HomeMy Public PortalAbout9118 HERMOSA DR_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY .M 0506 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0612230004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID:
FEES PAID BUILDING ADDRESS:
(
TR: 5905 LT: 85 9118 HERMOSA DR
IEEE DESCRIPTION: QUANTITY: UOM: AMOUNT: T TEMP CA 917801918
(ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET: LOMA
15387-016-031 101 PERMIT ISSUANCE FEE 27.75 T THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl
102 COMPEER 1 100 RBTD 1.00 COM 27.00
TENANT: 108 FURNACE/HEATER 1100 1.00 UNI 27.00 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
130 AIR INLETS/OUTLETS 12.00 UNI 52.20 112/23/08 SR 06/21/09
154 NO PERMT $224.70 MIN 257.00 257.00 1
TOWNER: TEL. N0: TOTAL FEES 390.95 IFINAL DATE `, g^F' ALL BY: CODE:
ISHEN, PATRICIA (626) 757-5536- E �IU1 ,
19118 HERMOSA DR Imo„1 1F{-�{r D
(TEMP 917801918 T (DESCRIPTION OF WOA
T TREPLACEMENT OF HEATER & AIR CONDITIONING UNITS, DUCTS, NO
TELECTRICAL NOR PLUMBING (GAS) IS ADDED OR ALTERED
APPLICANT: TEL. NO:
SAME AS OWNER - (SPECIAL CONDITIONS:
I
CONTRACTOR: TEL. NO: 1APPROVALS DATE INSPECTOR SIGNATURE
TSAME AS OWNER -
LIC. NO IFAU/WALL FURNACE I
ICOMBUSTION AIR OPENINGS
I I I I
(ARCHITECT OR ENGINEER: TEL. NO: (DUCT WORK
LIC. NO: IAC/COMPRESSOR
THERMOSTAT
IFIRE DAMPERS
1SMOKE DETECTION DEVICES
111 COMMERCIAL HOOD
I I IT I I I
11 111 I 1111 � Illl
II I I I II 1111
11111 � 11111 � � 11111 111
TREPORT ID: DPR264 ROUTE TO: BS0508
I I I I T I
WORKERS' COMPENSATION DECLARATION _ APPLICATION FOR PERMIT
-
' I hereby affirm,that I-hace a.cert ificate of consent to self � /'1 1�
insure, or a certificate of Workers Compensation Insurance, HEATING - VENTILATING - AIR CONDITIONING
or;a certified copy.thereof (Sec. 3800, Lob-C.) r 76A364C
. ^ 20-01 DPW 9/88. ,
Policy No. Company - w. -
❑. Certified copy is hereby furnished. COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy is filed with the county,bbilding inspec, FOR APPLICANT TO FILL IN
tion department: ADDRESS ADDRESS e
• (PRINT OR TYPE ONLY)
! ' Date Applicant - - LOCALITY
t NO: TYPE OF APPLIANCE OR EQUIPMENT -.FEE'
o CERTIFICATE OF.EXEMPTION FROM WORKERS' NEAREST
'COMPENSATION INSURANCE CROSS ST.
ABSORPTION UNIT, BTU r/
(This section need not a dred.d hits.the work involved by Disiaic D` eR E ev
the permit is for one hundred dollars ($100):or less.) (
t
I certify that in the performance of.the work for which this AIR HANDLING UNIT, CFM • It-}1-
permit is issued,-I shall not employ.any person in any manner
BTU
' so as to become subject to the Workers Compensation Laws. BOILER, O (� APPROVALS DATE N� i0 SIGNATURE
;Date ' Applicant 'COMPRESSOR, BTU - "4/' Cie(O �/ ROUGH �
.NOTICE TO APPLICANT i If, after making this Certificate of . •VENTILATION SYSTEM q FINAL
Exemption,' you should become subject to the Workers' d
Compensation provisions vi the Lhbor Code, you must forth- EVAPORATIVE COOLER . _ V ID TI N
with comply with such provisionror this permiV3hall be deem-
ed revoked. FURNACE: FAU-_GR VITY
LICENSED CONTRACTORS DECLARATION 'FLOOR BTU Ia QV�}�I
.
'Thereby affirm that am licensed under provisions of Chapter 9 -5USPENDED UNIT -
HEATER:- .
(commencing with Section 7000)of Division 3 of the Business WALL '
and Professions Code,and my license is in full force and effect. t '
License Number Lic. Class ► - d
UTL& O O
it
• Contractor -Date
—10
exempt under Sec. -� _ - O
Plan check fee _ IJ
6.8P.C. for is reason. d
PERMIT ISSUING 1n
. Dote: - TOTAL FEE. 3 d 2 ,
Signature -
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby affirm that.l am exempt from the Contractor's License •
Law for the following reason (Section 7031.5, Business and NAME
'Pro essions Code):
I, as owner of the property, or my employees with ADDRESS--
wages as their sole compensation, will do the work and .. a
ACCT`T
CITY- �« TEL NO.
the structure is not intended or offered for sale(Section - ee j
7044, Business and Professions Code). 3337 � � t.r,1�1,
OWNER T
I, as owner of the property,,am exclusively,contracting�, '�v a-C '�' r 1, - -' 1 ITEN; ----
with
_-.with licensed contractors to construct the project (Sec- MAIL
tion 7044, Business and Professions Code). - ADDRESS _. _ .._ TOTAL 55 - 00
CONSTRUCTION LENDING AGENCY - cfc f1
CITY � TEL. No. .�� ,9 J� - CHECK - Q.
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued CONTRACTOR R- - , •- CHANGE
(Sec. 3097, Civ. C:).
ADDRESS r ._.r ... .. .._f•
Lende'r's Nome �/ 3lsi•
CITY TEL NO. -0000-0001 ' 'J?U, 7a
Lender's Address lE•4 1 AM '9O ii)
I certif that I,have read this a lication and state that the STATE - •liC. - - -' - - -
Y PP
above information is correct.�f agree to comply with County LICENSE NO. CLASS
ordinances and State laws relating to building construction, - -"
and hereby authorize representatives of this County to enter
U p n the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date Os