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HomeMy Public PortalAbout9427 BROADWAY_Mechanical__ WORKEm that IPhave S ONDEGLARATION CE"81q(2-BO) APPLICATION FOR-PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate hereo ( Workers'Compensation Insurance,of HEATING-VENTILATING-AIR CONDITIONING- Policy certified cn y thereof(Sec. 3800 Lab. C:) t Policy No53�384-6 �om pany 5T A§_.FUND COMPENDATION 7i �. D Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY In Certified copy is filed with the county building inspection - - f� 71 FOR APPLICANT TO FILL IN BUILOIN 27 $ROADWAY Date -pY828 Tt, `ApplicantTEMPLE A I�_Q DLT_LQN (PRINT OR TYPE ONLY) ADDRESS CERTIFICATE OF EXEMPTION FROM WORKERS' NO. , TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY TEMPLE C tTY COMPENSATION INSURANCE - - NEAREST - y (This section need not be'completed if the work'involved ABSORPTION UNIT, BTU CROSS ST. CLOVERLYQ by the'permit 'is for one hundred dollars ($100).or leis.) DISTRICT NO. - vnocsss acv U I certify that in the performance,of the work for which this AIR HANDLING UNIT,CFM /y r permit is issued. I shall not employ any person in any manner S UV O so_as to become subject to the Workers' Compensation Laws. BOILER, BTU F ��p APPROVALS DATE INSPECTOR'S SIGNATURE W Dale Applicant - L COMPRESSOR, BTV `�J 000 /e ROUGH N. NOTICE TO APPLICANT: If, after making this Certificate of 'V ENTILATION.SVSTE M' - Z Exemption, you -should- become subject to the' Workers' FINAL - Compensation provisions of the Labor Code, you must forth. with,com I with such p EVAPORATIVE COOLER py provisions or permit shall be VALIDATION deemed revoked. x—+ROJ©0O - - - - LOR:FURNACE: FAU R Y_ LICENSED CONTRACTORS DECLARATION / FLOOR: BTU �Q I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT - 9 (commencing with Section.7000)of.Division 3 of the Busi. WALL - ness and Professions Code, and my license is in full force and - effect. . . 288806 C-20 " License Number - tic.Class Q p Contractor-ERANK_DEL-LA_ Date-5 7 am exempt from the licensing requirements as I am a - licensed architect or a registered professional engineer Plan cheek fee 25%Of above. acting in my professional capacity (Section 7051, Bus- ` iness and Professions Code). PERMIT ISSUING FEE $ J D Lic.or Reg.No. Date - TOTAL FEE 130 Iro , HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT �VOHN PEEBLES I hereby affirm that 1 am exempt from- the Contractor's NAME JOHN PEEBLES License Law for the following reason (Section 7031.5,-Busi- ness and Professions Code): ' ADDRESS � I , 1, as owner of the property, will do the work and the TEMPLE C lTY #.•: • s- 8 structure is not intended or offered for sale (Section CITY TEL. NO. 7044, Business and Professions Co-de). - - ,2r-• • 3J,Q�5 0 ❑ I, as owOWNER SAME ' net of the' property, am exclusively contracting `e.• • 30,'5.0�. with licensed contractors to construct, the project MAIL 9661. LAS TUNAS ' (Section 7044, Business and Professions Code). ADDRESS _ ��7 7 O 5,'.Z!� 1_8,4. CITVTEMP�E—CITY- TEL.NO. 28 2 ' CONSTRUCTION LENDING AGENCY ' I hereby affirm that [here`,is a construction lending agency --- - for the performance of the work for which this permit is CONTRACTOR TEMPLE AIR CONDITIONING issued (Sec. 3097,Civ..C.). ' Lender's Name ADDRESS 3727 TEMPLE.C ITY BLVD.pp t, ��tT Lender's Address _ CITY OSEMEA •TEL.NO. 448 4530 1 certify that I have read this application and state that the STATE LIC. above information is correct. I agree to comply with all County LICENSE NO. CLASS ordinances and State laws regulating Heating, Ventilating and Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE County to enter upe-. 0 a ahove-ment8ne property for inspect, 5-1 V—� ..rgnature of Permittee Date COUNTY OF IAS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1012020019 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID ON FILE BUILDING ADDRESS: 1 9927 BROADWAY 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ TEMP CA 917802446 (ASSESSOR INFORMATION NUMBER I INEAREST CROSS STREET: 18588-003-021 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: S4 LOCALITY: TEMPLE CITY, Cl 102 COMPRSR < 100 KBTU 1.00 COM 27.00 ITENANT: 108 FURNACE/HEATER-<100 1.00 UNI 27.00 (ISSUED ON: PROCESSED BY: PLAN BY: 1 TOTAL FEES 81.80 112/02/10 SR IOWNER: TEL. NO: (FINAL DATE FZNALAY: CODE: PEEBLES, FRED (626) 249-6395- 19427 BROADWAY ITEMP 917802446 IZESCRIPTION OF WORK (REPLACE HVAC EQUIPMENT THE EXISTING CONDENSER IS ON THE ROOF( I& THE FURNACE IN THE ATTIC (APPLICANT: TEL. NO: (AIR TRO (626) 357-5311- 11630 S. MYRTLE (SPECIAL CONDITIONS: MONROVIA, CA 91016 I � (CONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE 1 [AIR TRO INC. (626) 357-5311- 1 1 I 11630 S. MYRTLE LIC. NO FAU/WALL FURNACE (MONROVIA, CA 91016 258228C20 ' ICOMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. N0: , DUCT WORK 1- 449 1 LIC N0 1 1AC/COMPRESSOR (THERMOSTAT [FIRE DAMPERS [ I I ISMOKE DETECTION DEVICES COMMERCIAL HOOD [ I I I [ I I 1 I I I II I I I I I I I I I I I I I I I I 1 [ [ I I ' ADDITIONAL DATA ON FILE (REPORT ID: DPR264 ROUTE TO: BS0508 I I I I I I