HomeMy Public PortalAbout5414 HILTON AVE_Mechanical__ 16 A364-'ICE BIB- 5-73 APPLICATION F R PERMIT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY I,V1C hi
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE ADDRESS It p�.j
CIT
ABSORPTION
9 TEL. NO. ,y 3 "
ABSORPTION UNIT, BTU _o
CONTRACTOR' .<
AIR HANDLING UNIT, CFM �
ADDRESS d ��
BOILER, BTU CITV TEL, NO. 7�7C
COMPRESSOR, BTU STATE LIC.
LICENSE NO. C) I`/gI9`lf CLASS U
VENTILATION SYSTEM DISTRICT NO. GRDUP ZONE cess ED BY
1 EVAPORATIVE COOLERL) FL S
w
FURNACE: FAU�GRAVIT
FLOOR BTU INSPECTION RECORD
HEATER: SUSPENDED—UNIT—
WALL-
131.11
USPENDED_UNITWALLPIRn check fee 2596 0[ above. See reverse.
PERJU'P ISSUING UEE $ 3 OO
TOTAL FEE
PLAN CHECK APPLICANT -5�
NAME
ADDRESS
CITY TEL.NO. - ' Of1
THEREBY LEDGE THAT HAVE READ TNIS APPLICATION
AND STATE THATHAT THE
THE I$ CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND AND LAWS REGULATING HEATING, VENIN'I- APPROVALS CAT PECTOfs'S SIG 1URE
LATING, AIR CONDITIONING.
ROUGH
HEREBY CERTIFY THAT I NOT ACTING IN VIOLATION p
OF CHA GTEP 9, DIVISION 3, OF THE
OUSINE55 aN0 PqO FESSIONALFINAL IU
CODE OF THE STATE OF CAIIFOq NI A.
sIGNAT URe /J-� /�/�\ PERMIT VALIDATION Cx. M.o, cases
OF PERMITTEE
PLAN CHECK VALIDATION CN. M.D. CASH
9 9 8 A 7 4 1. u .5 0 6s
SEE DA CR OF APPLICATION FOR COM FILETS FEE SCHEDULE
WORKER'S COMPENSATION PENSATIONDECLARATION 7SA34 DPW 9/89 APPLICATION FOR PERMIT �� � � �� s
]6A3e4C
I hereby affirm that I have a certificate of consent to self insure,
or aV;ertificate of Worker's Compensation Insurance, or a certified - HEATING -VENTILA3ING -AIR CONDITIONING
copy thereof(Sec.3800 Lab.C.)
Policy N `? �9 ] Company `- .COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKSILDING AND SAFETY DIV.
❑ Certified copy is hereby furnished.
Certified copy is tiled with the co ty bu' ing action FOR APPLICANT TO FILL IN ADDRESS L a
Gdepartment.
Cr'9/ (PRINT OR TYPE ONLY)
Date Applicant LOCALITY Tr-- ^
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE I l/
CERTIFICATE OF EXEM ION� WORK S' NEAREST
COMPENS ON INS ANCE CROSSST. U L y/ (EQ
ABSORPTION UNIT,BTU ASSESSOR
(This section need not be completed If the work involved by the MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) AIR HANDLING UNIT,CFM DISTRICT NO. PRGGESSED BY
1 certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as to BOILER,BTU p
become subject to the Workers' Compensation Laws.
COMPRESSOR,BTU
APPROVALS DATE NSPECTGGS SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL
provisions or this permit shall be deemed revoked. FURNACE: FAU VIN Jp /D VALIDATION
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that am licensed under provisions of Chapter 9 SUSPENDED UNIT=
(commencing with Section 7000) of Division 3 of the Business and HEATER: WALL to
Professions Code,and my license is in full force and effect. �yj�y 10.50
�o��License Number 6 Lic.Class C_2V }
Contractor Date d IJ .3303 10.50 V
❑ Plan check fee Z ITEMS Q
eze oder Se O
B.t4P.C.for this reason PERMIT ISSUING'FEE$ O TOTAL 14/1 a QQ U
Date: TOTAL FEE .. O P - CHECK 161.00 d
Signature Zo
PLAN CHECK APPLICANT
OWNER-BUILDER DECLARATION � - CHANGE .00 Z
I hereby affirm that'I am exempt from the Contractor's License Law 'NAME 1 7
for the following reason (Section 7031.5, Business and Professions RJ OOOO—
Code): ADDRESS !1 S —�� , 01 1/11f95
❑ I, as owner of the property, or my employees with wages 1lJ 1794 1 AM 7:50
as their sole compensation, will do the work and the CITY N-'z .��l TEL.N
structure is not intended or offered for sale (Section 7044,
Business and Professions Code). OWNER
❑ N rT
I, as owner of the property, am exclusively contracting MAIL 1
with licensatl contractors to construct the project (Sec- ADDRESS , ` / U,AJ
tion 7044,CONSTRUCTION PLENDING AGENCY -
rofessions Code). CII-Y �!--� I t, ` TEL.NO.
herebyrfor affirm that there is a construction lending agency for CONTRACTOR 1�— �/l ,
the performance of the work for which this-permit Is issued o
(Sec.3097,Civ.C.). -
ADDRESS Z i y
Lender's Name
CITY.
Lender's Address LK
F"I
I certify that I have read this application and state.that the above UrENSE NO..�s C ASS
information is correct. I agree to comply with all County ordinances
and State laws relatin A o building construction,and hereby authorize _.
representati of t s Coun toenter upon the above-mentioned
property r sp tj� p p ses. SEE REVERSE FOR EXPLANATORY LANGUAGE O
/L o
SoNATU OF APPLIZ7 AGENT DATE
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1306100013
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 17387 LT: 13 5414 HILTON AV
I IFEE DESCRIPTION: QUANTITY: NOR: AMOUNT:1 TEMP CA 917803122
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
8588-029-005 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CA(
47 ALTER EXIST DUCT SYS 1.00 SYS 27.00 1 1
TENANT: I TOTAL FEES 54.80 JISSUED ON: PROCESSED BY: PLAN BY:
1 1 106/10/13 SR
OWNER: TEL. NO: (FIN^AL^DATE FINAL BY: CODE:
PARKS, RONALD/JUDITH (626) 826-3594- I C 2y^ 111
5414 HILTON AV J Y
ITEMP 917803122 IDES_RIPTION OF WORK
(ALTERATION OF EXIST DUCT SYSTEM
(APPLICANT: TEL. NO:
ICASTRO, RICK (714) 980-0349-
122632 GOLDEN SPRINGS (SPECIAL CONDITIONS:
DIAMOND BAR CA 91765
I I I
(CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE
(ALLIED RESTORATION SERVICES (714) 980-0349- 1-
22632 GOLDEN SPRINGS DRIVE LIC. NO �FAU/R'ALL FURNACE '
DIAMOND BAR CA 91765 908870 1 11
(COMBUSTION AIR OPENINGS
(ARCHITECT OR ENGINEER: TEL. NO: IDUCT WORK
IEARL AMMERMAN (951) 352-3588-
19980 INDIANA ST #3 LIC. NO: IAC/COMPRESSOR
RIVERSIDE CA 92503 NONE
ITHERMOSTAT
FIRE DAMPERS
I
ISMOKE DETECTION DEVICES
I
CONPiERCIAL HOOD
I 11 I lI 111 111
I I I I I I
I I I I I
I 11 I 11 I 111
I I I I I
I I I I I
REPORT ID: DPR264 ROUTE T0: HS 0508