HomeMy Public PortalAbout5304 GLICKMAN AVE_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0804290020
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: I FEES PAID 1 BUILDING ADDRESS: 1
ITR: 10558 LT: 31 1 1 5304 GLICKMAN AV 1
(FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917803328
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: OLIVE 1
18585-004-023 101 PERMIT ISSUANCE FEE 27.75 1 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, Cl
141 VENTILATION FAN 1.00 FAN 15.75 1 I
(TENANT: i TOTAL FEES 43.50 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
1 104/29/08 SR 10/26/08 I
1 1I
10WNER: TEL. N0: (FINAL DATE FIN Y: CODE:
(THOMAS DARYL G (626) 579-9065-
15304 GLICKMAN AV
(TEMP 917803328 1 (DESCRIPTION F WORK 1
1 i 1ADD VENTILATION FAN
I �
(APPLICANT: TEL. NO: 1 1 1
1WU (626) 912-3289- 1
118403 VILLA CLARA ST I ISPECIAL CONDITIONS:
1ROWLAND HEIGHTS
ICONTRACTOR': TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE
ITHAMAS SURACHAI (626) 579-9065- 1 1
15305 GLICKMAN AVENUE LIC. NO 1 IFAU/WALL FURNACE I
(TEMPLE CITY, CA 91780 NONE 1 I 1 I 1
1 (COMBUSTION AIR OPENINGS 1 1 I
1 ( 1 I I
1ARCHITECT OR ENGINEER: TEL. NO: 1 IDUCT WORK
1WU, STEVE C Y (626) 912-3289- 1 1 1 1 I
118403 VILLA CLARA ST. LIC. NO: 1 1AC/COMPRESSOR 1 I
IROWLAND HEIGHTS, CA 91748 26073 C 1 I I 1 1
1 (THERMOSTAT I 1 I
1 i (FIRE DAMPERS 1 1 I
I
I 1
1 ISMOKE DETECTION DEVICES I 1 I
(COMMERCIAL HOOD I I I
I
1 1 I I I I
I
1 1 I I I I
I I I I
I 1 1 I I I
1 (REPORT ID: DPR264 ROUTE TO: BS0508 1 1 1 I
V�
,
75A364-C,818-1170 APPLICATION FOR PERMI
• •; HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES ADDRESS �� GLI
DEPARTMENT OF COUNTY ENGINEER
304
BUILDING AND SAFETY DIVISION LOCALITY ` Mat
c— rim
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING CROSS ST. J2 (J DL1ll �{
FOR APPLICANT TO FILL IN OWNER'_DdVZVL6Z.
(PRINT OR TYPE ONLY)
MAIL
No. TYPE OFAPPLIANCE-OR EQUIPMENT FEE ADDRESS G-CIZ jyl GV
CITY t y 01 zi, TEL. NO. z^! V L
ABSORPTION SYSTEM, BTU
CONTRACTOR
AIR HANDLING UNIT, CFM x /L
ADDRESS
BOILER, HORSEPOWER CITY TEL. NO.
COMPRESSOR, HORSEPOWER STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICTN0. CLASS GROUP ZONE PROCESSED BY
EVAPORATIVE COOLER
FURNACE: FAUGRAVITY INSPECTION RECORD
FLOOR BTU
HEATER: SUSPENDED UNIT_
WA L
O
U
7 O
i--)
U
LV
NEW_ADDITION— PERMIT $ 3 00 �
ALTER—REPAIR— TOTAL FEE $
PLAN CHECK APPLICANT
NAME
ADDRESS "r
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 D TE If 1 PECTOR' SIG ATURE
LATING, AIR CONDITIONING.
ROUGH
1 HEREBY CERTI THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVI 10 3, OF THE BUSINESS A PROFESSIONAL FINAL _
CODE OF THE STAT OF ALIFORN
SIGNATUREJACK R. ALLEN,SUPERVISING MECH ICAL ENG'R.
OF PERMITTEE
PERMIT VALIDATION C,K. M.O. CASH
PLAN CHECK VALIDATION
�A'f'7 3:9 64'C:---' OCT 29 4 1 D 6.00- s'
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE /
WORKERS'COMPENSATION DECLARATION CEA 86 8(2-801 f I�!`1 1 I 111 FORS PERMIT
I hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers'Compensation Insurance,or HEATING-'VENTILATING-AIR ,CONDITIONING ,
rte d py t rer of 5 a 31100,Ip
Certified
-
P y N o i any COUNTY OF LOS ANGELES BUIL®ING AND SAFETY
Certtfted copy is hereby furnished.
C rtif'ed copy is filed with fh n- _uildi Inspection FOR APPLICANT TO FILL IN ' ADORES �� ^ �1��,\l�'�
~ }ne,' n
Date_ Apicant_ — (PRINT OR TYPE ONLY) ADDRES
LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
COMPENSATION INSURANCE P . �� NEAREST
GROSS ST. A a
(This section need not be completed if the -work involved. L ABSORPTION UNIT,BTU`�__ ��`-' ���� A
by the permit is'for one hundred dollars ($100) or less.) DISTRICT NO. PROCESSED BY U
I certify that in the performance of the work for which this AIR HANDLING UNIT,CFM- � v
permit is issued, 1'shall not employ any person in any manner LO 11
so ass tll000b'ecome subject to the
'WWo+rkers' ^ pensation Laws. BOILER, BTU P_
Date— Applicant,_Applicant r` COMPRESSOR,BTU to, 11 APPROVALS DATE INSPECTOR'S SIGNATURE a
ll ROUGH U)
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM
Exemption,' you should become subject to the Workers' FINAL
Compensation provisions of the Labor-Code, you must forth- EVAPORATIVE COOLER VALIDATION
with comply, with such provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAVITY
LICENSED CONTRACTORS DECLARATION FLOOR;' BTU
H
I hereby affirm that I am licensed under provisions of Chapter EATER: SUSPENDED UNIT
9 (commencing with Section 7000) of Division 3 of the Busi- WALL
ness and Professions Code, and my license is in full force and
effect. l
License Number V Lie.Clas
racting
tc� Date_ —H
m exempt'from the licensing requirements as-Iam a
nsed arcliitect or a registered professional engineer Plan check fee 26%of above.
in my professional capacity (Section 7051, Bus-ss and Prof- ns°Code). PERMIT ISSUING FEE.$
Lie.or Reg.No. Da#ef TOTAL FEE
HOMEOWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
\
I hereby affirm that I am exempt from` the- Contractor's NAME
License Lava for the following reason (Section,7031.5, Busi-
ness and Professions Code): ADDRESS
❑ ^
I, as owner,of the property, will=do the work and,f the
structure is not intended or offered for sale (Section CITY TEL, NO..
7044,Business-and Professions.Code). i -
21 3,1,'5 A
❑ I, as owner of the property, am exclusive) 'contpact'in OWNER a'e • e,,g
P P Y � g � tF
with licensed contractors to construct the project MAIL
(Section 7044,Business and Professions Code). ADDRESS
. 2:• 2700
CITY TEL.NQ 2 7,�'�'v
CONSTRUCTION there LENDING AGENCY � z
I hereby affirm that there is a construction lending agency CONTRACTOR
for the performance of the work' for which this permit is'
issued (Sec. 3097,Civ.C,): — 0 q 2 aJ—8 1
Lender's Name ADDRESS
Lender's Address
TEL.NO:lll//LLL-
I 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
��unty to enter upon .the above-m n ioned property for
coon ses.
�gnatur-Permittee Date
i