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HomeMy Public PortalAbout5616 HALLOWELL AVE_Mechanical__ • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1202090010 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID I BUILDING ADDRESS: 1TR: 12392 LT: 18 BL: .001 1 5616 HALLOWELL AV I 1FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 ARCD CA 910078419 ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LIVE OAK 18586-013-024 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: B3 LOCALITY: TEMPLE CITY, Cl 1 102 COMPRSR < 100 KBTU 1.00 COM 27.00 1 TENANT: 108 FURNACE/HEATER <100 1.00 UNI 27.00 JISSUED ON: PROCESSED BY: PLAN BY: I 130 AIR INLETS/OUTLETS 14.00 UNI 60.90 102/09/12 SR 1 141 VENTILATION FAN 4.00 FAN 63.30 1 1 OWNER: TEL. NO: I TOTAL FEES 206.00 IF DATE FIN BY: CODE: 1 1KASUBUCHI, GREGG (626) 215-5438- 1 I 15616 HALLOWELL AV I I I� (ARCD 910078419 1 ID SCRIPTION OF WORK 1 I 11NSTALLATION OF A NEW HEATI G & COOLING SLIP SYSTEM FOR 1 _I 1ADDITIONAL AREA AND VENTILATION FANS 1APPLICANT: TEL. NO: 1 INEW CENTURY HEATING AND A/C INC. (626) 831-1985- 1 1151 W. MARSHALL ST. 1 1SPECIAL CONDITIONS: 1 (SAN GABRIEL CA 91776 1 1 I ICONTRACTOR: TEL. NO: 1 1APPROVALS DATE INSPECTOR SIGNATURE 1 INEW CENTURY HEATING AND AIR (626) 831-1985- 1- 1151 1151 W MARSHALL STREET APT A LIC. NO 1 IFAU/WALL FURNACE I I i ISAN GABRIEL, CA 91776 922877020 * I I I I I I 1 1COM13USTION AIR OPENINGS I I I ARCHITECT OR ENGINEER: TEL. NO: i DUCT WORK `I LIC. NO: 1AC/COMPRESSOR llr I I I ITHERMOSTAT I I I I I 1FIRE DAMPERS I I I I 1 1SMOKE DETECTION DEVICES I 1 1COMMERCIAL HOOD I 1 I I I I I I 1 I I I I I I I I I I I I I I I I I I I I I I I 1 I* ADDITIONAL DATA ON FILE I I I I 1 1REPORT ID: DPR264 ROUTE TO: BS0508 1 I I I I I I I I L WORKER'S COMPENSATION DECLARATION 76A364C 46DPW 9,69 APPLICATION FOR PERMIT LAME GREEN ' 76A3 I'herebyi°affirm that I have a certificate'of consent to self insure, or,a certific4te of Worker's Compensation Insurance, or a certified HEATING -VENTILATING =AIR CONDITIONING copy thereof(Sec.,3800 Lab. C.) Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV. Certified copy is hereby furnished. ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING ADORES department. (PRINT OR TYPE ONLY) Date ApplicantLOCALITY NO. TYPE OF APPLIANCE OR EQUIPMENT FEE C� CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST COMPENSATION INSURANCE CROSS S ABSORPTION UNIT;BTU ASSESSOR (This section need not be completed if ttie work involved by the MAP.BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PROCESSED BY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to BOILER,BTU- to become subject to the Workers'Compensation Laws. ,`' � COMPRESSOR,BTU w Date/ �� �/ A IIC�^t.:_�a � APPROVALS DATE INSPECTOR'S SIGNATURE PP '��� VENTILATION SYSTEM p NOTICE TO APPLICANT: If, after making ,this Certificate of ROUGH Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER -92 provisions of the Labor Code, you must forthwith comply with such FINAL provisions or this permit shall be deemed revoked. / FURNACE: FAU GRAV TY ` LICENSED CONTRACTORS DECLARATION ( FLOOR BTU Gf� r_ LICENSED ©� VALIDATION I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT (commencing with Section 7000) of Division 3 of the Business and HEATER: WALL Professions Code, and my license is in full force and effect. D0 License NumberZ3,21/1 /�?_ Lic.Class Z1--!!19 a.Contracto c Date b-!!19" / 9 O ❑ Plan check fee Lam exempt under Sec. B.&P.C.for this reason PERMIT ISSUING FEE $ Q O Date: TOTAL FEE W Signature 0- OWNER-BUILDER OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT co Z I hereby affirm that I am exempt from the Contractor's License Law NAME - for the following reason (Section 7031.5, Business and Professions , 9-. .m• y Code): ADDRESS ❑ I, as owner of the property, or my employees with wages ? 55l_I1,41 as their sole compensation, will do the work and the CITY TEL.NO. structure is not intended or offered for sale (Section 7044, # ., L Business and Professions Code). OWNER _ 3 F.] I, as owner of the property, am exclusively contracting 55 - r-.i 0 MAIL with licensed contractors to construct the project (Sec- ADDRESS "'`R C, tion 7044, Business and Professions Code). CIT TEL.NO. NGE t CONSTRUCTION LENDING AGENCY ri Ly iA=.?3� Ihereby affirm that there is a construction lending agency for CONTRACTOR , the performance of the work for which this permit Is issued (Sec. 3097; Civ.C.). ADDRESS L/ Lender's Name v c CITY EL. Nliiy'a=' Lender's Address STATELIC. I certify that I have read this application and state that the above LICENSE NO, CLASS CZ information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. 9 SEE REVERSE FOR EXPLANATORY LANGUAGE �S18iPRTURE ICANT OR AGENT DATE I -