HomeMy Public PortalAbout4846 KAUFFMAN AVE_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0210310003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 5342 LT: 6 UN: .003 4846 KAUFFMAN AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804244
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA
8589-019-034 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY, C
08 FURNACE/HEATER <100 1.00 UNI 27.00
TENANT: TOTAL FEES 54.75 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
10/31/02 VG 04/29/03
OWNER: TEL. NO: FI74NA : AT FINAL B: CODE:
PEI WEN;WENDY T TRS PEI TRUST (626) 287-5477-4846 KAUFFMAN AVTEMP 917804244 DEI TION OF WORK
FAU CHANGE OUT
APPLICANT: TEL. NO:
KEAN AIR (626) 285-1928-
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO:
,/� _ � � APPROVALS DATE INSPECTOR SIGNATURE
KEAN AIR (818) 285-1928-
4851 KAUFFMAN LIC. NO ;'/ 1S �/ �� FAU/WALL FURNACE
TEMPLE CITY, CA 91780 630610
COMBUSTION AIR OPENINGS
ARCHITECT OR ENGINEER: TEL NO: (�� '� p DUCT 'WORK
LIC. NO:! AC/CQMPRESSO
------a i--1 X111?111s ��
THERMOSTAT
FIRE DAMPERS
SMOKE DETECTION DEVICES
— —
H00 D
COMMERCIAL
REPORT ID: DPR264 ROUTE TO: BS0508
1
WORKER'S COMPENSATION DECLARATION 20-0076A3646
PW 9/89_ �pp��� [Q'��®II CI ®� �LS�uHO��
I tiereby,affirm that I have a certificate of consent to self insure, LINE GREEM
or a certificate of Worker's Compensation Insurance, or a certifiedHEATING -VENTILATING-AIR CONDITIONINGLuu1lL�Jr LuILLL��� "
°copy there8f(Sec.3800 Lab.C,,) -
'Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS .BUILDING AND SAFETY DIV.
Certified copy is hereby furnished.
EJ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING
department. (PRINT OR TYPE ONLY), ADDRESSi;,,C
r> Date Applicant NO.. TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY f e �l G I—�
NEAREST `ii
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. W--
we,r 2_11,k_S cit
COMPENSATION INSURANCE ABSORPTION UNIT,BTU
This section need not be completed if the work involved,b the ASSESSOR -0
( P Y MAP BOOK Q O / PAGE PARCELD
permit,is for one hundred dollars($100)or less.). AIR HANDLING UNIT,CFM
DISTRICT NO. PROCESSED BY
•• I certify.that in the performance of the work for which this permit
is:issued, I shall not employ any person in any manner so as to BOILER,BTU
become subject to the Workers'Compensation Laws.
COMPRESSOR,BTU D�
- APPROVALS DATE INSPECTOR'S SIGNATURE
Date -Applicant � VENTILATION SYSTEM -
NOTICE TO APPLICANT: If, after making this Certificate of ROUGHe-Z
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER Dy v
,provisions of the Labor Code, you must forthwith comply with such FINAL �o T
provisions or this permit shall be deemed revoked. FURNACE: FAU GRAVITY
LICENSED.CONTRACTORS.DECLARATION FLOORBTU /P, � VALIDATION
I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT
(commencing with Section 7000) of Division 3 of.the Business and HEATER: WALL '
' 'Professions Code, and my license is in'full force and effect.
®�
License Number Llc.Class }
D ' o
Contractor Date
Plan check fee U
I am exempt under Sec. cc
-B.&P.C.for this reason PERMIT•ISSUING FEE$ V
Dater TOTAL FEE �� W
CL
Signature
OWNER-BUILDER DECLARATION ' PLAN CHECK APPLICANT Z
I hereby affirm that I•am exempt from the Contractor's License Law NAME ' D _
for the following reason (Section 7031:5, Business and Professions
A -�t t•{
.E e'8'
CojJe)• ADDRESS 7
I, as •`0 owner of the property, or my employees with wages � 53.L'00
as their sole compensation, will do the work and the. CITY TEL,NO. qI i TENS
"
structure is not intended`or offered for sale (Section 7044, 1 1TENS
Business and Professions Code). OWNERfi" —
> TOO 300
I, as owner of f6e property, am exclusively contracting MAIL
with licensed contractors to construct the project (Sec- ADDRESS - - r,.•sELP'.. - 53•!' '
tion 7044, Business and,Professions Code). L�
CONSTRUCTION LENDING AGENCY CITY TEL,NO. +' (-altiNGE ,!1!!
I hereby affirm that there is a construction lending agency for CONTRACTOR
the performance of the work for which this permit Is issued
(Sec.3097,Civ.C.). D
lII�l,i- %'•[E1 f'.1 /f;I
- ADDRESS - t _ t�;.i i i -
Lender's Name f?1t 74• rii f L 3?4 3
CITY TEL,NO.
Lender's Address STATE LIC.
certify that 1 have read this application and State that the above LICENSE NO. CLASS
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 the above-mentioned
property f inspection ,poses. SEE REVERSE FOR EXPLANATORY LANGUAGE
SIGNATURE OF APPLICAWr OR AGENT DATE -