HomeMy Public PortalAbout5034 ARDEN DR_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0202270017
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 13531 LT: 28 5034 ARDEN DR
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804004
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LA ROSA
8585-018-009 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY
30 AIR INLETS/OUTLETS 1.00 UNI 4.35
TENANT: TOTAL FEES 32.10 ISSUED ON: PROCESS Y: PLAN BY: EXPIRES ON:
02/27/02 JK 08/26/02
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
MCCLELLAND; MARK A (626) 444-1711-
5034 ARDEN DR 3 7
TEMP 917804004 DESCRIPTION OF WOR
MECHANICAL I=V4— Wog AnrcC m�,. i3p-r"iy
APPLICANT: TEL. NO: A-D-Zi -r/� '
SAME AS OWNER -
SPECIAL CONDITIONS:
Cc
CONTRACTOR:
TEL. NO: - �� �� APPROVALS DATE INSPECTOR SIGNATURE
SAME AO
LIC. NO FAU/WALL FURNACE
COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK
LIC. NO: 1111111 AC/COMPRESSOR
� THERMOSTAT
Lj �1\n�(��rff FIRE DAMPERS
SMOKE DETECTION DEVICES
COMMERCIAL HOOD
z7 0
t�
,.
REPORT ID: DPR264 ROUTE TO: SS0508
WGitKERS'COMPENSATION DECLARAT*L 3 `1 ? CEA�313~(2-80) A Gam'GP f� C Q T�O FN FOR p E R O 0T
+ •i'hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers'Compensation Insurance,-r
a ce-';fied ropy thereof(Sec.3800,', b.IC
7 3�S'33
Po.icy c. ompany COUNTY OF LOS ANGELES BWLMNG AND'SAFETY
IN Certified copy is hereby furnished.
(1 Certified copy is filed with the county building inspection FOR APPLICANT TO (FULL IN BUILDING
%% denar+nen . — ^
ADDRESS
(PRINT OR TYPE ONLY) _—_J v� i—
Date / .`/�- pplicant. — . _ _
LOCALITY
C6RTI' KATE OF EXEMPT JN FROM WORKERF NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
COMPENSATIOi. INSURANCE NEAREST }
CROSS ST. O_
(This section need not be completed if the work involved ABSORPTION UNIT, BTU 0
by the permit is for one hundred dollars ($100) oI less.) DISTRICT NO. PROCESSED BY 0
I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM
permit is issued, I shall not employ any person in any manner f 0
so as to become subject to the Workers' Compensation Laws. BOILER, BTU `— H
d �,,�/` APPROVALS DATE •,INSPECTOR'S SIGNATURE 0
_G
Date Applicant / COMPRESSOR,BTU-4-1,2_v `� " N
LLJ
/ // ROUGH
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM i a Z
Exemption, you should become subject to the Workers' FINAL
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION '
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU_�1RAVITY
LICENSED CONTRACTORS DECLARATION ` FLOOR: 8TU/ �e =140
I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT
9 (commencing with Section 7000)of Division 3 of the Busi- WALL _
ness and Professions Code, and my license is in full force and
effect. 7�(:q
License Number27356 / Lic.
1! -7 o9,
Contracto Date_
I/.nse'd
xempt .rom the licensing oquire ents as I am a
Ii ar, .itect or a registered professional engineer Plan check fee 25%of above.
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). PERMUT USSUING PEE $% ?
Lic.or Reg.No. Date TOTAL PEE ���
HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from- the Contractor's NAME z 4 7 0.6'A
License Law for the following reason (Section 7031.5, Busi-
ness and Professions Code): ADDRESS
I, as owner of the property, will do the work and the CITY TEL. NO. j o 0 3[I.QIQ
structure is not intended or offered for sale (Section
7044,Business and Professions Code). OWNER / �� opo o 34,0 Q
I, as owner of the property, am exclusively contracting
with licensed contractors to construct the . project MAILy'j �I p'8,2 3--8-3
(Section 7044, Business and Professions Code). ADDRESS 6--03/—
r� I
CONSTRUCTION LENDING AGENCY CITY TEL.NO.��Z'/��
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is CONTRACTO"s -
issued(Sec. 3097,Civ.C.). Lr�
Lender's Name ADDRESS
Lender's Address o u
CITY TEL.NO,
I certify that I have read this application and state that theSTATc �7 L LIC.
above information is correct.I agree to comply with all County LICENSE NO. / b9 CLASS G ��
ordinances and State laws regulating Heating, Ventilating and
Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County to enter upon the I -a-mentioned property for
inspe^ ,a purpc"as.
Signature of ermittee r Date ��