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HomeMy Public PortalAbout9231 BLACKLEY ST_Mechanical__ pp- 76A364 - CE818 - 3-69 APPLICATION FOR PERMIT g HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES fADDRESS UILDING DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONJOHN A. LAMBIE, COUNTY ENGINEER OCALITYCOLEMAN W. JENKINS,SUPERINTENDENT OF BUILDINGEARESTROSS $T. FOR APPLICANT TO FILL IN OWNER , (PRINT OR TYPE ONLY) MAIL NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS ABSORPTION SYSTEM, BTU CITY TEL. NO. " r AIR HANDLING UNIT, CFM CONTRACTOR ADDRESS BOILER, HORSEPOWER CITY r .f ,,,0,- TEL. N0.'G.. COMPRESSOR, HORSEPOWER STATELIC. LICENSE NO.~� � rZ CLASS VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED BY EVAPORATIVE COOLER FURNACE: FAU GRAVITY FLOOR BTU j.4-17 INSPECTION RECORD HEATER: SUSPENDED—UNIT UNIT a WALL O V Lm CC J_ ix Q DC O NEW—ADDITION— PERMIT $ 3 00 w H ALTER—REPAIR— TOTAL FEE $ ! PLAN CHECK APPLICANT 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,VENTI- LATING, AIR CONDITIONING. APPROVALS DATE INSPECTOR'S SIGNATURE I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF ROUGH CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL CODE OF THE STATE 06,CALIFORNIA. SIGNATURE ''--""-a f� JACK R. ALLEN, SUPERVISING MECHANICAL ENG'R. OF PERMITTEE �• _ ...,� PERMIT VALIDATION CK. M.0. cgsH _ PLAN CHECK VALIDATION .ACK OF APPLICATION FOR COMPLETE FEE SCHEDULE J ` 1 76A3641C CE f3113(REV 6/78) ©S- APPLICATION FOR PERMIT HEATING - VENTILATING - AIR CONDITIONING COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING FOR APPLICANT TO FILL IN. ADDRESS L (PRINT OR TYPE ONLY) QL LOCALIT�Y�— ` NO TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST CROSS ST ABSORPTION UNIT BTU OWNER AIR HANDLING UNIT CFM I MAIL ADDRESS L BOILER BTU CITYTEL NO ` COMPRESSOR BTU CONTRACTOR IQ W111- VENTILATION SYSTEM ADDRESS EVAPORATIVE C OLER CITY TEL NO FURNACE FAU GRAVITY STATE LIC FLOOR / BTUQ LICENSE NO CLASS HEATER SUSPENDED UNIT_ APPROVALS DATE INSPECTOR S SIGNATURE WALL ROUGH FINAL —�0"�9 / 0 INSPECTION RECORD V cc O Plan check fee 25% of above 9 PERMIT ISSUING FEE$ �� Z TOTAL FEE a PLAN CHECK APPLICANT PLAN CHECK VALIDATION NAME ADDRESS CITY TEL NO I HEREBY 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 CERTIFY THAT I AM NOT ACTING IN VIOLATION OF CHAPTER 9 DIVISION 3 OF THE BUSINESS AND P ESSIONAL CODE OF THE STATE OF CALIFORN SIGNATURE O O N OF PERMITTEE /41 =+ O O O DISTRICT NO PROLE D BY - IV O O O IV (11 N IV o 4LL J o N v O O o R -O O O Cn D n WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT I ,Sret y affirm that I have a certrflcatL of consent to self Irfsure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec 3800, Lab C') 76A364C HEATING - VENTILATING - AIR CONDITIONING 20-0046 DPW 9/88 1 � ' Policy No Company Certified copy is hereby furnished ' COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING tion department (PRINT OR TYPE ONLY) ADDRESS A (3fGCk� Date Applicant NO TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY t I& CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST / t , COMPENSATION INSURANCE CROSS ST BTU (This section need not be completed If the work Involved by ABSORPTION UNIT, DISTRICT NO PR ED BY the permit Is for one hundred`dollars ($100) or less ) l/ I certify,that in,the performance of the work for