HomeMy Public PortalAbout4937 GOLDEN WEST AVE_Mechanical__ tW° 8 ""°N°ECLAFLA"° �°°"6°?`"°'8° APPLICATION FOR PERMIT LIME GREEN
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I h6Yeby affirm that I have a oertlTlo#te of consent too sell Insure, �7
or,n oirttfloate of workers Camp•nsatlon Insurance,or a certlfled HEATING-VENTILATINp-AIR CONDIl7QNINQ ylull
tom!p Lo.H-0
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Pdlcy COM COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
D C&Ufl&d copy Is he"tur ww&
copy 4d, ,the ,ty buaaing IruV.otfon FOR APPLICANT TO FlLL IN BULDINGADDFIESS
(PRNT OR TYPE LY)
LOCI,LITY
' rt NO. TYPE OF,�l`"N(.'1'=OR EQUIPMENT FEF .
FICATE OF EXEMPTFROM NF�BT
ION
CIi088
COItIP194MTN INSURANCE ABSOFWTION UNIT BTU
fO
(TKW&ootlgn neid not be ooapleted H the work Invotved.by.the MAP BOOK PAGE PARCEL
parmtt Is for One hundred dolhn.(1100)or less.) AIR HAN:DuNO UNIT CFY OWFOOT Na MccrIsm By
I certify,that In the perfbrmanco of the work for whlch thts permit,
as Is#ued, I shall not employ any person In any manner so at to BOILER,BTU (/
. becdlno eubjW to the Workers' Compensation Laws; �f
.. .. BTU ArrRovµ.a DAn s.acroa•e aw"tunE
Date ApplbsrTt VENTLATION 8Y6TEIA
NOTICE TO APPLICANT: It, atter making this Certificate of ROUGH
Exemption,you shbdW become sub)eot to the Workers'Campenzatlon EyAPOFLATrVE COOLER
provisions of the LLbor Code, you must torthwhh comply with such FKAL
proylelon,or this permit sh6J be deemed revoked. FUFtNAM FAU GRAVITY
cToIRS DEC�AFLOOR ' BTU YALJDATJON
I•hereby afY rm that-I em-.Ilcansed under provisions of Chapter 9 H� -FL 8USPE]DI D UNITr.
(oomrrlencing with 8ectlon 7DD0) of dMslon 3 of the Business and WAII 0�
Prote}ebna Code,and my license Is In fulltoroe and effect
.. Lbense iJurnber.�� —Lk,Claes
C-&, for Fate
Plan Check fee CC
lam exempt under O
B.SJ?_C.for Ibis reason PERMIT ISSUING FEE_
Derta: � � �) TOTAL FEE W
Riorvntire �
OWNER B IDEA DECLARATION PLAN CIfCK APPLK ANI
I hereby affirm that I am exempt from the Contractor's Lloense Lew NAME Poo. u
for.the following reason ($tcton 7031.15, Business and Prdfesslons �+rT
Code): ADDRESS tfE,41 .'T.
F-1 I,:as owner of,the property, or my employees with wages `��•.� .�l
yJ17 f
as their mole compensation, will do the work and the CITY TEL NO.
structure Is not Intended or offered for tale (Section 7044, �[�1 .I 1�r F,�
Business and Profession.x Code). OWyl79
I, ne owner of the property, am exclusively oontraoting M/Ut TOTAL 2.5 00
with licensed contractors to construct the project (8eo- ApOREg$ -r� ���)
tion 7044, Business and Profs lons Code).{�
CONSTRUCTION LENDING AGENCY CITY TEL NO.
I herebyy affirm'that there Is a construction lending a9enoy 1dr T�
the pertormence,of.the work,for whloh thle permit s Issued
(8eo.qW7r Civ.b'.). r' y td�JV L 1 r�!
r ADDI E t 0000- 1 4J lfJ 91
LerWprs Name
C>n C
TES NO. O!sr 7414 1- 'AM 10:135
Lehder0 Address_ STATE IK.
I certfty that I have reed this appllcadon and state that the abovtr Lk E7y8E Nb. CLASS - �3
trtfJnTLatiorl IQ correct. I agree to comply wtth all County ordlnances
and State Tawe felatkV to building oonstix% n,and hereby au&gxt e ;
repreeentatfves of ti'Ile`County to enter upon:thb above-mentlbned
property.for,lnapbctlon pu SEH REVS :8E FOR EXPLANATORY LANGUAGE -
OF APPUCANT OR AGOICT DATE
COMLY OF LOS AnouT•s4 TEMPLE CIT7 / 0508 MECHI ICAL, PERMIT
DEPART14KNT OF PUBLIC WORTS 9701 LIDS TUNAS ME 0508 1309090016
BUILDING ADID SAF= / LAND DEVELAPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 ETT:
LEGAL ID: FEW PAID BUJ DING ADDRESS:
TR: 5342 IT: 9 BL: .001 4937 OOLaEN FEST AV
FEE DESCRIPTION: QUANTITY: UGH: AMOUNT: TEMP CA 917803938
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LA ROSA
8589-018-022 01 PERMIT ISSUANCE FEE 27.80 THCH S PAGE: 597 GRID: A5 LOCAL=: TE24PLE CITY CA
30 AIR INLRTS/OUTLETS 2.00 UNI 8.80
TENANT: 41 VENTILA=ON FAN 1.00 FAN 15.80 ISSUED ON: PROCESSED BY: PLAN BY:
47 ALTER 31= DUCT SYS 1.00 SYS 27.00 09/09/13 SR
TOTAL FEES 79.40
O$(NER: TEL. NO: FINAL DATE FINAL BY: CODE:
4937 GOLDEN NEST AV �/ /y\
TEMP 917803938 OL9tRIPTION OF WORK
2 As3i INLETS, VEN=ATION FAN AND ALTERATION OF =ST DUCT
SYSTEM
APPLICANT: TEL. NO:
CHAN, TERENCE (626) 379-4900-
560 N MAIN STREET SPECIAL CONDITIONS:
aT•ElAMBRA CA 91801
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
r.n.rTRIK DEVELOPMENT L.LC (626) 379-4900-
560 N MAIN STREET C278 LIC. NO FAU/FALL FURNACE
ALHAMBRA CA 91801 668443 +
COMBUSTION AIR OPENINGS
ARCF=CT OR ENGIN R: TEL. 190: DUCT WORK
HAN, FREEMAN (626) 796-5899-
9923 NADINE STREET LIC. 190: AC/COFPRESSOR
TEMPLE CITY, CA 91780 668443 + +
TfLER1DSTAT
FIRE DAMPERS
SMOTE DETECTION DEVICES
COMMERCIAL HOOD
+ ADDITIONAL DATA ON FILE
REPORT TD: DPR264 ROUT& TO: 1390508
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