HomeMy Public PortalAbout5829 GOLDEN WEST AVE_Mechanical__ 7GA364E ICE'=6IBA)- „/76 'APPLICATION FOR PERMIT 1
HEATIN ENTILATING - AI CONDITIONING
COUNT F LOS ANGELS
DEPARTME OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING
(PRINT OR TYPE ONLY) ADDRESS
LOCALITY C f
NO TYPE-OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST
ABSORPTION UNIT,BTU
OWNER
AIR HANDLING UNIT,CFM' MAIL -
ADDRESS
BOILER,BTU CITY - TEL NO
COMPRESSOR.BTU CONTRALTO
VENTILATION SYSTEM ADDRESS
EVAPORATIVE COOLER CIT O ZTEL NO
FURNACE FAU G Y �J STATE - LIC 7
FLOOR BTU 5 LICENSE NO�— CLASS C Z
HEATER SUSPENDED' UNIT— DISTRICT No GROUP ZONE PROCESSED BY
WALL
Z J
INSPECTION RECORD d
I f
Plan check fee 25% of above. /D - -/
PERMIT ISSUING FEE$ 5'U
TOTAL FEE
PLAN CHECK APPLICANT
NAME ,
i
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, VENTILATING, 'AIR
CONDITIONING t
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION OF, APPROVALS DATE INSPECTOR'S SIGNATURE
CHAPTER 9, DIVISION 3, THE BUSINESS'AND PROFESSIONAL-CODE s .,_� ..
OF THE STATE C NIA c ROUGH•Y42
SIGNATURE 1- - t FINAL '�I 8
OF PERM ITT
PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK - M O CASH
1 4 8-AUG 11 a,1':e 1 2.0 0 ® 8
®s
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1208130017
_B_UILDIN_G AND-SAFETY_ / LAND DEVELOPMENT_ _ _ TEMPLE CITY_CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID I FEES PAID I BUILDING ADDRESS - I
ITR 6561 LT 471 1 - - 1 5829 GOLDEN WEST AV - I
I IFEE DESCRIPTION- QUANTITY UOM AMOUNT TEMP CA 917802204
(ASSESSOR INFORMATION NUMBER: - `1 ' ' - 1 NEAREST CROSS STREET- I
18587-024-006 - - '101 PERMIT ISSUANCE FEE _.27.80 I THOMAS PAGE 597 GRID A3 LOCALITY TEMPLE CITY, Cl
1 102 COMPRSR' < 100 KBTU-- 1 00 COM 27 00, I
(TENANT - 108 FURNACE/HEATER _<100 1.00 UNI - '27•'00 (ISSUED ON -PROCESSED BY PLAN BY. - 1
1 130 AIR INLETS/OUTLETS 3 00 UNI 13 20 108/14/12 SR I_
141 VENTILATION FAN 3 00 FAN 47 40 1
(OWNER TEL NO. - 1 TOTAL FEES 142 40 1FI' TE F BY CODE - I
IWONG, RICHARD, - 'I 1
15829 GOLDEN WEST AV I - - I
ITEMP 917802204 1 1DESCRI TION OF WORK
I 1 11NSTALL A/C AND HEATING SYSTEM 3 AIR-INLETS AND 3 VENTILATIOI
INS FANS '
1APPLICANT TEL. NO
ITOBIN, ROBERT (909) 921-2033- -
15823 ZAPATA PL I ISPECIAL CONDITIONS 1
(RANCHO CUCAMONGA
.f
(CONTRACTOR - TEL NO I (APPROVALS -DATE INSPECTOR SIGNATURE 1
ITOBIN CONSTRUCTION INC (909) 989-9173- 1
15823 ZAPATA PLACE LIC NO 1 - IFAU/WALL FURNACE - 1
IRANCHO CUCAMONGA, CA 91737 593678
I - ICOMBUSTION AIR OPENINGS II'� .I
ARCHITECT OR ENGINEER- - TEL NO I - 15UCT WORK I� I
1 LIC NO. I t IAC/COMPRESSOR 1 1
I (THERMOSTAT
IFIRE DAMPERS
ISMOKE DETECTION DEVICES -
I
1 I ICOMMERCIAL HOOD
I I _ I _• I I - I
IREPORT ID• DPR264 - ROUTE TO BS0508 1
-WORKERS'COMPENSATION DECLARATION CEA 86 8 (2-80) 6 �1 If I�IC/r'Sl T'�®II YI FORI!— U�%If�T
I ereb'y-ii irm that I have a certificate of consent to self G'
insu e,ar t'.ficate of Wotkers'.Compensation Ihsurahce,orHEAYI'NG-VENTILATING-AIR CONDITIONING:
a certi�f .d f! (Sec 3800,
Policy TJc��i'y�Compady_
'Ciertified copy is hereby furnished.
