HomeMy Public PortalAbout5237 HALLOWELL AVE_Mechanical__ • T
' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
.DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1103220010
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 15874 LT: 15 5237 HALLOWELL AV
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: I TEMP CA 917803461
ASSESSOR INFORMATION NUMBER: 1 1 NEAREST CROSS STREET.
18585-019-015 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl
I 102 COMPRSR < 100 KBTU 1.00 COM 27.00
TENANT: 108 FURNACE/HEATER <100 1.00 UNI 27.00 JISSUED ON: PROCESSED BY: PLAN BY:
TOTAL FEES 81.80 103/22/11 SR
OWNER: TEL. NO: IFI AL DATE FINAL BY: CODE:
IPOLLARA BERT J (626) 444-5060-
15237 HALLOWELL AV I 1
TEMP 917803461 1DESCRIPTI, OF WORK
REPLACE EXISTING ROOF A/C HEAT UNIT
APPLICANT: TEL. NO:
1CONTRERAS, CARRA (626) 286-3157-
14931 N. ENCINITA AVE ISPECIAL CONDITIONS:
TEMPLE CITY CA 91780
CONTRACTOR: TEL. NO: APPWZOVAkS DATE INSP CTOR SIGNATURE
1CONNOR AIR CONDITIONING (626) 286-3157-
14931 ENCINITA AVE LIC. NO IFAU/WALL FURNACE
1TEMPLE CITY, CA 91780 403735 C20 I
1COMBUSTION AIR OPENINGS 1
ARCHITECT OR ENGINEER: TEL. NO: 1 1DUCT WORK I I I
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LIC. NO: IAC/COMPRESSOR 1
ITHERMOSTAT I
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I 1FIRE DAMPERS
f^� i ISMOKE DETECTION DEVICES I I 1
I I ICOMMERCIAL HOOD I I I
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1REPORT ID: DPR264, ROUTE TO: BS0508 I 1
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WORKERS'COMPENSATION DECLARATION CEA 8 8C(2-80) Al"\%p pUC A T p®N FOR.R. P E R vl�i 0
I•hereby .affirm that I have a' certificate of consent fo self
insure, or a•certiffcate of Workers'Compensation Insurance,or H(E�jYINCy-bENTIL.AT ll�Cs-l�ll� CQI�I®ITIO(f�INGi
a certified copy thereof(Sec. 3800,Lab.C.)
Policy No. Company 7,
❑ Certified copy is hereby furnished. - COUNTY OF LOS ANGELES ¢UI LDING AND SAFETY "
❑
department.
.bs filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING. -
department. ADDRESS
Date Applicant (PRINT OR TYPE ONLY)
r�
LOCALITY J ,
CERTIFICATE OF EXEMPTION FROM WORKERS', NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
COMPENSATION INSURANCE NEAREST �>_
(This section need not be completed if,the work involved ABSORPI ION CL
UNIT, BTU CROSS ST. __ r O
by the permit is for one hundred dollars ($100) or less.) DISTRICT NO. PROCESSE BY • V
I certify that in the performance of the work for which this - AIR HANDLING UNIT,CFM "'
permit is issued, I shall not emp)oy, any person in any manner .. j( � O
so as o be me subject to the Work '' Laws. BOILER, BTU I-
�"o 1 //'i� J 0O - - APPROVALS DATE INSPECTOR'S SIGNATURE (U
a / i5 LU
Applicant !�A✓�.IA�� COMPRESSOR, BTU
ROUGH
NOTICE TO APPLICANT: If, after making this Certificate o-fVENTILATION SYSTEM I ffo-oZ
Exemption, you should become subject to the'• Workdrs' FINAL
Compensation provisions of the Labor. Code, you must complyforth- EVAPORATIVE CO
with with such .provisions or this permit shall bOLCOOLIEe VALIDATION
deemed'revoked.
FURNACE:' FAUN Tia'
LICENSED CONTRACTORS DECLARATION [ FLOOR*-.,BTU_,/�7(Y��_- /
I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT (oma&
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.
License NumberLic.Class
Con+tf�c'1 ur�� 1 1s Date
❑ I am exempt from the licensing requirements as I am a
licensed architect or a registered -professional engineer Plan check fee 25%of above.
acting in rnY Professional capacity,,(Section 7051, Bus- -�
ihess and Professions Code). •- -,. - •- PERMIT ISSUING FEE $ - '
Lic.or Reg.No. Date TOTAL FEE•,
HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT _
I hereby .affirm that I am exempt from- the Contractor's .NAME
License Law for the following reason (Section 7031.5, Busi-
ness and Professiohs Code): ADDRESS
❑ I, as owner of the property, will do the work and the
Structure is not intended' or offered for sale (Section CITY TEL. NO.
7044, Business and Professions Code).:•
2 0.0.5'A
OWNER
'I,
;
I, as owner of the property, am exclusively contracting # e 'o•o e o 8 r
with licensed contractors to construct theproject MAIL
-(Section`70.44, Businessand Professions Code). ADDRES 1 _ � _ 2tio% 2;7'0'0 -
CONS,TRUCTION LENDING AGENCY CITY TEL.N�s� �f' ��� r - o 0 x.
I hereby affirm that' there is a construction lending agency 0 2.7,0 0 U
for the performance of the work for which' this permit is CONTRACT' `,_ _`art_ G
-issued (Sec. 3097,Civ.C.). • 1 1, 1 8.-'8'1
Lerider's Name, ADDRES _ `_ .!�- • I
Lender's AddressCITTEL. N
Y O!•7fl ,
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— (w,� CLASS C�
ordinances and State laws regulating Heating, Ventilatingand
Air Conditioning,•and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY-LANGUAGE
County to enter upon the above-mentionedprop rty for ;
in, ecti purp S.
t' -
ill
Permittee .'Date