HomeMy Public PortalAbout9580 KENNERLY ST_Mechanical__ 76A364E ICE-:,9A,-u7 APPLICATION FOR PERMIT
• HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN ADDRESS 43 D
(PRINT OR TYPE ONLY)
LOCALITY
NO TYPE OF APPLIANCE OR EQUIPMENT FEE Je
NEAREST
CROSS ST
ABSORPTION UNIT BTU -
OWNER
4
AIR HANDLING UNIT,CFM MAIL pp '
ADDRESS
BOILER,BTU CITY TEL NO
COMPRESSOR BTU '
CONT ACTOR F,
VENTILATION SYSTEM ADDR SS
EVAPORATIVE COOLER CITY TEL NO
FURNACE FAU_GRAVITY STATE LIC
FLOOR BTU LICENSV=NO CLASS '
HEATER SUSPENDED UNIT- DI TRICT NO f�. �GGROUP ZONE RO Y
WALL - CJ l't--3 l
INSPECTION RECORD 0
V
OL
Plan check fee 25% of above
PERMIT ISSUING FEE$ `7 U-t) Z
TOTAL FEE /
PLAN CHECK APPLICANT
NAME J7,6AJ <C K4b,f�
ADDRESS a �IV� KL ` 7
CITY PLC_ (f/ TEL NO � '
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL
ORDINANCES AND LAWS REGULATING HEATING VENTILATING, AIR
CONDITIONING
I HEREBY CERTIFY THAT I AM.NOT ACTING IN VIOLATION OF APPROVALS DATE INSPE ORSSIGNATURE
CHAPTER 9, DIVISION 3 OF THEBU N SAND PR FESSIONAL CODE 7G
OF THE STATE OF C IFORRN ROUGH
SIGNATURE FINAL L(
OF PE RMITTE
PLAN CHICK VALIDATION CK mo CASH PERMIT VALI A cK M D CASH
2 3;6,�Y 2'4,1 D -1 :5.0 0 ��%
i
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PERMIT
I hereby affirm that 1 have a certificate of consent to self
insure, c;'a•ce�,tibica- of Workers' Compensation Insurance, - HEATING -- VENTILATING - AIR CONDITIONING
or a certified copy thereof (Sec 3800, Lab C ) 76A364C
CE-818(REV 10/81)
Policy No Company
Certified copy Is hereby furnished COUNTY OF LOS ANGELESBUILDING AND SAFETY
❑ Certified copy Is filed with the county building inspec- FOR APPLICANT TO FILL IN BUILDING O
tion department (PRINT OR TYPE ONLY) ADDRESS
_ _ x
D6te Applicant LOCALITY tI�
- NO TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST ' '
COMPENSATION INSURANCE CROSS ST
(This section need not be completed if the work involved by ABSORPTION UNIT, BTU DISTRICT NO • PROCES D BY
the permit is for one hundred dollars ($100)or less.) AIR HANDLING UNIT, CFM / / 4
I certify that In the performance of the work for which this, 50
permit Is'Issued, I shall not employ any person In any manner BOILER, BTU
so as to become sublect to the Workers'Co77at,on LOWS APPROVALS DATE I SP OR S SIGNATURE
Z pplCOMPRESSOR, BTU 0 ROUGH
Date Ica _
NOTICE TP APP ICANT If, after making t Is Certificat of VENTILATION SYSTEM FINAL
Exemption, you should become subject to the Workers' v
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATI N
with comply with such provisions or this permit shall be
deemed revoked FURNACE FA GRAVITY O
LICENSED CONTRACTORS DECLARATION FLOOR BTU
I hereby affirm that I am licensed under provisions of,Chapter 9 HEATER_ USPENDED UNIT
(commencing with Section 70DO)'of Division•3 of the Business WALL
and Professions Code,and my license Is in full force and effect i— d
License Nube . Llc Class L7
mr
Coniracto L 7 ate 0
❑ I am exempt under Sec _ U
Plan check fee d
- B&P C for this reason N� Z
PERMIT ISSUING FEE $
ate
TOTAL FEE
Signature
OWNER-BU DER DECLARAT N PLAN CHECK APPLICANT
I hereby affirm that I am exempt from the ontractor's License pop. 27829 A
Law for the following reason (Section 7031 5, Business and NAME ,
•Professions Code) #,o,e • e 8
❑ -I, as owner of the property, or my employees with ADDRESS e
wages as their sole compensation,will do the work and °f° 4,1,0 0 t
the structure is not Intended or offered for sale(Section CITY TEL NO
°.°,°41
7044, Business and Professions Code) 0,0 r, ,
. OWNER � •
❑ I, as owner of the property, am exclusrvely'contrachng
with,licensed contractors to construct the project (Sec- MAIL C) 02 +8 7
hon 7044, Business and Professions Code) ADDRESS v
CONSTRUCTION LENDING AGENCY ' CITY TEL' NO
-I,hereby Affirm that there is a construction lending agency for
the performance of the work for which this permit is Issued CONTRACTOR
(Sec 3097, Civ C ) ! -
ADDRESS Iib D '
Lender's Name r
CITY ( e,[ TEL NO 13 7
Lender's Address
STATE LIC
I certify that I have read this application and state that the LICENSE NO 3tp (�O CLASS
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 the above- nt ned property for Inspection purposes r SEE REVERSE FOR EXPLANATORY LANGUAGE _
Signature of kppfiLont or Ag t ate
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0906040003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID FEES PAID
ITR 19316 LT 6 1 BUILDING ADDRESS 1
1 9580 KENNERLY ST 1
1 IFEE DESCRIPTION QUANTITY UOM AMOUNT 1 TEMP CA 917803837 1
(ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET
18590-014-027 101 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID A4 LOCALITY TEMPLE CITY, Cl
1 141 VENTILATION FAN 1 00 FAN 15 75 1
TENANT 1 TOTAL FEES 43 50 JISSUED ON PROCESSED BY PLAN BY EXPIRES ON
1 i 106/04/09 SR 12/01/09
(OWNER TEL NO 1 I 190
AL DA/T�E FI��7? BY CODE 1
IPHU, NANCY (626) 287-3814- 1 'I
19580 KENNERLY ST 1 / 'r
(TEMP 917803837 1 1DESCRIPTI N OF WORK v1
1VENTILATION FAN FOR BATHROOM REMODEL 1
(APPLICANT TEL NO 1 I
1LAI (626) 288-2651- 1
18748 VALLEY BLVD #K 1 1SPECIAL CONDITIONS 1
1ROSEMEAD, CA 91770 1
I I
I
1CONTRACTOR TEL NO 1 1APPROVALS DATE INSPECTOR SIGNATURE 1
IPHU, ANDY (626) 287-3814- 1
1HOA T N PHU LIC NO 1 1FAU/WALL FURNACE I I I
19580 KENNERLY STREET NONE 1
TEMPLE CITY, CA 91780 1COMBUSTION AIR OPENINGS 1 1 1
ARCHITECT OR ENGINEER TEL NO i (DUCT WORK
LIC NO 1 JAC/COMPRESSOR 1 _
1THERMOSTAT 1 1 1
1 i (FIRE DAMPERS 1 1
1SMOKE DETECTION DEVICES 1 1 1
(COMMERCIAL HOOD 1 1 1
1 I I I I I
1 I I I I I
I I I I I I
I I I I I I
1 I I I I I
1 I I I I I
I 1
1 1REPORT ID DPR264 ROUTE TO BS0508
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