u.0 or u certificate of Workers Compensation Insurance or HEATING-VENTILATING-AIR CONDITIONING
a certified c 7800 �h �
Policy No IMM any_rZ
Certified copv is hLreby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy s fled with the counh building inspection BUILDING ). /
EER
tmeJA�TP
h /) FOR APPLICANT TO FILL IN qDD RESS (F K'
Date phcd tit 'L/ (PRINT OR TYPE ONLY)
LOCAL-
—.TY
II II FXEAIPTION FROM WORKERS NO TYPE OF APPLIANCE OR EQUIPMENT FEE
COMPLNSATION INSURANCE NEAREST }
jh
Section need not be completed If the work Involved _ ABSORPTION UNIT BTU d
e permit is for one hundred dollars ($100) or less) DISTRICT NO 1_ �- PR ss9 Y SU.�
if) that in the pLrformance of the work for which this AIR HANDLING UNIT CFM rs/ t=
it IS Issued I shall not employ ans person In my manner (� t- O
to become subioct to the Workers Compensation law• BOILER BTU t
�� f 1 APPROVALS DATE n'�P 991GIA'JRE LU
A phconl_N/r_�✓ _ 2 COMPRESSOR BTUZ/_d� gOVGH '� N
CF TO AYYI ,ANT It eller making this Certificate of VENTILATION SYSTEM ?
pit )ou should become subject to the \Yorkers FINAL
ensntiun prova,o ns of the Labor Code you must forth EVAPORATIVE COOLER
comply with such prostsiona br this permit shall he 'y VALID ION
ed revoked FURNACE FAUEQAVTVLILFNSLD CONTRACTORS DLLLAR ATION FLOOR EET
eby affirm that I am licensed under prosislons of Chapter HEATER SUSPENDED UNIT
mmencing with Section 7000) of Division 3 of the Bust WALL
and Professions Code end m) bcense is m full lorce andt f/1
LicenseNumber Lic Clea
C,mtractor_'J-w
Date
1 am exempt from the licensing requnrLments as I am a
licensed architect or a registered professional engineer Plan Check fee 25%of above _
acting in my professional capacity (Section 1051 Bus
mess and Professions Code) PERMIT ISSUING FEE $
Lic or Reg No Data TOTAL FEE
HOME OWNLR BUILDER DI CLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractors NAME 7vNa�s�e L
License Law for the following reason (Section 7031 5 Bus,
nese and Professions Code) ADDRESS pfHews D
I as owner of the property wall do Inc work and theL,(�Oy
eruct ore n not intended ur altered for sale (Section
CITY �•1���1"./Q/�(I rI F-� TEL
044 Business and Ymfessions CodL) '
\ 1 as owner of the property em eXelu9le Liy cuntMCtmg OWNER �1� ✓ Tia(,) ACCT.T
1 with licensed contractors to construct the project MAIL 4 e
/ (SLclion 7044 Business and Professions Lode) ADDRESS �� C0*111-At _ 317 52.25
CONSTRUCTION LENDING AGENCY CITY TEL NO 1A 1 ITEMS
I hereby affirm that then ,s a construction lending agency . !L, 7 TOTAL
52 - 25
for the performance of thL work for which this permit Is CONTRACTOR /r
7 ZoF/ _L_/_fN� 52.25
issued (SLc a Co, C ) //Lll1CCfV
Lender s Name ADDRESS Q(� H � � x.l l{--t�,trs� i1/7
Lender s Address CITY /�/-u.��il f IDATbf_ NO ]/'1 — ��'� LHI'03'3G •UU
1 certify that I havL read this application and state that the STATE '� /`s,o LIC
above Information Is correct 1 agreL to comply with all County LICENSE NO CLASS
ordinances and State laws regulating Heating Ventilating and (1OW-0001 1/25/89
Air Conditioning and hereby authorize representutives of this SFF REVLRSL I OR EXPLANATORY LANGUAGP 1744 1 AM11�S0
County to enter upon the abole mentioned property for
Inspection purposes
Signature
� Pate _