HomeMy Public PortalAbout9124 WOOLLEY ST_Mechanical__ ION
048 DPW
WORKER'S I have
a certificate
of consent to 766A364C 9f89 APPLICATION FOR PERMIT LIME GREEN
I hereby affirm that I have a certificate of consent to self Insure,
or a certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING
copy thereof(Sec.3800 Lab.C.)
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
❑ 9 inspection FOR APPLICANT TO FILL IN BUILDING um
department. (PRINT OR TYPE ONLY) ADDRESS
Date ApplicantLOCALITY e
NO. TYPE OF APPLIANCE OF 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 MAP ASSESSOR
PAGE PARCEL
permit Is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU-
become p C/G�
become subject to the Workers'Compensation Laws. O
COMPRESSOR,BTU
APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers'CompensationEVAPORATIVE COOLER
provisions of the Labor Code,you must forthwith comply with such FINAL
provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
(commencing with Section 7000)of Division 3 of the Business and WALL
Professions Code,and my license is in full force and effect.
License Number Lic.Class
a
Contractor Date C
ElI am exempt under Sec. Plan Check fee I a
B.f:P.C.for this reason
PERMIT ISSUING FEE$ C
Date: TOTAL FEE Ov LL
Signature a
PLAN CHECK APPLICANT U,
OWNER-BUILDER DECLARATION L
1 hereby affirm that I am exempt from the Contractor's License Law NAME ,
for the following reason(Section 7031.5, Business and Professions
Code): ADDRESS �•r•i
I, as owner of the property, or my employees with wages `'`-''
as their sole compensation, will do the work and the CITY TEL.NO. `Lja I 1-5.C(i
structure is not intended or offered for sale(Section 7044,
TC4
Business and Professions Code). OWNER ` T;_I I.,I
1, as owner of the property, am exclusively contracting ' MAIL TOTAL 15 m 00
with licensed contractors to construct the project (Sec- 1 ADDRESS
tion 7044,Business and Professions Code). CITY TEL.NO. I`' r'H 15°Ij=1
CONSTRUCTION LENDING AGENCY 1'
I hereby affirm that there is a construction lending agency for I CONTRACTOR , CHANGE 4j.Il
the performance of the work for which this permit Is issued '
(Sec.3097,Civ.C.).
ADDRESS
Lender's Name T' i•I+� r f,I{ � "I
CITY TEL.NO. ?:'i;;wJi i
•.I6Z �
1 Nil [,a a=1, 1
Lender's Address STATE LIC.
I certify 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 relating to building construction,and hereby authorize
representatives of this County to enter upon the above-mentioned I
property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
t
SIGNATURE OF AP NT OR AGENT DATE
7GA 64C
CE 618(REV.6/78)
e: ( A•PPLICATI N FOR PERMIT
HEATING - VENTILATING - AIR CONDITI ING
COUNTY OF LOS ANGELES BUILDING.AND SAFETY
FOR APPLICANT TO FILL-IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS 9124 Wooley Way
LOCALITY Temple City.
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
' NEAREST
CROSS ST.
ABSORPTION UNIT,BTU OWNER Albert Haste
AIR HANDLING UNIT,CFM AMAIL DDRESS 9124 Wooley Way
BOILER,BTU CITY Temple City TEL.NO. $5
1 COMPRESSOR,BTU 2.-1/2 ton 10.00- CONTRACTOR Bryant Heat. & Air Cond
VENTILATION SYSTEM ADDRESS
1350 E. Las Tunas Drive
EVAPORATIVE COOLER . CITY ' San Gabriel TEL.NO. 286-114
FURNA1 FLOORCE: FAU BTU G vv+�+(�T/� lO OO STATE LIC.
LICENSE NO. 221751 CLASS C20
HEATER: SUSPENDED UNIT AppROVALS DATE INSPECTOR'S SIGNATURE
WALL d
ROUGH 1'
FINAL ®
O
INSP TION RECORD U
• dy
Plan check fee 25%of above. �
PERMIT ISSUING FEE$ 7 00 z
TOTAL FEE 2 7 GO
PAN CHECK APPLICANT PLAN CHECK VALIDATION
NAME
ADDRESS
CITY TEL.NO.
IHEREBY 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. PERMIT VALIDATION
I HEREBY CE FY THAT I'AM NOT AC�ING�IN VIOLATION OF
CHAPTER 9, DIVIS O 3, OF THE BUSINESS AND�P"OFESSIONAL CODE
OF THE STATE OF`ALO ORNIA.
SIGNATURE � /�`,• �(h /� /
OF PERM ITTE / %d�LJ�/Y✓
DISTRICT WO. PROCESSED BY
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