HomeMy Public PortalAbout5344-5346-5348-5350 VILLAGE CIRCLE DR_Mechanical__ 76 A364- CE 818- 5-73
APPLICATION OR PEt
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUI NG
DEPARTMENT OF COUNTY ENGINEER ADD SS 1 S3�fN 53y' � s3s'o
BUILDING AND SAFETY DIVISION LOCALITY V ( C
NEAREST
CROSS ST. `
FOR APPLICANT TO FILL IN .OWNER ,
(PRINT OR TYPE ONLY)
MAIL 1 .
No. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS
CITY 10L. NO. %Q 7
ABSORPTION'UNIT, BTU
CONTRACTOR
AIR HANDLING.UNIT, CFM ' 'rr
ADDRESS Y�`I'
BOILER, BTU CITY �^ TEL. NO. /ff-vy
COMPRESSOR, BTU STATE LIC.
Colo LICENSE NO. CLASS a+A
VENTILATION SYSTEM DISTRICT NO. GROUP I ZONE ROCESSED BY' .
EVAPORATIVE CO LER r �• ,- D ,
FURNACE: FAU_GR ITY INSPECTION RECORD ool
FLOOR BTU J000
HEATER: SUSPENDED UNIT_
WALL
O
C')
O
I--
W
a
Plan check fee 25% of above. See reverse. z
PERMIT ISSUING FEE 8 0
TOTAL FEE
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL,NO. ,.
1 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 INSPE�OR'S SIGNATURE
EATING,AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT 1 AM NOT ACTING IN VIOLATION /
OF CHAPTER 9, DIVISION 3, OF THE BUSINE S ND'PROFESSIONAL FINAL 7�1b - 6
C OD.F,O.F THE STATE OF FOR NIA.
SIGNATURE PERMIT VALIDATION cK. r..t.o. cnsH
OF PERMITTEE
PLAN CHECK VALIDATION" CK. M.O. CASH
2 4 9'rFE ':29 41 6 4.5'OA,8
WORKER'S COMPENSATION DECLARATION 20-0048 DPW 9/89 APPLOCATI®tltl [FOR PEflV{IC9110r E
I hereby affirm that I have a certlflcate of consent to self Insure, 76A364C
a NE
or a certificate of Worker's Compensation Insurance, or a certified HEATIM-!VENTILATING-AIR CONDITIONING V
copythereof(Sec.3800 Lab.C.)
Policy No.PC943677 company Republic Indemnity COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIN.
❑ Certified copy Is hereby furnished.
® Certified copy is filed witPou I ' nspection FOR APPLICANTTO FILL IN BUILDING
department. (PRINT OR TYPE ONLY) ADDRESSDate 12/$/92 AppliNO. TYPE OF APPLIANCE OR EQUIPMENT FEELOOALTM Temple CitCERTIFICATE OF EXE WO �nvolved
S' NEAREST
CROSS ST.
COMPENSACE ABSORPTION UNIT,BTU
(This section need not be completed If the vior by the ASSESSOR
MAP BOOK PAGE PARCEL
permit Is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU
become subject to the Workers'Compensation Laws. �O
COMPRESSOR,BTU
APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH .�
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL 14 .F
provisions or this permit shali be deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION 1 FLOOR BTU !VALIDATION
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
(commencing with Section 7000)of Division 3 of the Business and WALL
Professions Code,and my license is in full force and effect.
f
Lice se N r 22175 Lic.Class C-20
DCCT o4 ?
Cor Date 12/8/92 `r�7 42J-110 a
I am exam u or
Sec.
Plan check fee 1 STEKS CC',
BAP.C.for this reason PERMIT ISSUING FEE$ I OTAL
� C
24 75
Date: TOTAL FEE Cf_� � lrl I C
Signature C°O t: 1y1'� .03a
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT ✓ f (/
G_
1 hereby affirm that I am exempt from the Contractor's License Law NAME P4 /K
for the following reason(Section 7031.5, Business and Professions �t
Coe )' ADDRESS i�G r7 1 AH 10 57
I, as owner of the property, or my employees with wages
as their sale 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 M
r. Terry Walker
❑ I, as owner of the property, am exclusively contracting MAIL
with licensed contractors to construct the project (Sec- ADDRESS 5350 Village Circle Drive
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY CITY Temple City TEL.No 818 287-1101
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.).
Bryant Hpatmirig X, ALC Inr-
Lender's Name ADDRESS 1350 East Las Tunas Drive
CITY San Gabriel TE`-NO.818 286-1141
Lender's Address STATE
I certify that I have read this application and state that the above CENSE NO. 221751 CLASS C-20
information is correct. I to comply with all County ordinances
and State laws relatin b 'ding construction,and hereby authorize
repro as unty to enter upo the above-mentioned
pro arty s urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
12/8/92
SIG T OF APPLICANT OR Aa DATE