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HomeMy Public PortalAbout9451 BLACKLEY ST_Mechanical__ 76 A364 - CE 818-1/75 APPLICATION FOR PERMIT ' HEATING - VENTILATING - AIR CONDITIONING I COUNTY OF LOS'ANGELES ADDID ESS C` DEPARTMENT OF COUNTY ENGINEER J _rq BUILDING AND SAFETY DIVISION LOCAL NEAREST CROSS ST FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) MAIL NO TYPE&SIZE OF EQUIPMENT FEE ADDRESS "C - _ SEE BACK OF APPLICATION CITY EL NO FORCE AIR FURNACE, BTU CONTRACTO COMPRESSOR, BTU ADDRESS VENTILATION FAN CITY Q ,_^ten/ } TEL NO�'OO) LIST ALL OTHERS BELOW LiC LICENSE NO J�-n CLASS C5� DISTRICT NO OUP ZONE SSED BY Ile, INSPECTION RECORD r O U O H U W 0- Plan check fee See reverse i r�rlivll 15�IrI�c F1 1 S PLAN CHECK APPLICANT 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 ALLORDINANCES AND LAWS REGULATING HEATING VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE LATING AIR CONDITIONING ROJG H I HEREBY CERTIFY T I AM NOT ACTING IN VIOLATION _ OF CHAPTER 9, DI VISI 3 7 USI NE 55 AND PROFESSIONAL FINAL �^ �7, CODE OF THE STATE CALIF R IA SIGNATURE PERMITTEE PERMIT VALIDATION- ,�e'� M o CASH - PLAN, CHECK VALIDATION K M o CASH �J 7-3 29,R M- 34 41 9 15.75A96 } Q V'p WORKERS' COMPENSATION DECLARAate�of TION APPLICATION FOR PERMIT insucebt o atertif Gate of Vjorkse san �<oTI�n f mpensatibInsurcel or a certified copy thereof (Sec 3800, Lab C ) 76A364c HEATING - VENTILATING - AIR CONDITIONING 20 0046 DPW 9/88 Policy No' Company ❑ Certified copy is hereby furnished COUNTY OF LOS ANGELES BUILDING AND SAFETY El ,Certified copy is filed with the county building inspec- J FOR APPLICANT TO FILL IN BUILDING e/ C tion department ADDRESS �(7 (PRINT OR TYPE ONLY) Date Applicant LOCALITY /C G;r NO TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS ST "(This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO PROCE the'permit is for one hundred dollars ($100) or less) h I certify that in the performance of the work'for which this AIR HANDLING UNIT, CFM t permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws IBOILER, BTU APPROVALS DATE SPECTOR 5/NATURE O GI92 ��' / COMPRESSOR BTU O O 0 ROUGH Date Applicant 110 _1 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 LI A V)8�)/ with comply with such provisions or this permit shall be deem- ed revoked I " FLOOR CE FAU BTU ITY LICENSED CONTRACTORS DECLARATION Q� 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�/QTS puT�T 1 D C—�� 0 License Number Lic Class • d CAL G4�IRi�. ,� V Q p �� IM Contractor 4e 7'' T 0 � ❑ _ I am exempt under Sec U Plan check fee LU B&P C for this reason CLPERMIT ISSUING FEE $ H Date ' TOTAL FEE Q � , OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT 3 5 I hereby affirm that I am exempt from the Contractor's License Law for the'following reason (Section 7031 5, Business and NAME Professions Code) - 1, as owner of the property, or my employees with ADDRESS a'tiiTaa wages as their sole compensation,will do the work and CITY TEL NO 7^ 7 i; the structure is not intended or offered for sale(Section L �, t1,_1 t 7044, Business and Professions Code) OWNER 1, as,owner of the property, am exclusively contracting I � 1 ITEMS with licensed contractors to construct the project (Sec- MAIL /efITt�I_ tion 7044, Business and Professions Code) ADDRESS CONSTRUCTION LENDING AGENCY CITYJf6V/e ,' TEL NO S7y�0� C HE(K j,)_1:1 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CONTRACTORL� NIA L� �►' IOG , CNkNGE • i`-' (Sec 3097, Civ C ) d ADDRESS Lender's Name 101000-001 it 9/'j l i CITY Lender's TEL NO .�sD Lender's Address _ 1113 (yii�;y!y I cern that I have read this application and state that the STATE LIC certify PP LICENSE NO 3Z CLASS L. above information is correct I agree to comply with all County ordinances and State laws relating to building construction, and hereb authorize representatives of this County to enter Up n the ve-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE (SwOjof Applic nt or A& t Date + ©s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0612120006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS ON FILE 9451 BLACKLEY ST :EE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803141 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET ENCINITA 8590-004-020 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY, C 08 FURNACE/HEATER <100 1 00 UNI 27 00 TENANT TOTAL FEES 54 75 ISSUhD ON PROCESSED BY PLAN BY EXPIRES ON 12/11/06 JK 06/10/07 OWNER TEL NO FINAL DATE FINAL BY CODE HSU ROGER,SANDY (626) 641-6995- Jl / 9451 BLACKLEY ST /C Y�- TEMP 917803141 DESCFIPTION OF-WORK REPLJ.CE F A U & EVAP COIL APPLICANT TEL NO BRADNEY (562) 935-9134- 4609 SUNFIELD SPECIAL CONDITIONS LONG BEACH, CA 90808 CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE BRADNEY H V A C R (562) 938-9134- 4609 SUNFIELD LIC NO FAU/VALL FURNACE LONG BEACH, CA 90808 548122 C20 � COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER TEL NO DUCT WORK LIC NO AC/COMPRESSOR THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES t COMMERCIAL HOOD REPORT ID DPR264 ROUTE TO BS0508