HomeMy Public PortalAbout5921 HART AVE_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0208090008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 5904 LT: 330 5921 HART AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801913
ASSESSOR INFORMATIO NUMBER: NEAREST CROSS STREET: HERMOSA
5384-015-028 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY
30 AIR INLETS/OUTLETS 2.00 UNI 8.70
TENANT: 41 VENTILATION FAN 1.00 FAN 15.75 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 52.20 08/09/02 JK 02/05/03
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
TRUONG;VI 4�_ _'4,-��
5921 HART AV
TEMPLE CITY 91780 DESCRIPTION OF WORK
MECHANICAL FOR ADDITION
APPLICANT: TEL. NO:
SAME AS OWNER
SPECIAL CONDITIONS:
CONTRACTOR: TEL. N0:
SAME AS OWNER APPROVALS DATE INSPECTOR SIGNATURE
- ��; �`�' �!�� \
LIC. NO ��\\ AU/WALL FURNACE
,�
COMBUSTION AIR OPENINGS
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ARCHITECT OR ENGINEER: TEL. N0: f'� , , � _ ` � DUCT WORK ZA/ 6,'3
LIC. N0 1 I AC/COMPRESSOR
�- + �1t1111P �
-'f ll_ J i_1 ._ THERMOSTAT
FIRE DAMPERS
LI i� SMOKE DET CTION DEVICES
- -
- - �q COMMERCIAL HOOD
REPORT ID: DPR264 ROUTE TO: BS0508
DEC
TION
. WOWERS'CI have ATION cafe of corse APPUCQYPOIIV 'FOO R l!"LSII�IIVv1 P
I hereby affirm tFiat I have a certificate of consent to self •
insurg, or a certificate of Workers' Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
or a certified copy thereof'(Sec. 3800, Lab. C. 76A364C
CE-818(REV. 10/81)
Policy No. Company
Certified copy is hereby furnished.. COUNTY OF LOS ANGELES' BUILDING AND SAFETY
Certified copy is filed with the county.buildirig inspec- FOR APPLICANT TO FILL IN, BUILDwG
Tion department. ADDRESS�3Z
(PRINT OR TYPE ONLY) j
Date Applicant LOCALITY
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST � '
COMPENSATION-INSURANCE CROSS ST b
BTU DISTRICT NO.' PROCESS
(This section need not be completed if the'work involved by ABSORPTION UNIT, _
the permit is for one hundred dollars ($100)or less.) I
AIR HANDLING UNIT, CFM n
I certify that in the performance of the work for which this eq Q
permit is issued, I shall not employ any person in any manner
BOILER, BTU
so as to become subject to the Workers'Compensation Laws. _ nPPRovnls'• DATE INSPE TOR'S SIGN RE
COMPRESSOR, BTU ROUGH
Datta z � Applicant r
NOTI TO APPLICANT: If, 'atter making this Certificate of VENTILATION SYSTEM FINAL 1711
Exemption, you should 'become subject 'to the Workers' .
Compensation provisions of the Lobar 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 9 HEATER: . SUSPENDED UNIT
(commencing with Section.7000) of Division 3 of the Business WALL
and Professions Code,and my license*is in full force and effect.
License Number Lic. Class V
Contractor Date O
H
❑ I am exempt under Sec: us
Plan check fee
6.&P.C. for this reason NZ
PERMIT ISSUING-FEE $
Date:
Signature 7F.TOTAL FEE 0
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the Contractor's License D
Law for the following reason (Section 7031.5, Business and NAME
Professions Code):
❑ I, as owner of the property, or my employees with ADDRESS _
wages as their sole compensation,will do the work and CITY TEL. NO.
the structure is not intended or offered for sale(Section
7044, Business and Professions Code).
OWNER
as owner of the property, am exclusively contracting
with licensed contractors to construct the'project (Sec- MAIL
tion 7044, Business and Professions Code). ADDRESS
CONSTRUCTION LENDING AGENCY CITY TEL. NO.
1 hereby affirm that there is a construction lending agency for U,
the performance of the work,for which this permit is issued CONTRACTOR D
•(Sec. 3097, Civ. C.).
ADDRESS
Lender's NameCI
TY TEL NO.
Lender's Address
STATE LIC.
I certify that I have read this applicationand state that the LICENSE NO. -CLASS
above information is correct. I agree to comply with all County
ordinances and State laws relating to building construction,
a hereby'authorize representative's of this.County to enter
` n the above=men ed property fottts pgction purpo s. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date