which this AIR HANDLING UNIT, CFM (JX permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws J BOILER, BTU ' APPROVALS DATE INSPECTOR S SIGNATURE / Date Applicant COMPRESSOR, BTU l O O ROUGH i NOTICE TO APPLICANT If, after making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' / Compensation provisions,of the Labor Code, you must forth- EVAPORATIVE COOLER VA with comply with such provisions or this permit shall be deem- ed revoked % FURNACE FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU 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 WALL and Professions Code,and my license is in full force and effect l j.O­� — / j& d�/� l (J License Number L Lic Class `— Poo. d r OU Contractor Date W ❑ I'am exempt under Sec Plan check fee B&P C for this reason' © H Date PERMIT ISSUING FEE $ Z ^ Signature TOTAL FEE - Ing OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031 5, Business and NAME Pr essions Code) ty j, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and ACC 'y the structure is not intended or offered for sale(Section CITY- TEL NO 7044, Business and Professions Code) OWNER, , +:307 51-5.O I ❑ 1, as owner of the.property, am exclusively contracting with licensed contractors to construct the project (Sec- MAIL 1 ITEMS tion 7044, Business and Professions Code) ADDRESS TOTAL 53- 00.700 CONSTRUCTION LENDING AGENCY CITY TEL NO I hereby affirm,that there is a construction lending agency for CHEC k 53.00 the performance of the work for which this permit is issued CONTRACTOR , CHANGE (Sec 3097, Civ C ) ADDRESS Lender's Name LSTATE TEL NO 0000-0001 Lender's Address LIC Dn n CC I certify that I have read this application and state that the O CLASS i=+-11 1 �Q1�1�1•" above 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 purposes I r SEE REVERSE FOR EXPLANATORY LANGUAGE }tom-ice /_//`9U Signature of Applicant or Agent Date ©s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1306270019 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ILEGAL ID j FEES PAID BUILDING ADDRESS ITR 11492 LT 14 BL 001 1 9231 BLACKLEY ST I IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803137 IASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET ENCINITA 18590-001-018 101 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY CAI 1 102 COMPRSR c 100 KBTU 1 00 COM 27 00 1 ITENANT 108 FURNACE/HEATER <100 1 00 UNI 27 00 (ISSUED ON PROCESSED BY PLAN BY I TOTAL FEES 81 80 106/27/13 SR I (OWNER TEL NO I IFINAL PATE FIN BY CODE IWOO ARTHUR,ANNA TRS (626) 285-7363- I 1 / I 19231 BLACKLEY ST 1 1 ! 1 ITEMP 917803137 I IDE CRIPTION OF WORK �l 1 1 IREPLACE EXISTING FURNACE & ACTS ADD A/C & COIL I I I I (APPLICANT TEL NO 1 IPISANO, ROSS (626) 286-1141- I I 11350 E LAS TUNAS DR I ISPECIAL CONDITIONS ISAN GABRIEL CA 91760 I I I I (CONTRACTOR TEL NO (APPROVALS DATE INSPECTOR SIGNATURE 13RYANT HEATING AND AIR CONDITIONING (626) 286-1141- 1 1 11350 E LAS TUNAS DRIVE LIC NO 1 IFAU/WALL FURNACE ISAN GABRIEL CA 91776 948151 I 1 1 1 1 ICOMBUSTION AIR OPENINGS 1 (ARCHITECT OR ENGINEER TEL NO IDUCT WORKI I I I LIC NO ! IAC/COMPRESSOR /v I /i ITHERMOSTAT I I 1 IFIRE DAMPERS 1 ISMOKE DETECTION DEVICES ICOMMERCIAL HOOD I I I I I I I I I I I I I I I I I I I I i f I I I I I I I I I I I I I I I I I I I I I I I I I I I I i I I I I I* ADDITIONAL DATA ON FILE I I I I I I 1 IREPORT ID DPR264 ROUTE TO BS0508 I i I I I I