HomeMy Public PortalAbout5813 GOLDEN WEST AVE_Mechanical__ 76A366E - CE61=vlB-9/75 APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CONDITIONING
BUILDING AND SAFETY DIVISIONAI
FOR APPLICANT TO FILL IN BUILDINGQ
(PRINT OR TYPE ONLY) ADDRESS SC7 O j `
LOCALITY . .
~ NO. TYPE OF APPLIANCE OR EQUIPMENT FEE NEAREST
ABSORPTION UNIT, BTU �?
OWNER
AIR HANDLING UNIT, CFM MAIL
ADDRESS '� L
BOILER, BTU CITY TEL. NO.
COMPRESSOR, BTU :;?!J d?s'_8`
CONTRACTOR
VENTILATION SYSTEM ADDRESS 1- S V�
EVAPORATIVE COOLER CITY (
RC1 TEL. NO. �
FURNACE: FAUG ITY STATE 1c7 LIC.
FLOOR BTU Q LICENSE NO.. 6 CLASS C`
HEATER: SUSPENDED UNIT_ DISTRICT NO. GROUP ZONE PROLES D BY C-
W A L L G9 ' .._..gyp--�•-J U
30 8 UA & C SJ O� CD
INSPECTION RE C0
OA F in
z
Plan check fee 25% of above.
PERMIT ISSUING FEE $
TOTAL FEE
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-
LATING, AIR CONDITIONING.
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION APPROVALS DATE INSPECTOR'S SIGNA UR
OF CHAPTER 9, DIVISION 3, OF TH BUSINESS AND PROFESSIONAL
CODE OF THE STATE OF CALIFOR A ROUGH
SIGNATURE FINAL --�
OF PERMITTEE
PERMIT VA`LJ
_IDd ION CK. `4M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
6 4;7KM i2 4.. O 1 9.50 AS8
76A364C
�vUicKERS'COMPENSATION DECLARATION CF -SIB (2.80) Q p p�QCT A V O N FOR p E R� T
I hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AM (CONDITION ONG
a certified fopy thereof(Sec.3800,Lab,C.)
Policy N6.7J71tl Company_STA /�C.J✓
`Certified copy is hereby furnished.
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy is il with tt ou :y�u' d inspection - q-
de arts ent. ( p FOR APPLICANT TO FILL IN ADDRESS
r --.. ' r
Date 'Irl-I Applicant_ _ I (PRINT OR TYPE ONLY)
LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' I NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
COMPENSATION INSURANCE NEAREST
( his .section need not be completed if the work involved ABSORPTION UNIT, BTU CROSS ST. a
by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. PROCE. ED BY O
1certify that in the performance of the work for which this ' AIR HANDLING UNIT,CFM C)
permit is issued, I shall not employ any person in any manner
!so as to become subject to the Workers' Compensation Laws. BOILER,BTU
( APPROVALS DATE INSPE R'S SIGNATURE U
Date Applicant COMPRESSOR,BTU IJJ
ROUGH
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEMFINAL ✓ Z
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 HEATER: SUSPENDED UNIT
9 (commencing with Section 7000)of Division 3 of the Busi- I WALL U oc
ness and Professions Code, and my license is in full force and
effect.
License Num F; _ / Lic.Class�J
Contracto _ _ _ __'P!C.. Date--4 9__ A C?'" It
Y��7•
I am exempt from the licensing requirements as I am a W Tri 71 G hia
licensed architect or a registered professional engineer Pian check fee 25%of above.
acting in my professional capacity (Section 7051, Bus- V 1 i I L
iness and Professions Code). PERMOT ISSUING FEE $ ,C) Z
3 F?i W,L 2 C ¢CR
Lie.or Reg.No. DateTOTAL FEE 1
HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT { ', ...-C,
I hereby affirm that I am exempt from- the Contractor's I NAME t }=
License Law for the following reason (Section 7031.5, Busi-
ness and Professions Code): ADDRESS
e)2f% v�� aFP
hcl-I. l 1:_(i 2
z 2i
1, as owner of the property, v ill do the work and the
CITY ����`, TEL.NG.
structure is not intended or offered for sale (Section /� 4'i� / C / =��ZC3 i - i A 9 j30
7044, Business and Professions Code).
❑ y C%1K� JfIl �
I, as owner of the property, am exclusively contracting OWNER
with licensed contractors to construct the project MAIL
(Section 7044, Business and Professions Code). ADDRESS (JO j caL,/ Cj0W8J r
'!1/ �+
CONSTRUCTION LENDING AGENCY CITYj �G�- TEL.NO.
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is CONTRACTOR ,IN
issued (Sec. 3097,Civ.C.).
Lender's Name ADDRESS,3®,/v
Lender's Address CITY TEL.N0'
i �- f:_7tZ
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_y�� Oj5 CLASS
ordinances and State I ws regulating Heating, Ventilating and
Air Co 1ditioning, a, 1 hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
Coun to ente I on the above-mentioned 'property for
ills*F'Cis'..pl rip
_ 2/ /moi
Signa ure of. :m.ttee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1404030021
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID I BUILDING ADDRESS:
ITR: 6561 LT: 468 5813 GOLDEN WEST AV
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917802204 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LAS TUNAS
18587-024-003 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY CAI
141 VENTILATION FAN 1.00 FAN 15.80
(TENANT: I TOTAL FEES 43.60 (ISSUED ON: PROCESSED BY: PLAN BY:
I 104/03/14 SR
I J i 1
(OWNER: TEL. NO: I IFI .DAT$ FIN L BY: CODE:
IBEN - I
15813 GOLDEN WEST AV I I� \
ITEMP 917802204 I (DESCRIPTION bF WORK U I
IVENTILATION FAN I
(APPLICANT: TEL. NO:
ITO, LANH V (626) 309-9623- I I I
14841 TEMPLE CITY BL (SPECIAL CONDITIONS:
TEMPLE CITY CA 91780
I I
ICONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE I
(ALAN SERVICE CO. (626) 309-9623-
14841 TEMPLE CITY BLVD LIC. NO I IFAU/WALL FURNACE I _
ITEMPLE CITY CA 91780 648308 I 1 1 I
ICOMBUSTION AIR OPENINGS
1ARCHITECT OR ENGINEER: TEL. NO: IDUCT WORK I I I
LIC. NO: I IAC/COMPRESSOR II
ITHERMOSTAT I I
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IFIRE DAMPERS
ISMOKE DETECTION DEVICES I
I I ICOMMERCIAL HOOD I
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11 I I I I I
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1 I* ADDITIONAL DATA ON FILE I I
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IREPORT ID: DPR264 ROUTE TO: BS0508 I I
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