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Home My Public Portal About9502 BLACKLEY ST_Mechanical__ 76'364-�CEe>B-1i70 APPLICATION FOR PERMIT 4 , HEATING - VENTILATING - AIR, C,QNDITIANING COUNTY OF LOS ANGELES FESUILDING '" /�5�� DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LITYJOHN A. LAMBIE. COUNTY ENGINEER ESTCOLEMAN•W.'JENKINS, SUPERINTENDENTOF'BUILDINGST. 'FOR APPLICANT TO 'FILL IN OWNER (PRINT (PRINT OR.TYPE ONLY) STS £µ 4 MAIL NO^ TYPEOFAP.PLIANCEOR�EQUPPMENT FEE� ADDRESS. s CITY t ABSORPTION SYSTEM, BTU y CONTRACTOR ,/Y [{� i AIR HANDLING Lf CFM ' ' 'ADDRESS BOIL ER,"°HORSEPOWER CITY TEL. NO. COMPRESSOR,'HORSEPOWER , STATE 1" LIC. LICENSE NO. 'CLASS VENTILATION SYSTEM DISTRICT NO CLASS GROUPY ZONE PROCESSED BY EVAPORATIVE COOLER FURNACE:, F=AU=GRAVITYr FLOOR BTU INSPER CTION RECOD; / HEAT ER:',SUSP,ENDED UNIT_ 4 WALL X, DD NEW—ADDITION- PERMIT, $; 3 000 Z ALTER REPAIR— TOTAL FEE $ c PLAN.0 HECK APPLICANT' NAME ; A-DDRESS- a 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, VENTI- APPRO,VAL'S. �.•.. ^DATE°• •NSPECT 'S,SIGNATURE 'LATING, AIR CONDITIONING. - _ - ROUGH I, HEREBY CERTIFY THAT I AM NOT-ACTING IN VIOLATION OF CHAPTER 9, DIVISION 3OF T BUSI_NESS'AND PROFESSIONAL' FINAL i CODE OF'TME STATE OF CA FO SIGNATURE �. JACK-RI.-ALLEN,SU ER ISI NG MECHANICAL ENG'R. 'OF PERMITTEE - ' Ink m PERMIT VALIDATION CK. M o. : ,CASH PLAN `CHECK- VALIDATION SEE BACK OF'APPLICATION FOR COMPLETE FEE SCHEDULE'' c - ,�•q r J 76 A{�CE 8'IB-1/75 {' APPLICATION FOR PERMIT: 0'ATING - VENTILATING - AIR CONDITIONING - COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY ' 4 ` NEAREST CROSS ST. �L6uE�L-y FOR APPLICANT TO FILL IN OWNER (PRINT OR TYPE ONLY) / - MAI L •-NO TYPE&SIZE OF EQUIPMENT FEE ADDRES - SEE BACK OF APPLICATION CITY >>`� � ` ..TELjN-0.4Vj FORCE AIR FURNACE, BT _• ,- CONT'RA'CTOR" COMPRESSOR, BTU " ADDRESS' VENTILATION FAN CITY, TEL. NO LIST ALL OTHERS-BELOW STATE LIG LICENSE NO. CLASS • - DISTRICT NO • GROUP ZONE)= PROCES ED BY, " INSPECTION RE COR CL O. LLJ Plan check fee. See reverse. z {'h NUI'1 1YS 1;1\(, 1,I'I,'S e I'0'1'A1, FEI`', I PLAIN CHECK APPLICANT : NAME ADDRESS CITY 'TEL NO �' r 1 HEREBY-ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY , WITH ALL ORD A S AND LAWS REGULATING HEATING,'VENT1= ,APPROVALS DATE INSPECTOR'S SIGNATURE EATING, AIR C DIT 10 G _ ROUGH I•r HEREBY RTIFY T AT I AM NOT .ACTING IN' VIOLATION - OF CHAPTER 9, V�SIO 9 OF THE BUSINESS AND PROFESSIONAL FINAL CODE OF THE STA OF CAL RNIA " - SIGNATURE PERMIT VALIDATION_ M,0. cASH OF PERMITTEE ' PLAN CHECK VALIDATION CK M 0 CASH 9 8 9 NOV r. c� ®< 1 g.-5 0 m� WORKER'S COMPkNSAT:ON DECLARATION 20-0046 DPW 9/89 �l he' by affi4� Ii3t-4 have�a certificate of consent to self insure, 76^364° APPLICATION FOR PERMIT LIME GREEN,, , or a certificate of WorKer's Compensation Insurance, or a certified HEATING-VENTILATING -AIR CONDITIONING copy thereof(Sec.3800 Lab.C.) u Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished. rr El Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN ADDRESS %�d department. (PRINT OR TYPE ONLY) /J Date Applicant LOCALITY G/ PP �N0. TYPE OF APPLIANCE OR EQUIPMENT FEE , CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST CROSS ST. COMPENSATION INSURANCE ABSORPTION UNIT,BTU ASSESSOR (This section need not be completed if the work involved by the MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY , I certify that in the performance of the work for which this permit `r is issued, I shall not employ any person in