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Home My Public Portal About5447 HILTON AVE_Mechanical__ 7� a7:' v o t WORKERS'that t I hove a certificate DECcafe of corse APPLICATION FOR PERMIT �\ .,I.h�•e� affirm That I hove a certificate of consent to self �l "'insure;or o-tertificate of Workers'Compensation Insurance, 76A364C HEATING - VENTILATING - AIR CONDITIONING or a certifi d co y thereof (Sec. 3800r^J Lob. C.) 7r IC� 1 T�NMi� CE-818(REV. 10/81) Policy No. y ompany 't 1C �( i 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 ./ O� tion department. �� ADDRESS Q i( // 1 (PRINT OR TYPE ONLY) Dafen L��Applicant LOCALITY NO, TYPE OF APPLIANCE OR EQUIPMENT FEE CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST / COMPENSATION INSURANCE CROSS ST. (This section need not be complatad if the work involved by ABSORPTION UNIT, BTU DISTRICT NO. �. PROCESSED BY the permit is for one hundred dollars ($100)or less.) I certify that in the performance of the work for which this AIR HANDLING UNIT, CFM t V U permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. BOILER, BTU APPROVALS DATE INS T R'S SIGNATURE Date Applicant COMPRESSOR, BTU 3 La{ DOO ROUGH r NOTICE TO APPLICANT: If, after making this Certificate of VENTILATION SYSTEM FINAL Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION with comply with such provisions or this permit shall be deemed revoked. - FURNACE: FALL GRAVITY LICENSED CONTRACTORS DECLARATION 1 FLOOR BTU O I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED—UNIT— '(commencing USPENDED WALL UNIT_ '(commencing with Section 7000) of Division 3 of the Business Y and Professions Code,and my license is in full force and effect, d License Number �l037 3 S Lic. Class C 3 g , V q 09 Contractor e e NNJ Q PrIC- Dote 7-`1—t S U I am exempt under Sec. .2241.6A Ch.Plan check fee # e e e e e 8 H B.BP.C. for this reason' PERMIT ISSUING FEE $ ') z Date: 1 ° - 3050 Signature TOTAL FEE . S(� OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT a 0,0 3 0.5 0 a0D I hereby affirm that I am exempt from the Contractor's License , 7.09785 Law for the following reason (Section 7031.5, Business and NAME 0 Professions Code): ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section CITY (' TEL. NO. 7044, Business and Professions Code). OWNER /02 S tJ ❑ I, as owner of the property, am exclusively contracting 2 e ALC with licensed contractors to construct the project(Sec- MAIL lion 7044, Business and Professions Code). ADDRESS q 77 lAr, On ' Q QOtJE' CONSTRUCTION LENDING AGENCY CITY S(Iro / 4 CfIZ a TEL NO, S I hereby affirm that there is a construction lending agency for ��l cl ► the performance of the work for which this permit is issued CONTRACTORqq (Sec. 3097,-Civ. C.). OA//✓D/1 ADDRESS C& NC N / ' Lender's Name CITY y- „E rC , TEL NO.1&S___ /!/r / Lender's Address r-- s 7 7/2 STATE I LIC. c, 39 I certify that I have read this application and state that the LICENSE NO. Q � CLASS O 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 upo the above-mention property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE a 7— ?- YS Signa Nre of Applicain or Agenr Dote COUNTY OF LOS ANGELES TEMPLE CITY N 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS M£ 0508 1005180011 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0468 EXT: (LEGAL ID: FEES PAID BUILDING ADDRESS: ITS: 19341 LT: 10 1 5447 HILTON AV I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803124 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18588-030-010 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, Cl 1 108 FURNACE/HEATER 1100 1.00 UNI 27.00 1TENANT: I TOTAL FEES 54.75 (ISSUED ON: PROCESSED BY: PLAN BY: 105/18/10 SR (OWNER: TEL. NO: IFINAL DATE FINAL BY: CODE: (ISAAC MANUEL G (626) 825-9075- 1 1 1 15447 HILTON AV ITEMP 917803124 IDESCRIPTION OF WORK (1) FURNACE REPLACE 70K CLOSET (1) DUCT SEALMENT 1APPLICANT: TEL. NO: 1 IZAMORA, CARLOS (818) 735-7826- 1 1 1 15858 DOVETAIL DR. j (SPECIAL CONDITIONS: IAGOURA HILLS 91301 I 1 II I CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE ISERVICE CHAMPIONS HEATING AND A,C (714) 777-7777- 1 1 1 122911 SAVI RANCHY PKWY LIC. NO FAU/WALL FURNACE IYORBA LINDA, CA 92887 799170 C20 COMBUSTION AIR OPENINGS 1 1 ARCHITECT OR ENGINEER: TEL. NO: IDUCT WORK I LIC. NO: 1AC/COMPRESSOR 1 1 ( (THERMOSTAT I i iFIRE DAMPERS ISMOKE DETECTION DEVICES 1 I (COMMERCIAL HOOD 1 1 1 I I I I 1 I I i I I I I 1 EXPIRED I II I I I I I IREPORT ID: DPR264 ROUTE TO: BS0508 1 II1 1 I I I I I I