COUNTY MALPO- E LES BUILDING AND SAFETY
i Certified copy is filed with the county building inspection - BUIL revartment. FOR APPLICANTTO
Date. _ltiepphcant 2_ (PRINT 0RTYPE,ONLY) ADD SS J 8 /'��fj��l:p�f/ �/
-LOCALITY x,04 OF
CERTIFICATE(]F EXEMPTION FROM,WORKERS' NO.' TYPE OF,APP_LIANCE OR EQUIPMENT - FEE
C0MPENSATI0N INSURANCE NEAREST
CROSS ST. �(!✓lf
(This section need, ,not be completed if the ,work•involved ABSORPTION UNIT, BTU O'
by the'permif is for ;one hufldied dollars ($100) ai less.) DISTRICT NOo ' PRocess' _ev
I certify that m'the peaformance of the. this AI'R HANDLING UNIT,CFM
pe{trait is-issued,1 shall not employ any person,m any manner �` ,° O -
so as4o become'subject,to fee Wbrkem'Comp>nsatlon Laws. �' BOILER; BTU F—
t^r _ APP-RQVALS `DATE -'INSPECTOR'SSIGN,'TURE -IU
Date �pP11c?nt' ��• COMPRESSOR?BTU' U .I� ROUGH,
NO°rICE TO APPLICANT: If,after making ihi Certificate of. _ VENTILATION SYSTEM^iy3 @Z
Exemption,, you s4ould',become'subject '!a'the_ Workers'
FIN-AL"
'Compensation provisions of the Labor Code, you must forth- 1 ,
with 'comply with such provlsions'or this permit shall,lie EVAPORATIVE COOLER t VALIDATION`
` deemed revokedi `. FURNAC�.� FAU GRAVITY
_= LICENSED_CONTRAC'rORS,�ECLA$ATION _ , FLOOR' BTU _ az
I hereby affirm that I am-licensed under proyisiong of Chapter ! , HEATER SUSPENDED-- UNI r. .,
9'(commencing with Section 7000)of Division 3 pf the Busi- WALL
ness and Professions Code, and my license is in full'force and ;
effect. 7
License Number 74��/ 'Class / " -
Contractor/kv— lt'y Date
I am exempt from the licensing requirements as°I am a
hcensed.'architect,of a 'registered .professional engineer Plan check.fee 25%of,above.
Bug-
acting tri my professihnal capacity (Section 7o51, Bus-
' '`iness and Professions Code). PERMIT'ISSUING FEE $
Lib.or'Reg.No, Date.'
-TOTAL FEE -1 -
HbME OWNER-.BUILDER DECLARATION PLAN CHECK APPLICANT
.I hereby affirm that�L,•am exempt frbin- the Contractor's NAME
License. Law foe the following reason (Section 7031.5', Susi ,
-nessand-ProfeiNbhs Code): ADDReSS,>
I;as owner,o�the property, will-do the work and-the tNO,`
structure" is not :intended` or offered for sale�(Section CITY • TEL.
7044,`Busmess and Erofessions Code) z -� 6{7,'7'x'
OWNE yb�
I, as owner of the property, am exClusibely contracting R
with licensed, contractors to construct, the, - protect MAIL - .
(Secitoh 7,044;Busmes�and Prpf�ssions Code). - AD DRESS, � � o „
_ - c�` - 'Zi � r7,00
CITY ` TEL NO'.� %�/. z
CONSTRUCTION LENDING AGENCY T� f!d �C.J�j �w �° i
I hereby affirm that there.is' a construction lending agency-°� w _+ e.,•e o 1,7f
for the. performance of the work for.which this permit is CONTRACTOR � _ v
.a,°issued'(Sec. 3097,Civ.-C.) 8-1 2-8 0,-
Lender'sName ADDRESS ��
-Lender's.Address — CITY ,� r r� r�
TE L'NO.
I certify that I have read this a licition and state that. `
Y Pp, STATE .� ,LIC!`
above information is correct.I agreeto comply with all County- LICENSE NO' rCLASS
r ordinances dnd State laws regulating Heating, Ventilating and ' - '• - - ,- '
Air Conditioring, and hereby authorize representatives of this SEE REVERSE,FOR EXPLANATORY LANGUAGE"
County to enter upon the 'above mentioned property for
tusp, con purposes
17
St natu�i Permiiree D�e � `
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