HomeMy Public PortalAbout5019 ENCINITA AVE_Mechanical__ _,,,,;��
db4TsitiC> kS'C;OMPF NS.4TiON DECLARATION 76A364C qq ( p o �p �p (�(��/�
I;terehv atfiini-1 " I Have a.certificate of eonsent to self
CE-818 (2=80), `6%.-P " iS C ATA O N F®R• If—ice.U-'S YV T -
-insure, or a certificate of Workers'Compensation Insurance,or °'
0-OiEAYING=blENYILATI,WG-AiR COib®IYIOPdIWCv �J
a certified copy thereof(Sec. 3800,Lab- ) ', - - - • -
Policy Nc Cpmpa_n, iiP�
- �
Certified copyjs,hereby*furnished.: - -. -
COUNTY OF LOS,ANGELES- BUILDING AND.SAFETY
r I" Cer�tfied copy is filedwtth the county, inspection BUILDING /y
department 177
FOR APPLICANT TO FILL IN -
D.ip_— j"pplicant_, (PRINT OR TYPE ONLY) ADDRESS �(/ l7
LOCALITY
GERIIFIC,>TL OF.EXEMPTION.FROM WORKERS'; NO: TYPE OF APPLIANCE OR EQUIPMENT- FEE
COMP-NSATiONINSURANCE _ NEAREST
(This section need not be completed if the work inVolved ABSORPTION UNIT, BTU CROSS ST. O
by the pp$mit is ,for one hundred dollars-($100) OI less.) DISTRICT NO PROCESSED Y Q
I certify that in the'performsnce of`the work for which this AIR HANDLING.UNIT;CFM
permit is,i$sued,')`Shalt not employ any,person-in any manner 0
so•is to become subject to the Workers'-Compensation Laws 801LER;.BTU
APPROVALS' DA"611,SSIGNATU ,-
S
UaDefe = Applicant COMPRESSOR,BTU rFtOUGH^�— Z
NO"fICE TO APPLICANT: If, after mlking this-Certificate own VENTfI'ATIO_ S YSTEM 7ompensatiowprovisions of the•Laboi Code, you must forth- EVAPORATIV-E COOLER VAL
with comply with such =provisions or this permit shall'be
deemed-revoked. , FURNACE FAU�� GRAVITY-
"LICENSED CONTR,ACTOR§DECLARATION' FLOOR - -BTU , � --
I hereby affirm that I am licensed under provisions-of Chapter HEATER. SUSPENDED
9 (commencingnvith Section 7000)'of Division 3 of the Busi__-, _ _WALL "
rtes and-Professions�Oridtj and-my license s'rn�61 �fdree' and
effect. •" Q - - _. = - ,
License-Numbe= -Q3�T.ic_Cla�s��
.Contractor, _L;S��B 'Date 1���. a '
I am er` .apt from the Incensing requirements as I am a 7&6 Af
licensed'architect.or a-registered professional engineer . Plan Check fee 25%-,of above.
acting`in my professional capacitk (Section 7051, Bug- # i a o 0,0 8
mess,afid Professions Code) PERMIT ISSUING FEE $ IU SO
• Lie.or Reg-No. Date TOTAL FEE 3� tSd a • 3 Q 5 0
HOhrE'Ot4�NETt-BL7iI Di R DECLARATION PLAN CHECK APPLICANT f A
i'hereby affifm that I am _exempt•from-the Contractor's', NAME - _•¢�-y=��^ - •' - - _ .
License Lbw'for the following reason (Section 7033.5, Busi- Q 2 9 y$Je ,
nets and-Protessions Codi)! ADDRESS
I, asi owner of the property, will do the work and-the. '
CITY TEL. NO.
structure Is not intended or offred for sale (Section "
-7044,Brlsiness and Professions Code).
` OWNER_
I, as ovyner of the property_am construct
t contracting
with 'licen'sed contiactors to construct the project' MAIL
(Section 7044, Business-and Professions Code). ADDRESS
^ /L`
TEL. 0'.
CONSTRUCTION LENDING AGENCY CIT'
h hereby affirm that,there is a construction lending agencyo ` •f
for the performance of the work for which this permit is CONTRA OR
-issued (Sec.309-7,Ctv.C.): a
Lender's Name ADDRESS
Lender's Address ` CITY = TEL N
I certify that I-have read This application and state that-theSTATE, LIC.
above information is Correct.-I agree to comply with all County LICENSE NO _� CLASS C7
ordinances-and State laws regulating Heating, Ventilating and s
Air Conditioning, and hereby authorize representatives of this SEE REVERSE'FOR EXPLANATORY LANGUAGE 4
„
CO iD _nter upon the•above-mentwned property for "
• uispech%r ,rurpr .es. ;_ ', - - - .. _ , 1 � '• ,
Signature pf Permittee : Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0201160015
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 5019 ENCINITA AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803708
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
5388-009-007 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY
03 COMPRSR 101 500 KBTU 2.00 COM 104.40
TENANT: 09 FURNACE 101 500 KBTU 2.00 UNI 104.40 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
35 AHU < 2000 CFM 2.00 AHU 25.80 01/16/02 JK 07/15/02
_ TOTAL FEES 262.35
OWNER: TEL. N0: FINAL DATE FJ,M L BY: CODE:
SAN GABRIEL JAPANESE COMMUNITY CENT (818) 286-9850- L �---- ---�_
5019 ENCINITA AV `?
TEMP 917803708 DESCITIPTION OF WORK
INSTALL NEW HVAC
APPLICANT: TEL. NO:
TADAHIRO TED KANZAKI (213) 620-9275-
PO BOX 3297 SPECIAL CONDITIONS:
MONTEBELLO 90640
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
KANZAKI, TADAHIRO TED (213) 620-9275-
PO BOX 3297 LIC. NO FAU/WALL FURNACE
MONTEBELLO, CA 90640 438527
COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER: TEL. N0: DUCT WORK
LIC. NO: AC/COMPRESSOR
THERNFOSTAT
FIRE DAMPERS
SMOKE DETECTION DEVICES
COMMERCIAL HOOD
REPORT ID: DPR264 ROUTE TO: BS0508