HomeMy Public PortalAbout6341 TEMPLE CITY BLVD_Mechanical__ "E CF RIS 116 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESSOCALITY C E 1 1
N/
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L ' C I
NO, TYPE OF APPLIANCE OR EQUIPMENT FEE ---'
NEAREST
CROSS ST.
ABSORPTION UNIT.BTU
OWNER
AIR HANDLING UNIT,CFM MAIL
ADDRESS
BOILER.BTU CITY TEL.NO.
COMPRESSOR,BTU CONTRACTOR
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CITY TEL.NO.
FURNACE: FAU—GRAVITY STATE LIC.
( FLOOR BTU O LICENSE NO. CLASS
HEATER: SUSPENDED—UNIT— DISTRICTNOQQ GROUP ZONE Roc[SSEDbr
WALL z,
INSPECTION RECORD V
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Plan check fee 25% of above. rg
PERMIT ISSUING FEE$ d A
TOTAL FEE IZ p
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY -STEL.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 I AM NOT ACTING IN VIOLATION OF APPROVALS DATE INSPECTOR'S SIGNATURE
CHAPTER 9. DIVISION 3. OF THE BUSINESS AND PROFESSIONAL CODE
OF THE STATE OF CALIFORNIA. ROUGH
SIGNATURE FINAL
OF PERMITTE FI
LAN CHECK VALIDATION ..K. M.O. CASK PERMIT VALIDATION ca. N.O. CASH
1. w
1 0 51. •" J
®E
ION
• WORKER I have a certificate
of consent
alM APPLICATION FOR PERMIT LIME GREEN
ITeroby affirm that I have a certlficefe of consent fo sell Insure
or a certificate of Worker a Compensation Insurance or a cenifined HEATING-VENTILATING-AIR CONDITIONING
copy thereof ISec 38001ab C)
Policy No Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV
Canif ed copy is hereby furnished
❑ Cerefnd copy a hied With the county building Inspection FOR APPLICANT TO FILL IN BUILDING ,� ` C// V
depertmant (PRINT OR TYPE ONLY) ADDRESS ✓
Data Applicant LOCALITY
NOTYPE OF APPLIANCE OR EQUIPMENT,, FEE
CERTIFICATE OF EXEMPTION FROM WORKERS NEAREST
COMPENSATION INSURANCE CROSS ST
u section need not be completed If the work Involved b the ABSORPTION UNIT BN
(Th P Y MAP BOOK PAGE PARCEL
permH Is for one hundred dollars n
(1100)or Is) AIR HANDLING UNIT CEM
aarecr w mocsssm er
I certify that in the performance of the work for which this permit
Is Issued I shall not employ any person In any manner to as to BOILER BTU p
become subject to the Workers Compensation Laws I
COMPRESSOR BTU
MPA'Ylµa DAM NBPBmCa 8 si a w%
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT If alter making this Certificate of ROUGH W U4
Exemption you should become subject to the Workers Compensation EVAPORATIVE GOOIER
provisions of the Labor Code you must forthwith comply With such FINAL
provisions or this Permit shall be deemed revoked FURNACE FA VRY 2
LICENSED CONTRACTORS DECIAMTION PLooR BTU— VALIDATION
I hereby affirm that I am licensed under provisions of Chapter B SUSPENDED—UNIT—
(commencing
USPENDED UNIT_(commencing with Section 7000)of Division 3 of the Business and NEATER WALL
Professions Code and my license Is In full force and effect
License Number Lo Class
}
0 a
Contractor Date S
F1 am exempt under Sec Plan Check fee v
2
B AP C for this reason PERMIT ISSUING FEE$ 0
Date TOTAL FEE U
pD W
Signature C•
OWNER BUILDER DECLARATION PLAN CHECK APPLICANT Z
I hereby affirm that I am exempt from the Contractors License Law FUME Poo. -
for the fallowing reason (Section 7031 S Business and Professions -
C�¢o -
I as owner of the property or my employees with wages ADDRESS
as their sole compensation will d° the work and the CITY TEL NO �.1�7 7d,IJl
structure is not Intended or offered for sale (Section 7044
Business and Professions Cede) fMNER -.. / i ITEMS,
❑ I as owner of the property am exclusively contracting MUL TIITAL 53 - dd
with licensed contractors to construct the project (Sec ADDRESS) U� C
Ilan 7044 Business and Professions Code) C�k J�.�a.l
CONSTRUCTION LENDING AGENCY CITY TEL �� UII ISL
1 hereby sHHm that there is a construction lending agency for ,
the performance of the work for which this permit Is Issued CONTRACTOR
(Sec 3087 Civ C) _
Lenders Name
ADDRESS 0090-0001 61 17/41
_
CITY TEL NO •�0 1 ( ::Ili
Lander a Address STATE LIC
I cerfify that I have read this application and state that the above LICENSE NO CLASS
information is correct I agree to comply with all County ordinances
and State laws reteung to building construction and hereby autha¢e
repretentatwae of this County to enter upon the above mentioned
property f ins c p rp SEE REVERSE FOR EXPLANATORY LANGUAGE
Z, 1.7
•Tl,1+E APP DATE