HomeMy Public PortalAbout6311 TEMPLE CITY BLVD__5/10/2017_TEMPLE CITY PERMIT NO. M17-34170
City of Temple City 1 9701 Las Tunas Drive I Temple Oty, Califomia 91780 1 (626) 285-2171 1 www.templecity.us
Address: 6311 Temple City Boulevard, Temple City, California Parcel: 5382-022-061
91780
Permit No: M17-34170 Type: Mechanical Subtype: Subtype: Residential
Description: ROOF PACK CHANGE OUT - MECHANICAL VENT Special
CHANGE OUT Conditions:
Issue Date: 05-10-2017 Expire Date: 11-06-2017 Extension: Extension:
Permit expires on date shown if: 1) work does not commence, or 2) work is suspended or abandoned, or 3) applicant fails to obtain code
required inspection.
Contacts
Owner lonnathan Lee
Applicant Michelle Correa
Contractor
Mechanical Details
Compressor/Furnace 2
/Etc up to 100k BTU
Appliance Vent 0
Ventilation Fan 1
Fireplace 0
Futura Energy Inc.
6311 Temple City Boulevard, Temple City, California 91780
9211 Greenleaf Avenue, Santa Fe Springs, California 90670
9211 Greenleaf Avenue, Santa Fe Springs, California 90670
Compressor/Furnace 0
/Etc 100-500k BTU
Air Handler up to 0
2,000 CFM
Ventilation System 0
Fees Total
Plan Check Fees $113.60 Permit Fees $86.72
Mechanical Inspections
Approval Date, 7� In —
FAU/WeiF — --
Furnace
Combustion _
Air
Openings
Duct Work
(626) 267-8135
(562)941-7459
(562)360-2045 985827
Compressor/ Furnace 0
Air 0
OR Floor 0
/Etc over 500k BTU
Inlet/Outlet
Area
Qty
Air Handler 2-10,000 0
Air Handler 0
Evaporative 0
CFM
over 10,000
Cooler
CFM
Kitchen Hood/Spray 0
Fire Damper 0
Duct 0
Booth
Alteration
Approval Date Inspector Approval Date Inspector
AC/ComThermo pressor Smoke
Thermostatliw Detectors
Fire Dampers Commercial
Hoo
FIN
FINAL
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from
the Contractors' State License Law for the reasons) Indicated
below by the checkmark(s) I have placed next to the applicable
Hems) (Section 7031.5, Business and Professions Code): Any
city or county that requires a permit to construct, alter, improve,
demolish, or repair any structure, prior to its issuance, also
requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the
Contractors' State License Law (Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professions
Code) or that he or she is exempt from licensure and the basis
for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($501
U I, as owner of the property, or my employees with wages as
their sole compensation, will do (✓) all of or U portions of the
work, and the structure is not intended or offered for sale
(Section 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of
property who, through employees' or personal effort, builds or
improves the property, provided that the improvements are not
intended or offered for sale. If, however, the building or
improvement is sold within one year of completion, the Owner -
Builder will have the burden of proving that it was not built or
improved for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with
licensed Contractors to construct the project (Section 7044,
Business and Professions Code: The Contractors' State License
'Law does not apply to an owner of property who builds or
improves thereon, and who contracts for the projects with a
licensed Con" or pursuant to the Contractors' State License
Law).
U: I am exemdt from licensure under the Contractors' State
License Law for the following reason:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, and my
license is in full force and effect. °
////'''� 2� License No.
�icense Class
(� t t
-Date l \� Contractor SignatureJ��
By my signature below I acknowledge that, except for my
personal residence in wi I must have resided for at least
one year priorl to completion( of the Improvements covered by
this permit, Icannot legally sell a structure that I have built as an
owner -builder If it has not been constructed in its entirety by
licensed contractors. I understand that a copy of the applicable
law, Section 7044 of'the Business and Professions Code, is
available upon request when this application is submitted or at
the following Web site: hftt),/Iwww.leginfo.ca.ciov/calaw.html.
cegov/calaw html/(www leainfo ca�ov/calaw html
Date:
Signature of Property Owner or Authorized Agent
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION
COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN
EMPLOYER TO CRIMINB.L PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION
TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED
FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEYS FEES.
I hereby affirm under penalty of perjury one of the following
declarations:
I have and will maintain a certificate of consent to self -
insure for workers' compensation, issued by the Director of
JOB ADDRESS
LOCALITY
HAZARDOUS MATERIAL DECLARATION
Will the applicant or future building occupant handle a hazardous
material or a mixture containing a hazardous material equal to or
greater than the amount specified on the hazardous materials
information guide?
Yes ❑ No ❑
Will the intended use of the building by the applicant or future
building occupant require a permit for construction or
modification from the South Coast Air Quality Management
District (SCAQMD)? See permitting checklist for guidelines.
Yes ❑ No ❑
i
I have read the hazardous materials Information guide and the
SCAQMD. permitting checklist, I understand my requirements
under the Los Angeles County Code Title 2, Chapter 1120'
Sections 220.100 through 220.140 concerning hazardous
material reporting and for obtaining a permit from the SCAQMD.
Industrial Relations as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit ASBESTOS NOTIFICATION
is issued. -
PoJicy No. ❑ Notification letter sent to AQMD and/or EPA
F„'[' I have and will maintain workers' compensation
insurance; as required by Section 3700 of -the Labor Code, for ❑ I declare that notification of asbestos removal is not
the erformance of the work for which this permit is issued. My applicable to addressed project.
w open tion Ins nqe c 'er�� If uyr ire: ,� �aS
`'yy p�(� 1/ % SLY DEC(pdiATION REGARDING CONSTRUCTION LENDING
Carrie olicy er EtpfratiSn'Date AGENCY
Name of Agent Phone Number
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 become subject to the workers' compensation laws of
California, and agree that, 'if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions
i
ig ature of Applicant e
LOBBYIST ORDINANCE CERTIFICATION
Complete this section for permits in
Unincorporated Los Angeles County only
This is to certify that I, as permit applicant, am familiar with the
requirements of Los Angeles County Code Chapter 2.160 at seq.,
(relating to the Los Angeles County Lobbyist Ordinance) and that
all persons acting on behalf of myself complied and will continue
to comply therewith through the application process.
Applicant (Print Name) Applicant Signature
Company Name Date
I hereby affirm under penalty of perjury that there is a
Construction lending agency for the performance of the work for
which this permit is issued (Section 3097, Civil Code).
Lender's Name
Lender's Address
By my signature below, I certify toeach of the following:
I am the property owner or authorized to act on the
property owner's behalf.
I have read this application and the information I have
provided is correct.
I agree to comply with all applicable city and county
ordinances and state laws relating to building
construction.
I authorize representatives of this county to enter the
above -identified property for inspection purposes.
Signature of P perty Owner or Authorized Agent