HomeMy Public PortalAbout6221 HART AVE_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1312160012
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS:
ITR: 5904 LT: 211 I 1 6221 HART AV 1
I IFEE DESCRIPTION: , QUANTITY: DOM: AM0UNT: 1 TEMP CA 917801631
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1
15384-007-023 .101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CAI
1 102COMPRSR < 100 KBTU 1.00 COM 27.00 1 1
(TENANT: 108 FURNACE/HEATER <100 1.00 UNI 27.00 (ISSUED ON: PROCESSED BY: PLAN BY: 1
1 TOTAL FEES 81.80 112/=_6/13 SR
1OWNER: TEL. NO: 1 (FINAL DATE ( FII�VAL BY: CODE:
ISTEINBERG ROBERT D;PHYLLIS A (626) 287-5411-
16221 HART AV
ITEMP 917801631 I IDtSC� 'RIP OF WORK
I I IREPLACE EXISTING A/C-HEAT SYSTEM 1
(APPLICANT: TEL. NO: 1 1
ICONTRERAS, CARRA (626) 286-3157-
14931 N ENCINITA AVE 1 ISPECIAL CONDITIONS: I
ITEMPLE CITY CA 91780 1 I 1 - (J-9
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ICONTRACTOR: TEL. NO: 1 (APP OV DATE INSPECTOR SIGNATURE I
ICONNOR AIR CONDITIONING (626) 286-3157- I I
14931 N ENCINITA AVE LIC. NO I -IFAU/ ALL FURNACE I 1
(TEMPLE CITY CA 91780-3706 403735
I 1C _ USTION AIR OPENINGS 1
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(ARCHITECT OR ENGINEER: TEL. NO: 1 IDUCT WORK 1 I
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I LIC. NO: 1 IAC/COMPRESSOR
I 1 ITHERMOSTAT I ! IAI
1 (FIRE DAMPERS I I
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1 ISMOKE DETECTION DEVICES I I
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IREPORT ID: DPR264 ROUTE TO: BS0508 1 I
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WQRKEth :l /av' a cer i DECLARATION n r�nn C n VONn FOnq PERM
47
~I hereby.p�°firm tham,l have a certificpte'of consent to self (�j�IrLL, G�1 11V I1� h'LSll�llV'll,
insure, or d certificate of Workers' Compensation Insurance, 76A364c HEATING -' VENTID ATIR�G - AIR COV�DITIOfdLI�G
or,ace tified copy thereof (Sec 3800, Lab. C.')
/ CE-818(REV.'10/81)
Poli No.f1��'_ Company (� �� D 2
.Certified copy is hereby furnished. COUNTY OF'LOS ANGELES BUILDING AND SAFETY
Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING" '7� f,
tion department. ADDRESS
(PRINT OR TYPE ONLY)
Date -/2-y.7 Applicant LOCALITY 4 cy/1`
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS` NEAREST
COMPENSATION INSURANCEROCESSED By
BTU DISTRICT NO.• CROSS ST.
P
(This section need not be'compleTed if'The work involved by ABSORPTION UNIT, _ GGG�
The permit-is for'one hundred dollars($100).oE less.) AIR HANDLING UNIT, CFM 1 U�
'I .certify that'in the performance of the work for which this. �J
ov
permit is issued, I shall not employ any person in any manner BOILER, BTU
s0'as to become:subject-fo.the Workers'Compensation Laws. - II _ - /( / APPROVALS. DATE SPE OR•S SIGNATUR
Date Applicant f COMPRESSOR, BTU 14 VV ROUGH'
zz
NOTICE TO APPLICANT: If,: after making this Certificate of VENTILAT'ION'SYSTEM FINAL
Exemption, you should become,subject to the- Workers' �—
Compensation provisions of the Labor'Code you.must forth- EVAPORATIVE COOLER O . TI
with comply with such 'provisions or this permit shall be
deemed revoked. FURNACE: FAU GRAVITY{
LICENSED CONTRACTORS DECLARATION I FLOOR - BTU /1
I hereby offirmthat I am licensed un'dernprovisioris of Chapter 9 HEATER: SUSPENDED UNIT
(commencing with Section 7000) of Division 3 of the Business WALL
HEATER-
and Professions Code,and my license is in full force and effect:
LL
License Number yb'373-" -Liq. Clas t7 .
�r�iU• 2 �� D
Contractor 0
Date 0
❑' I am exempt under Sec.
Plan check fee
B.&P.0 for' hisreason
_• " �
PERMIT ISSUING FEE$
Date:
TOTAL FEE
Signature
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): 7 6 63 A
❑ I, 'as owner of the property,. ADDRESS
p p y, or':my employees'with _.' #+0 0 0 0,0
wages as their sole compensation;will do the work and °0 0°
the structure is not intended or offered for sole(Section CITY TEL NO. �'r,
2
7044, Business and Professions Code.). 8 ".
/O. 1
❑ OWNER V�L ! ^�/N�✓C
I, 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 AGENCYTEL. NO.
CITY p
I hereby affirm that there is a construction lending agency.for
the performance of the work for which this permif.is issued CONTRACTOR O �d� /2 W/1��� D
(Sec. 3097, Civ. C.).' ?.
��✓ /`� N/
Lender's-Name ADDRESS
n `/ 7 "
CITY TC� TEL NO. �J
Lender's Address
STATELIC.
I certify that I have read this application and state that the LICENSE NO. 110273, CLASS (2 03.Y
above 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 he aabbboov�e-menti property for.inspection purposes.. SEE REVERSE FOR EXPLANATORY_LANGUAGE.
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Signature'of Applicant'or Agent Date