HomeMy Public PortalAbout9215 BROADWAY_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0208060003
' BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
_ PHONE: (626) 285-0488 EXT:
LEGAL ES PAID BUILDING ADDRESS:
TR: 12410 LT: 3 9215 BROADWAY
FEE DESCRIPTION: QUANTITY: LOM: AMOUNT: TEMP CA 917802402
ASSESSOR TION NUMBER: NEAREST CROSS STREET: ENCINITA
8588-002-003 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY
O8 FURNACE/HEATER <100 1.00 UNI 27.00
TENANT: 20 FIREPLACE < 100 KBTU 1.00 APL 27.00 ISSUE ON: PROCESSED BY: PLAN BY: E X IR nFEN:
30 AIR INLETS/OUTLETS 7.00 UNI 30.45 08/06/02 JK 02/02/03
TOTAL FEES 112.20
OWNER: TEL- N0: FINAL DATE FINAL BY: COD :
SY;PHUNG (MARIE) (626) 308-2849-WK
9091 ARGO PLACE 3
ROSEMEAD DENIM ON F WORK
CENTRAL HEATSYSTEM
APPLICANT: TEL. NO:
SAME AS OWNER
SPECIAL CONDITIONS:
CONTRACTOR: TEL. N0: •� �L` � '�
e%�S \ Y) APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER - G
LIC. NO AU/WALL FURNACE
COMBUSTION AIR OPENINGS
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ARCHITECT OR ENGINEER: TEL. NO: DUC RK
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r� ✓'
LI L. NO7l AC/COMPRESSOR
TH 0 TAT
FIRE DAMPERS
SMOKE DETECTION DEVIL
COMMERCIAL HOOD
\SSi VICE:
REPORT ID: DPR264 ROUTE TO: BS0508
`WORKER'S COMPENSATION DECLARATION 2Peea6 DPW 9/69 APPLICATION,- FOR,PERMIT
I hereby affirm that,l have a'mrtificate of consent to self insure, 76MMC
or certificate(Sec. 3800 Libc ( of Worker's Compensation Insurance or a dang
GREEK-
copy theled - '- :"',HEATING-VENTILATING -AIR CONDITIONING:
Lab C.) -' � ' •" r .
poficy/se.�3�7✓��/ 'Compapy , - COUNTY OF LOS ANGELES - 'DEPT OF PUBLIC WORKS BUILDING AND SAFETY.DIV:' - -
❑ Certified copy is hereby furnished. ,a
❑'•t Certified copy is filed with the'county building inspection FOR APPLICANT TO FILL IN - gooRE88 -
'.department. (PRINT OR TYPE ONLY)
Date Applicant - LOCALITY -
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE -
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST ,
.COMPENSATION INSURANCE - • CROSS ST.-
ABSORPTION UNIT,BTU ASSESSOR '
(This'section need not be completed if the work involved by the -
permit Is for one hundred dollars($100)or leas.) MAP BOOK AGE .PARCEL'.
11 AIR UNR CFM - - DISTRICT ND. PRocEssE ar "
I certify that in the performance of the work for which this permit� _ - �
is issued,.) shall not employ any person in any manner so as to - BOILER,BTU �/• �j
become subject to the Workers'Compensation Laws. „ . •• O• n� 'C�GL�LLZi�-rilt�✓ -
COMPRESSOR,BTU -
APPROVALS' - DATE INSPECTOR'S SIGNATURE
Date -Applicant VENTILATION SYSTEM,.
NOTICE TO APPLICANT: If; after making this Certificate of ROUGH
Exemption,you should become subject to the Workers' Compensation EVAPORATIVE COOLER
provisions of the Labor Code,-you must forthwith comply.with such FINAL v
provisions or this permit shall be deemed revoked. FURNACE: FAU__GRAVITV _ -
LICENSED CONTRACTORS DECLARATIONFLOOR BTU - VALIDATION
6 hereby_affirm.lhat l am licensed under provisions of.Chapter 9• r SUSPENDED - UNIT_
(commencing with Section 7000)of Division 3 of the Business and HEATER: WALL
-Professions Code,and my license is in:full force and effect.
License Number (D�CWff LID'.Class '
J (L
r Conlrac • � Date / /''/S , _ - - '• O
❑ I am exempt under Sec. PIED Check fee � � � - _ Felt•�'a. U
cc
BAP.C.for this reason' `PERMIT ISSUING FEE$ 3 II?. c ''C O
to�5 - f—
Date: L ht�l�`• V
TOTAL FEE. AGE a
Signature - -. _ r RITA'AI
� _
PLAN CHECK APPLICANT - - 0)OWNER-BUILDER DECLARATION ' )
I Z_
hereby affirm that I am exempt from the Contractor's License Law NAME '
Y
for Ihe•toflowing reason (Section 7031.5, Business and Professions
Code) - ADDRESS -
❑ ,
1, as owner of the property, or my employees with wages /
J/ r
as their sole compensation, will,do the,work and the CITY TEL• i
NO' I}IiQI)—I11�1�y, SIi .f:d
structure is not intended or.offered for sale IS 7044,• -I _
Business and Professions Code). '•- OWNER e T.' gA77 f h
'•I^as owner.of the property,yam exclusively contracting MAIL. - -
�with licensed contractors to construct the project (Sec.- ADDRESS
tion 7044, Business and Professions Code). _ _ - -
CONSTRUCTION LENDING AGENCY CITY TEL.NO.
I hereby affirm that there is a construction lending agency for CONTRACTOR '
the performance of the work for which this permit Is issued x'37 0,
(Sec.3097,Civ.C.). r ,_ - rl - . ! r per',
'ADDRESS
Lender's Name
NO:
Lander's AddressSTAT
certify that I have read this application and state that the above' LICENSE NO. CLAS
information is correct.' I agree to'bomply with all County ordinances -
and State laws relating to building construction,and hereby authorize
representatives of this County to enter upon the above-mentioned'
props for in ection.purpos s. SEE REVERSE FOREXPLANATORY LANGUAGE
S TUREOFAPPLICANT ORAGENT ATE �. •-