HomeMy Public PortalAbout5221 BARELA AVE_Mechanical__ • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0307090004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 15683 LT: 63 5221 BARELA AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803849
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BLACKLEY
8589-012-004 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY
02 COMPRSR < 100 KBTU 1.00 COM 27.00
TENANT: 08 FURNACE/HEATER <100 1.00 UNI 27.00 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
30 AIR INLETS/OUTLETS 11.00 UNI 47.85 07/09/03 JK 01/05/04
TOTAL FEES 129.60
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
LIU ROBERT YUNG-PING;SUN CHRISTINE (626) 285-8176- "1 .�Lb-o3
5221 BARELA AV
TEMP 917803849 DESCRIPTION OF WORK
INSTALL NEW HVAC SYSTEM
APPLICANT: TEL. NO:
SAME AS OWNER -
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECT07 SIGNATURE
SAME AS OWNER -
LIC. NO TAU/WALL FURNACE
3
COMBUSTION AIR OPENINGS 2
ARCHITECT OR ENGINEER: TEL. N0: DUCT WORK
LIC. NO: AC/COMPRESSOR
THERMOSTAT
FIRE DAMPERS
SMOKE DETECTION DEVICES
COMMERCIAL HOOD
REPORT ID: DPR264 ROUTE TO: BS0508
s WORKER'S COMPENSATION DECLARATION 76A364C 46DPW9/69 APPLICATION FOR PERMIT LI E GomREEN
76A3
I hereby affirm that I have a certificate of consent to self insure, �y
or a certificate of Worker's Compensation Insurance, or a certified HEATING-VENTILATING-AIR CONDITIONING yljJll
copy thbreof(Sec. 3800 Lab. C.)
Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
Certified copy is hereby furnished. BUILDING
o�
❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN ADDRESS �07c�✓s� ._J
department. (PRINT OR TYPE ONLY)
Date Applicant LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE '
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
CROSS ST.
COMPENSATION INSURANCE ABSORPTION UNIT,BTU
SSOR
(This section need not be completed if the work involved by the
MAPBOOK PAGE�j� PARCEL
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO. PROCESSED BY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU f�
become subject to the Workers' Compensation Laws.
COMPRESSOR,BTU
_ APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers'CompensationEVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL ,s
provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY VALIDATION
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT
(commencing with Section 7000) of Division 3 of the Business and HEATER: WALL
Professions Code, and my license is in full force and effect.
License Number Lic.Class u
ACCT.o
Contractor Datett1t
under' Sec. Plan Check fee 33-503rJ� 53.900 1 am exempt
7 0
B.&P.C.for this reason PERMIT ISSUING FEE$ 1 ITEMS 0
TOTAL
Date: 90
TOTAL FEE r0 LU
CL
Signature CHECK 53.90 rA
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
pop-
CHANGE a iJi 1
I 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 [000-01 iU i 4/11/96
" ❑ LF VU E7 1
I, as owner of the property, or my employees with wages
as their sole compensation, will do the.work and the CITY TEL.NO. 5847 1 AM 9*-11
structure is not intended or offered for sale (Section 7044,
Business and Professions Code). OWNER �'kPi g`T W E 1
I, as owner of the property, am exclusively contracting MAIL L 1 /t A /�
with licensed contractors to construct the project (Sec- ADDRESS 522-1 ARF— AV6 -
tion 7044, Business and Professions Code). tr _ rrB }
CITY T6f����t: Cf I C� TEL. C a IJ ? '�J7
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for CONTRACTOR V�f�pA lrriv'CS
the performance of the work for which this permit Is issued
(Sec.3097,Civ.C.). ��
ADDRESS
Lender's Name
CITY TEL.NO.
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
property for inspection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF APPLICANT OR AGENT DATE