HomeMy Public PortalAbout6039 ENCINITA AVE_Mechanical__ B.le'_ "Bs-°p" APPLICATION FOR *PERMIT
HEATING - VENTILATING.- AIR CONDITIONING
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO -FILL IN BUILDING
A�
(PRINT OR TYPE ONLY)
LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST ////
CROSS ST. C.:i �
ABSORPTION UNIT, BTU
OWNER
AIR HANDLING UNIT, CFM - MAIL ,{-
ADDRESS
BOILER, BTU
^� CITY TEL. NO. 4r�T�
COMPRESSOR, BTU-. d
. CONTRACTOR
VENTILATION SYSTEM ADDRESS O 3Wi��
EVAPORATIVE COOLER CITY ,A TEL. NO.
FURNACE: FAUGR IT O STATE � CLASS
FLOOR BTU LICENSE NO.
HEATER: SUSPENDED—UNIT DISTRICT No. cflouP I zouE cess ED BY CD
WALL CL.
U
J- C Q- '
0
INSPECTION RECORD w
a
N
Z
Plan check fee 25%D of above.
PERMIT ISSUING FEE $
TOTAL FEE 0
PLAN CHECK APPLICANT
NAME
A OGRESS
CITY T,EL.NO.
1 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-
LATING. AIR CONDITIO
I HEREBY CE IFI T AT I AM T ♦CTING IN/IOLATION APPROVALS DATE INSPECTO ' SIG TURE
OF CHAPTER 9, D ISION H{ IN ANO I. ESSIO NAL
CODE OF THE SS E OF IF / ROUGH /
SIGNATURE -yl/r FINAL 3
OF PERMITTEE
PLAN CHE K ALIDATIONRMIT VgLIDATI c CASH
M.O.M..O, ASM
p p p
C) `p O
ro
D rj ro . a O
I tJ V 0 �,I
O
O O O D
CH
COUNTY OF LOS ANGELES TEMPLE CITY k 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0907200006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 5904 LT: 376 ON: .002 1 6039 ENCINITA AV 1
I IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( TEMP CA 917801935 1
(ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: WOODRUFF
15384-013-019 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl
1 102 COMPRSR < 100 KBTU 1.00 COM 27.00
(TENANT: 108 FURNACE/HEATER <100 1.00 UNI 27.00 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1
1 130 AIR INLETS/OUTLETS 1.00 UNI 4.35 107/20/09 SR 07/20/10 1
1 131 AIR INLETS/OUTLETS 1.00 SQ 37.05 1 1
IOWNER: TEL. NO: 136 AUG 2001-10000 CFM 1.00 AHU 38.85 IFINAL DATE//, FI Y: CODE: 1
IHARTY, ANGELA - I 'DOTAL FEES 162.00 �
16039 ENCINIT AVE.
ITEMP 917801123 1 ESCRIPTION OF WORK
I IREPLACE AND REDUCT FURNACE AND AIR CONDITIONING FROM CLOSET
ITO AT'PIC
(APPLICANT: TEL. NO:
JHARLAN AIR (626) 278-3954- 1 1
15933 CAMELLIA AVE. I ISPECIAL CONDITIONS: 1
(TEMPLE CITY CA 91780 1
I
CONTRACTOR: TEL. NO: I JAPPROVALS GATE INSPECTOR SIGNATURE
HARLAN AIR (626) 278-3954- 1
15933 CAMELLIA AVENUE LIC. NO I FAU/WALL FURNACE
ITEMPLE CITY, CA 91780 873592 C20
I 1COMBUSTION AIR OPENINGS 1
I
IARCHITECT OR ENGINEER: TEL. NO: I (DUCT WORK 1
I LIC. NO: 1 IAC/COMPRESSOR
I I ITHERMOSTAT
I 1 1
1 IFIRE DAMPERS
I
I I ISMOKE DETECTION DEVICES I I I
GDNPIERGIAL HOOD
� I
I ) I I I I
I I I I I
I I I I I I
I I I I I I
I I I I I I
REPOAT ID: DPR264 ROUTE T0: BS 0508
I I I I I
1
17.-ecl
ORKERS'COMPENSATION DECLARATIONnsen'•firm that I have a certificate a'.*coto self APPLICATION FOR PERMITcertificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
copy thereof (Sec. 3800, Lab. C.) 76A364C
CE-818(REV. 10/61) -
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 / 1�r, //�
tion department. _ (PRINT OR TYPE ONLY) ADDRESS 6 sE./VyMjl /q mle
Date Applicant LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE V C
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
COMPENSATION INSURANCE CROSS ST. A1,4_s
(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 ($100) or less.) - S
I certify that in the performance of the work for which this AIR HANDLING UNIT, CFM
permit is issued, I shall not employ any person in any manner f'
so as to become subject to the Workers BOILER, BTU Compensation Laws. APPROVALS DATE i PELT 'S NATURE
Date
COMPRESSOR, BTU ROUGH
/ Applicant
NOTICE O PPLICANT: If, after making th&kertificate 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
deemed revoked. FURNACE: FAU—GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I 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 - I -
and Professions Code,and in full force and effect. T N }
C� 6
t O
License Number �ss T Lic. Class ^ !j{Jl
V
Contractor eAL18 4&41_4&DDateto/ D O
❑ F
am exempt under Sec. w
Plan check fee - d
' N
B.BP.C. for this reason' PERMIT ISSUING FEE $ s Z
Date:
T /
Signature TOTAL FEE
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Connoctor's License
Law for the following reason (Section 7031.5, Business and NAME D ;? :1 Gil •A
Professions Code):
I, as owner of the property, or my employees with ADDRESS '� • e've • 8
El
wages as their sole compensation,will do the work and CITY TEL. NO. 'I • - 2 (15 Q
the structure is not intended or offered for sale(Section
7044, Business and Professions Code). OWNER e - 20,505
❑ , I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec- MALL ,I 1. 09- 88
tion 7044, Business and Professions Code). ADDRESS erA/6 •r,4 /P'`ei
CONSTRUCTION LENDING AGENCY CITY �rn
a TEL. NO. 992,-,Iv
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.),
ADDRESS
Lender's Name CITY /y TEL. NO (J p•
D//7 .
Lender's Address C
STATE LIC G— l
Icertify that I have read This application and slate Ihat the LKENSE NO. Y7352,jCLASS ZV _
above information is correct. I agree to comply with all County
ordinances and State laws relating to building construction,
and hereby uthonire representatives of this County to enter
u the ove-m Toned property for ins coon purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
pplicant or ent ,/ D to 7,