HomeMy Public PortalAbout9331 BROADWAY_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY N 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1112130018
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 12410 IT 12 9331 BROADWAY
I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( TEMP CA 919802404
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
IS588-002-012 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, Cl
108 FURNACE/HEATER <100 1.00 UNI 27.00
TENANT: TOTAL FEES 54.80 TISSUED ON: PROCESSED BY: PLAN BY:
112/13/11 SR
OWNER: TEL. N0: FINAL DATE FINAL BY: CODE:
LING, FLING M
19331 BROADWAY lb
ITEMP 917802404 1 DSC;w `�
? ON OF WORK q1
I I IREPLACE FURNACE
I
APPLICANT: TEL. NO:
TRAN QUM ELECTRIC A/C S HTG (626) 674-1555-
ISPECIAL CONDITIONS:
I I
Old Cbo�iuS inn We teV P �� %� OR SI I
CONTRACTOR: TEL. N0: APPROVALS DAT INSPECTOR SIGNATURE
1TRAN QDAN ELECTRIC A, C AND HEATING (626) 674-1555- 1 1 1
14108 BARTLETT AVENUE LIC. NO FAU/W FORNACE ',� L
ROSEMEAD CA 91770 649827 1II !
COMBUSTION AIR OPENINGS
(ARCHITECT OR ENGINEER: TEL. NO: IDUCT WORK
I
LIC. NO: JAC/COMPRESSOR
ITHERMOSTAT
FIRE DAMPERS
i I I 6
ISMOKE DETECTION DEVICES
' COFm1ERCIAL HOOD
1 I i I I I
I I I I I I
1
REPORT ID:'DPR254 ROUTE T0: 2SO508
WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT
hereby affirm that I have o certificate of consent to self.
injure, or-a certificate
(Sec. 3800, Lab. C.)ate of Workers' Compensation Insurance,
or a certified copy 76A364C HEATING • VENTILATING • AIR CONDITIONING.\ .
t., t - 20-0046 DPW 9/88
Policy No. Company
✓Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY
•Certifiedcopyis filed with the county building inspec- FORAPPLICANT TO FILL IN BUILDING pj
tion department, _ ADDRESS
(PRINT OR TYPE ONLY)
Date - Applicant NO. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCAUTY�.J �/
CERTIFICATE SOF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST. LESS _""50ABSORPTIONUNIT,"BTU
(This".section need not be completed if the work Involved by aIS. T NO. PROLES ED By
the permit is for*one hundred dollars ($100) or less.)
CFM Q
I certify that in the performance �of the work for which this AIR HANDLING UNIT,
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers"Compensation Laws. BOILER, BTU APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applicant l COMPRESSOR, BTU ROUGH
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 VALIDATION
with comply with such provisions or this permit shall be deem- - -
ed.revoked, t , , _ t FURNACE: FAU_(pRAVITY
.� LICENSED CONTRACTORS DECLARATION - 1 FLOOR
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED Y, UNIT '
(commencing with,Section 7000)of Division 3 of the Business" - WALL
and Pt'ofessions Code,and my license is in full force and effect.
License Number 'Lic. Class 9 D 0
Contractor Date Of
❑ V
• I am exempt under Sec. s plan Check fee m
8.8P7C. for this reason - O.
Date: PERMIT ISSUING FEE $ �� un
Signature TOTAL FEE J&_Jj QQ
OWNER-BUILDER DECLARATION PLAN CHECK•APPUCANT' -
I hereby affirm that I am exempt from the Contractor's License D
Law for the'following reason (Section 7031.5, Business and NAM '/&Z—
F
cions Code): ppJ '5711(
I as owner of the property, or my employees with
ADDRESS9gj - Erj G -
' r n
wages as their sole compensation, will do the work and 1 ITch.
the structure is not intended.or offered for sale(Section CITY^�+y J�� �7z TEL.,NO. =f7j TOTAL 6:3 m 00 -
7044,-Business and Professions Code). OWNER CHECK
I, as owner of.the property, am exclusively contracting , - .�H�4K -
'with licensed contractors to construct the project (Sec- MAIL ♦�ti
tion 7044, Business and Professions Code). ADDRESS - CHANGE -
CONSTRUCTION LENDING AGENCY CITY TEL.
y I hereby affirm that there is a construction,lending agency for - - L)llllh-1 I_( _ -I
the performance of the work for which this permit is issued CONTRACTOR D � a301 1../ `/'11_
(Sec. 3097, Civ. C.).
ADDRESS
4265 1 ArtV:�i
Lender's Name G
CITY16 4V ' TEL. NO.
Lender's Address
I certifythat I hove read this application and state that the BTATE LIC. -
PP LICENSE NO. LIC.
above information is correct. I agree to comply with all County
CLASS
ordinances and State laws relating to building construction, '
and hereby authorize representatives of this County to enter
upon the above-mentio ed pro erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Ap icaln or Agent Data Cs