HomeMy Public PortalAbout10793 BLACKLEY ST_Mechanical__ •
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 9904200028
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 13613 LT: 88 10793 BLACKLEY ST
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803502
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: MCCULLOCH
8573-007-016 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY
30 AIR INLETS/OUTLETS 4.00 UNI 17.40
TENANT: TOTAL FEES 45.15 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
04/20/99 UT 04/20/00
OWNER: TEL. NO: FINAL DATE FINAL CODE:
WINSTANLEY ERIK C;CATERINA RIZZI
10793 BLACKLEY ST A,2-v
TEMP 917803502 DESCRIPTION OF WORK
4 NEW DUCTS FOR ADDITION
APPLICANT: TEL. NO:
SAME AS OWNER -
_ SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: ® �G9� APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO � FAU/WALL FURNACE
COMBUSTION AIR OPENINGS
DUCT WORK
ARCHITECT OR ENGINEER: TEL. NO: -
LIC. NO:// 1111111 1� AC/COMPRESSOR
THERMOSTAT
I
FIRE DAMPERS
SMOKE DETECTION DEVICES
COMMERCIAL HOOD
i7 I
ti
REPORT ID: DPR264 ROUTE TO: BS0508
WORKER'S I have
a certificate
DECLARATION 76A346DPW9/89 APPLICATION FOR PERMIT LIME GREEN
' 76A364C
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
copyrhereof(Sec.3800 Lab.C.)
Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑
Certified copy is hereby furnished. R f
❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN ADDRESS lJ E {J Ae
.department. (PRINT OR TYPE ONLY)
Date Applicant - LOCALITY _
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEARE
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. 'CUO XIX
COMPENSATION INSURANCE ABSORPTION UNIT,BTU
(This section need not be completed if the work involved by the MSSOR
APEBOOK PAGE SSOR PARCEL
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO. PROCESSED BY
certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU
become subject to the Workers'Compensation Laws.
COMPRESSOR,BTU
APPROVALS DATE INSPEC OR'S SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL - 1
provisions or this permit shall be deemed revoked. FURNACE: FA U GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU VALIDATION,
I hereby affirm that l am licensed under provisions of Chapter 9 SUSPENDED UNIT
(commencing with Section 7000) of Division 3 of the Business and HEATER: WALL
Professions Code, and my license is in full force and effect.
License Number Lia Class
3 D `I irCL
_
Contractor Date _ 'T' Y 0
F-1am exempt under Sec. Plan check fee 1 i c .; U
TOTAL 110 »r 10 oC
B.&P.C.for this reason PERMIT ISSUING FEE$ Z-14 ..QO
Date: TOTAL FEE
Signature /� /0 (_iIk( E , I ; a
PLAN CHECK APPLICANT
OWNER-BUILDER DECLARATION (n
I hereby affirm that I am exempt from the Contractor's License Law NAME
for the following reason (Section 7031.5, Business and Professions w STA , :y;_I I—''I sl.} -
oda): ADDRESS 1 U 1 CI �;Y, i. F�;{ e ti
I, as owner of the property, or my employees with wages
as their sole compensation, will do the work and the CITY C-_-Y TEL.NO.
structure is not intended or offered for sale (Section 7044,
Business and Professions Code). , OWNER ��� t4s-rA�1e�/
❑ I, as owner of the property, am exclusively contracting MAIL
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code). -� p
CONSTRUCTION LENDING AGENCY CITY `� { �� C;t TEL.NO. 4 4 W-7�5
I hereby affirm that there is a construction lending agency for CONTRACTOR 1
the performance of the work for which this permit Is issued ����f ,.
(Sec.3097,Civ. C.).
-f!� A t1+y ADDRESS
Lender's Name r1 (�
' 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. 1 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
pro rty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF APPLICANT OR AGENT DATE