HomeMy Public PortalAbout9705 BROADWAY_Mechanical__ 76A;6' - cEgle , 5-69 APPLICATION FOR PERM(
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING s
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION �-
JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY (.)
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING NEAREST L
CROSS ST O
FOR APPLICANT TO FILL IN ow NEft
(PRINT OR TYPE ONLY)
MAIL
O. 7ypE OF AP
NPLIANCE OR EQUIPMENT FEE ADOft E55 rl
ABSORPTION SYSTEM, BTU CITY TEL. N0.
CONTRA
AIR HANDLING UNIT, CFM p -
ADDRESS
BOILER, HORSEPOWER
T r•� T NO. 4V� (/ Z
COMPRESSOR, HORSEPOWER STATE LIC.
LICENSE NOY, lj5k7,26CLASS , 2
VENTILATION SYSTEM DISTRICT NO.('`� GROUP ZONE PROCESSED BY
V
EVAPORATIVE COOLER G X /1
FURNACE: FAU GRAVITY `J
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED-UNIT
WALL y
v
.7 !
a
N
NEW_ADDITION_ PERMIT S 3 ,000 Z
ALTER R EPAIR_ TOTAL FEE S V V
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL. N0.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION S.
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING HEATING,VENTI- APPROVALS DATE IN DR'S SIGNATURE
LATING, AIR CONDITIONING.
1 HEREBY CERTIFY THAT I AM N TING IN VIOLATION OF ROUGH
CHAPTER 9, DIVISI N 3, OF THE 51 NE AND PROFESSIONAL fFNALCpOEOFTHE STAT0CA FORNISIGNATURE JACK R. ALLEN, SUPERv1s ECHANICAL ENG'R.
OF PERMITTEEIF ERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION
f � . 3 7 9 4r F-822 A 1 0 6,00`'
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE / //� '
WORKERS' COMPENSATION DECLARATION APPLICATION FOR PERMIT
" y affi7FA that I have a certificate of consent to self. "
re, r a certificate of Workers' Compensation Insurance, 7eAse4C HEATING - VENTILATING - AIR CONDITIONING
or a certified copy thereof(Sec. 3800, Lab, C.) CE-818(REV. 10%81)
Policy No. Company
Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY
❑ Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING
tion department. (PRINT OR TVPE ONLY) ADDRESS
Date - Applicant - LOCALITY 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. PROCESSED BY
the permit is for one hundred dollars($I00)or leis.)
I certify that in the performance of the work for which this AIR HANDLING UNIT, CFM [ u
permit is issued, I shall not employ any person in any manner BOILER, BTU
so as to become subject to the Workers'Comperfsat��s. APPROVALS DATE INSPE T S SIGNATURE
Date Applicant VUT COMPRESSOR, BTU ROUGH'
NOTICE TO APPLICANT: If, aftek]nakioJh this Certificate of VENTILATION SYSTEM FINAL /
Exemption, you should become subjec'I to the Workers'
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDAT
with comply with such provisions or this permit shall be
deemed revoked. FURNACE: FAU_GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU
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. d
% y "awe—r�Ur�P 0
License Number Lic. Class— %0
V
OG
Contractor Date 0
❑ 1 am exempt under Sec. ;27 6 52 Q
Plan check feeCL
B.BP.C. for this reason- N
PERMIT ISSUING FEE $ t o # o e e e'e 8 Z
Date:
Signature "TOTAL FEE S" 2 0.5 0
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor's License / s e e 2 Q,5 OF-4
Law for the following reason (Section 7031.5, Business and NAME
1Profe ions Code):
as owner of the property, or my employees with ADDRESS 0 al 2a.-87
wages as their sole compensation,will do the work and CITY - TEL. NO.
the structure is not intended ar offered for sale(Section
7044, Business and Professions Code).
OWNER 41,t1iFe
El
I, as owner of the property, am exclusively contracting _ T
with licensed contractors to construct the project (Sec- MAIL
tion 7044, Business and Professions Code). ' ADDRESS �J
CONSTRUCTION LENDING AGENCY CliY�y ��� C7T- TIIT.W.
1 hereby affirm that there is a construction lending agency for -
the performance of the work for which this permit is issued" CONTRACTOR
(Sec. 3097, Civ. C.). q -
ADDRESS - -
Lender's Name
CITY - . .
Lender's Address E .
STATE ' LIC
I certify that I have Eead this application and State that the LICENSE NO. CLASS -
above Information is correct. I agree to comply with all County
ordinances and State laws relating to building construction,
and hereby authorize representatives of this County to enter
upon the ab ve- collared
property for.inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE . - ..
W
ature of pplicant or Agent Dote - -
l)
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 9902080002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 9705 BROADWAY
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803213
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GOLDEN WEST
8588-010-031 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY
02 COMPRSR < 100 KBTU 1.00 COM 27.00
TENANT: 08 FURNACE/HEATER <100 1.00 UNI 27.00 ISSUED ON: PROCESSED BY: PLAN Y: EXPIRES ON:
TOTAL FEES 81.75 02/08/99 UT 02/08/00
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
ASHWORTH JERRY L (626) 309-1422-
9705 BROADWAY
TEMP 917803213 DESCRIPT ON OF WORK
CHANGE OUT OF EXISTING HEATER ANDD A/C
APPLICANT: TEL. NO:
SAME AS OWNER -
SPECIAL CONDITIONS:
P�,iGELES CO
CONTRACTOR: TEL. NO: �S ��/�, APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO FAU/WALL FURNACE
/ COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER: TEL. N0: / DUCT WORK
LIC. NO: 11�711I AC/COMPRESSOR
THERMOSTAT
R (� D n �C (( /A 0r, (1/J ((� FIRE DAMPERS
IUB IMI ILIS \11111\tl Jll IUr-,CU I11111� "SMOKE DETECTION DEVICES
( e B r':, COMMERCIAL HOOD
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REPORT ID: DPR264 ROUTE TO: BS0508