any manner so as to BOILER,BTU Q � � become subject to the Workers'Compensation Laws. COMPRESSOR,BTU APPROVALS DATE INSPECTOR'S SIGNATURE Date Applicant VENTILATION SYSTEM NOTICE TO APPLICANT: If, after making this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER provisions of the Labor Code, you must forthwith comply with suchFINAL provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY LICENSED CONTRACTORS DECLARATION FLOOR BTU O CQ VALID^ ION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED-UNIT- (commencing USPENDED UNIT(commencing with Section 7000) of Division 3 of the Business and HEATER: WALL Professions Code, and my license is in full force and effect. Co License Number Lic.Class D. Contractor Date 0 F-1I am exempt under Sec. Plan Check fee cc B.&P.C.for this reason PERMIT ISSUING FEE$ U Date: TOTAL FEE Signature (n OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT Z I hereby affirm that I am exempt from the Contractor's License Law NAME for the following reason (Section 7031.5; Business and Professions ,, , (•;• s �e): ADDRESS A H.T.T AI, as owner of the property, or my employees with wages 1y 3r 11022.75 as their sole compensation, will do the work and the CITY TEL.NO. T7_ t _ structure is not intended or offered for sale (Section 7044, 1 S t F t Business and Professions Code). OWNER /�ag 102 ••�pp ❑ I, as owner of the property, am exclusively contracting t CIT" �!rtL §J m MAIL with licensed contractors to construct the project (Sec- ADDRESS s CHECK 11322.75 tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CITYT EL'NO. f C; �AGE I hereby affirm that there is a construction lending agency for CONTRACTOR the performance of the work for which this permit Is issued Poo. (Sec. 3097,Civ. C.). — `93 ADDRESS Itl�f ii�lLll iI_#� dF. .t% Lender's Name "4 �' ' ?I a'L3. CITY TEL.'NO. - 90•!• 1 AMI` 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 repr sentative f this Cou y nter upon the above-mentioned pro '0 i ection p r S. SEE REVERSE FOR EXPLANATORY LANGUAGE PeNATU E OF APPLICANT ORA NT DATE �-' T •' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT � DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0807140005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ILEGAL ID FEES PAID BUILDING-ADDRESS ITR 14572 LT 58 9502 BLACKLEY ST I (FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803142 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET 18590-007-023 101 PERMIT ISSUANCE FEE 27 75 I THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY, Cl I 141 VENTILATION FAN 1 00 FAN 15 75 I 1 ITENANT I TOTAL FEES 43 50 11SSUED ON: PROCESSED BY PLAN BY EXPIRES ON 1 107/14/08 SR 01/10/09 1 I 10WNER TEL NO I - IFINAL DAT BY CODE IJACKSON, KEITH (626) 309-1733- I 1 19502 BLACKLEY ST I EXPIRM ITEMP 917803142 1 IDESCRIPTION OF WORK I 17NTILATION FAN I I I I 1APPLICANT TEL NO- IDIANE MAROCCHI (562) 631-3684- 18407 ENRAMDA AVE I ISPECIAL CONDITIONS 1WHITTIER, CA 90605 I 1 I 1CONTRACTOR TEL NO I _ , (APPROVALS DATE INSPECTOR SIGNATURE 1 ID & T GENERAL CONTRACTING (562) 945-2083- 1_ I 18407 ENRAMADA AVE LIC NO 1 IFAU/WALL FURNACE I I 1WHITTIER CA 90605 B C10 I I I 1COM13USTION AIR OPENINGS 1 (ARCHITECT OR ENGINEER- TEL NO1 IDUCT WORK I I I _ I 1 1 1 LIC NO 1 IAC/COMPRESSOR 1 1 I I I ITHERMOSTAT I I I 1 I IFIRE DAMPERS I I I 1 ISMOKE DETECTION DEVICES I 1 ICOMMERCIAL HOOD I I I I I I 1 I I I L I I 1 1 1 I I I I I I I I I I I I I I I I 1* ADDITIONAL DATA ON FILE I I I I IREPORT ID DPR264 ROUTE TO BS0508 1 1 1 I I I I I I