HomeMy Public PortalAbout4824 CLOVERLY AVE_Mechanical__ 17
76: A364 - CE 818 - 9-71 PLVTION FOR ERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING i/1d/�;( '
DEPARTMENT OF COUNTY ENGINEER ADDRESS Gl 41 /�
BUILDING AND SAFETY DIVISION LOCALITY =L T/
NEAREST 7
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADORES
CITY TEL. 9/
ABSORPTION UNIT, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CIT L. N
COMPRESSOR, BTU STA E J LIC. V
LICENSE NO. // CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER5-�/(T �� � c-
FURNACE: FAUGRAVITY C:)
FLOOR BTU INSPECTION RECORD
HEATER: SUSPEND UNIT_ r�y� F-
WALL 0/ F-
C-3
LIJ
CL.
CL
N
Z
Plan check fee 25% of above. See reverse.
PERMIT ISSUING FEE S s 00
TOTAL FEE U
PLAN CHECK APPLICANT
NAME
ADDRESS
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- APPROVALS DATE SPECTOR'S SIGNATURE
EATING, AIR CONDITIONING.
CROUGH
CHAPTER
CERTIFY T AT I AM NOT CTING IN VIOLATION
OF HAPTER 9, DIV[ OF T E BUSIN S AND PROFESSIONAL FINAL G'
CODE OF THE STATE OF CA VO�Aw
SIGNATURE PERMIT VALID TION CK. M.O. CASH
OF PERMITTEE
PLAN CHECK VALIDATION CK. M.O. CASH
:6:4„ 4 Z D 8.0(J— a
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE -
WORKER'S COMPENSATION DECLARATION 20-0046 DPW 9,69 AP, L��ATION FOR PERMIT LIME GREEN
I heretiy affirm that I have a certificate of consent to self insure, 76A364C
or a certificate of Worker's Compensation Insurance, or a certified HEATING i-VENTILATING -AIR CONDITIONING
copy thereof(Sec. 3WO Lab. C.) r
Company
Policy No � �r
El COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
Certified copy is hereby furnished.
R APPLICANT TO FILL IN BUILDING
Certified copy is filed with the county building inspection FOR
OR TYPE ONLY) ADDRESS
Vdepartment. _ _/�(�/1
Date r Applicant 1� %'` LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. ���t '✓� /f /�J"q
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($100)or less.) AIR HANDLING UNIT,CFM
DISTRICT NO. PROCESSED BY
('certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU p
become subject to the Workers'Compensation Laws.
COMPRESSOR,BTU B�
- APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL 1 f
provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY R
LICENSED CONTRACTORS DECLARATION FLOOR BTU 7�43 ✓ V LI ATION
I hereby affirm that I am licensed under provisions.of Chapter 9 SUSPENDED UNIT
(commencing with Section 7000) of Division 3 of the Business and HEATER: WALL
Professions Code, and my license
eiisiniinn�full force and
/effect.J
License Number ^Lic.Class
�� •; � o}..
Contractor ✓�le 17"eO Date l�—✓` ,F IA'`C ' na
Plan check fee ° U
El I am exempt under Sec. 33310-17
; c �
B.&P.C.for this reason PERMIT ISSUING FEE$ "� -�r 113_t° ` O
Y ITEMS
Date: U
Signature TOTAL FEE TOTAL 105 ® 72 C/)OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT CHECK
RC`r 105.72
I hereby affirm that I am exempt from the Contractor's License Law NAME
for the following reason (Section 7031.5, Business and Professions , CHANGE ol�l1
Code): ADDRESS -
I, as owner of the property, or my employees with wages r,� �1 rr�l�eiq q
as their sole compensation, will do the work and the CITY TEL.NO. LFLf0Lf_>.iW1 11/13/92
structure is not intended or offered for sale (Section 7044, A 1 i �t,l C
Business and Professions Code). OWNER fJ� _�- ��g.-�� % l�}4t8.0 1 7:56
I, as owner of the property, am exclusively contracting MAIL
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY CITY j _ Cj�f TEL.NO.
hereby
eby affirm that there is a construction lending agency for CONTRACTOR
the performance of the work for which this permit Is issued =.ems/iliG-
(Sec. 3097,Civ.C.).
Lender's Name v - ADDRESS (/
CITY �v f n TEL.NO.
Lender's Address STATE .�b� LIC.
I certify that I have read this application and state that the above LICENSE NO. J�> >Z� CLASS
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 above-mentioned
pr pe ty f r inspection purposes. �j SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF APPLICANT OR AGEN DATE
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0309190008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGA ID: FEES PAID BUILDING ADDRESS:
TR: 11454 LT: 26 4824 CLOVERLY AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803808
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA
8590-020-009 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY, C
30 AIR INLETS/OUTLETS 3.00 UNI 13.05
TENANT: 47 ALTER EXIST DUCT SYS 1.00 SYS 27.00 ISSUED ON: PROCESSED-BY: PL N BY: EXPIRES ON:
TOTAL FEES 67.80 09/19/03 VG 03/17/04
OWNER: TEL. NO: FINAL DATEXF BY: CODE:
JACKSON BELZORA TR BELZORA JACKSON (626) 285-9717-
4824 CLOVERLY AV I KED
TEMP 917803808 DESCRIPTION OF WORK
EXTEND DUCT TO ADDITION WITH 3 OUTLETS
APPLICANT: TEL. NO:
SMITH (909) 605-6691-
4055 GUASTI RD.#106 SPECIAL CONDITIONS:
ONTARIO, CA 91761
CONTRACTOR: TEL. NO: - APPROVALS DATE INSPECTOR SIGNATURE
ENTERPRISE BUILDERS (909) 621-7455-
4045 GUASTI RD., SUITE 203 LIC. NO �� _ .��. FAU/WALL FURNACE
ONTARIO, CA 91761 808254 B ��
% COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER: TEL. NO: r -� DUCT WORK
LIC. N0: ___ _._. _- -- --- AC/COMPRESSOR
THERMOSTAT
FIRE DAMPERS
SMOKE DETECTION DEVICE
�- COMMERCIAL HOOD
REPORT ID: DPR264 ROUTE TO: BS0508