HomeMy Public PortalAbout10211 GREEN ST_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY * 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC.WORKS 9071 LAS TU AS ME 0508 9609200002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:.
LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 10211 GREEN ST
FEE DESCRIPTION: QUANTITY: LKM: AMOUNT: TEMP CA 917803337
ASSESSOR IMMATION WUM FR: NEAREST CROSS STREET: GLICKMAN
8585-005-018 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY
30 AIR INLETS/OUTLETS 2.00 LIN1 8.70
TOTAL FEES 36.45 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
09/20/96 TC 09/20/97'
OWNER: TEL. NO: FINAL DATE FI MDE:
AMARE SHIMELIS;HAILU ELENI (818) 444-6467- ?--q
10211 GREEN ST
TEMP 917803337 DESCRIPTION OF WOR-K
EXTEND TWO DUCTS
SAME AS 06MER .
SPECIAL CONDITIONS-
TEL. W: APPROVALS DATE 7WECTOR SIGNATURE
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SAME AS OWNER
LIC. NO XPi +��' `"'ARCHITECT OR ENGINEER: ,�
• -1/ I
DUCT WOR-K
LIC. N0: llr - _ �,/,i
THERMOSTATFIRE DAMPERS
. l ;'I ��« fes• �.
REPORT ID: DPR264 ROUTE TO: BS0508
WORKERS'COMPENSATION DECLAR1tT10N CE 818 C(2-80) APPLICATION FOR PERMIT
1 hereby affirm that 1 have e' certlficnte of consent to self
insure, or a certificate of WorkeR'Cont nsntlon Insurance,or r HEATING-VENTIL.ATI NG-A C NDITI ING
e certified copy thereof(Sec. 3800,La )
Policy No.~ Company COUNTY OF LOS ANGELES' 1LD"ANAFETY
Certified Cgpy,ls hereby furrilshed.
Ceritflad copy Is flied with the county bull g spection FOR APPLICANT TO FILL IN BUILDING
rt n ADDRESS
,Date �r Applicant (PRINT OR TYPE ONLY)
CERTIFICATE OF EXEM ION FROM WORKERS' LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
COMPENSATION INSURANCE NEAREST
(This Section need not,be Completed if the work Involved ABSORPTION UNIT, BTU CROSS ST.
by tfie pennit' la for one hundred dollars ($100) or leap.) MOTRICT tvo. P en ev
1 Lerdfy timt in the performance of the work. for which this AIR HANDLING UNIT CFM
permit is issued. 1 shall not employ any person in any manner ! / l0
so as-to become subject to the Workers' Compensation laws. BOILER BTU — �.
APPROVALS DAYE ' IN9FS=I31t9I¢NATUR[
Date Applicant C MPRESSOR BTU LLJN
ROUGH
NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM Z
Exemption, you should become tubject to the Worker' FINAL Compensation provisions of the Labor Code, you must rortil-
tivlth comply with such provislons or this_ permit shall be EVAPORATIVE COOLER •VALIDATION
deemed revoked. FURNACE: FAUAVITY D O�
LICENSED CONTRACTORS DECLARATION FLOOR BTU ,-,
I hereby affirm that I em licensed under provislons of Chapter HEATER: SUSPENDED UNIT
9 (commencing with Section 7000) of Division 3 of the Busl- WALL
nets and Professions Code, and my license is in full force and
erfect.
License Nurhbe Lic, Class—fc._/_�C—C7.L�—j
Contractor , e
I am exam roquirempnb a�I am n
licensed architect or a registered professional eglneer Plan chock fee 25%of above.
acting in my professional capacity (SectioA 7051,,Bus-
iness and Professioni Code). PERMIT ISSUING FEE.$
Lic,or Reg.No. Date TOTAL FEE
HOME OWNER-BUILDER DECLARATION PLAN CHEC}C APPLICANT
1 hereby aff'Irm that I am exempt from- the -Contractor's NAME
License Law for the following reason (Section 7031.5• Busi-
ness and Professions Coda): ADbRESS '� 3 3 3 A
1, as owner of the property, will do the work and the s
structure Is not intended or offered for sale (Section CITY TEL. NO. ,# C,Jo,e o o 8
7044, Business and Profeealons Code). ' '
property, am exclusively El 1, as owner of theOWNER 2100° 3 Q 6 0
contracting
with licensed contractors to construct the project MAIL
(Section 7044, Business and Professions Code)- ADDRESS f o 0 i 0 3 0.6 0'�
CONSTRUCTION LENDING AGENCY CIT TEL. NO�� _
ola,ao,=83
1 here4y nftlrrn that there it a construction tending agency
for the performance of the .work for which this permit is CONTRAC OR
issued (Sec. 3097,Cly.C.).
Lender's Name ADDRESS
Lender's Agdreis CITY TEL. NO./i
1 certify that I have read this application and state that the I STATE LIC. 7
above information is correct. I agree to comply with all County 1 ENSE N CLASS
ordinance-& and State laws re-guloting Heating, Ventilating and
Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County to enter u the above-mentioned property for
1118pcctir purpose
SIv u ol Permittee Date