HomeMy Public PortalAbout10420 LIVE OAK AVE_Mechanical__ 76A364E ICe-616A)-9/77 APPLICATION FOR PERMIT
HEATING ENTILATING - AIR CpNDITIONING
COU F LOS ANGELES
DEPARTM T OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN BUILDING / �—
(PRINT ORTYPE ONLY)
ADDRESS
LOCALITY –c u4-
NO TYPE OF APPLIANCE OR EQUIPMENT FEE
NEAREST
CROSS ST 4 O
ABSORPTION UNIT,BTU'
OWNER y`
AIR HANDLING UNIT,CFM MAIL
ADDRESSlot/?-a 1 ,/C- /
BOILER.BTU CITY' TEL NO
G L l..JJ
COMPRESSOR,BTU CONTRACTOR u mjrmoi– r
VENTILATION SYSTEM P ADDRESS Z� kv..L !–NAS Fc ,
EVAPORATIVE COOLER CITY TEL NO y,Vr= /�
FURNACE FAU GRAVITY STATE LIC
FLOOR BTU LICENSENO„ ��dQ�z CLASS ir-5
HEATER SUSPENDED UNIT— DISTRICT NO GROUP ZONE RO SED BY
WALL
POO, ! oev uw .Jh r
INSJACTION RECORD
QC `
O
Plan check fee 25% of above.
PERMIT ISSUING FEE$
TOTAL FEE 2 7
PLAN CHECK APPLICANT
NAME
ADDRESS' ,
CITY _ TEL NO -
I HEREBY 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 1 PECTOR'S SIGNATURE
CHAPTER,9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL CODE '
OF THE STATE OF CA RNIA ,may ROUGH `
SIGNATURE FINAL -
OF PERMITTE
PLAN CHECK�VALIDATION CK n,o CASH
PERMIT VALIDATION cK Mo1�1 CASH
VY
OR 'ERS C0mp=KTQ TION
ti , 43 JUL 541 U 27.00At;s
POLICY HOLDER: Cid — " - -
POLICY NUMBER: ,C
WORKERS'COMPENSATION DECLAAATIC-0 CEA 818(2f.__ --80) APP LSA C LST LON FOR P E R M M
I hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers'Compensation Insurance;o'r W��+YIil1Cv-!lEI�YILe�YIWG;-A1�3 CONDITIONING
"fl
a,P_f,f,o,+ b,.w eof(Sec.'?^n0,L-ti r 1
23'107900779 Ca. Cas'ua 1 ty Ndemn i ty• .� �,
Certified copy is hereby furnished.
Policy Company 'COUNTY OF LOS ANGELES' BUILDING AND SAFETY
•
Certified copy is filed with the county building mspecfion FOR APPLICANT'TO FILL IN BUILDING
department
Date Applicant—E.—L. PAYNE CO `(PRINT OR TYPE ONLY)^• ADDRESS 1_0420=L-I ve-Oak_Av_enue;/�Jj�J
LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF AP•PLIANCE.OR EQUIPMENT_ __ FEE.-,, (/
COMPENSATION INSURANCE NEAREST
CROSS ST d
(This section-need not be completed if_the work' involved ABSORPTION UNIT-, BTU-- '-•-��'!� O
by the permit is for one hundred dollars ($100) or less.) DISTRICT NO PROCESSED.BY - U
I certify that in the performance of the work for which ihis AIR HANDLING UNIT,CFM• _ cc
permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers' Compensation Laws BOILER-,-BTU _
E• L. PAYNE`CO s APPROVALS ' DATE INSPECTOR'S SIGNATURE
LU
Dated Applicant 1 COMP.RESSOR,BTU -0.0 _ ROUGH N
20
NOTICE TO APPLICANT. If, after making this Cefrtificate of VENTILATION SYSTEM Ab p . -r Z
Exemption, you should become subject to the 'Workers' FINAL
Compensation provisions of the Labor Code, you must forth- EVAPORATIVE COOLER VALIDATION a
with comply with such provisions or this permit shall be-
deemed revoked. FURNACE , -FAUX GRAVITY
LICENSED CONTRACTORS DECLARATION 1 FLOOR, BTU
I hereby affirm that I am licensed under provisions of Chapter HEATER.' ,SUSPENDED UNIT ...
9 (commencing witli Section 7000)of Division 3 of the Busi- =WALL' -
ness abd Professions Code, and my license is in full-force and
effect.
License Number 120228 Lic Class C-20 "
Contractor E. L, . PAYNE Date—' --
F am exempt from the licensing requirements as I am a
licensed architect or a re istered rofessional�en ineer
g P g Plan check fee 25%of above.
acting-in my professional capacity (Section 7051;"•Bus-
mess and Professions Code). PERMIT ISSUING-FEE:SL
Lic.,or Reg No. Date _ TOTAL FEE
HOME OWNER-BUILDER DECLARATION- PLAN CHECK APPLICANT '
I hereby- affirm that I am exempt from- the Contractor's NAME -
License Law for the following reason (Section•7031 5, Busi-
ness and Professions Code) ADDRESS
I, as owner of the property, will do the'work'and the CITY TEL NO t 4 0 9,9 A
structure is not intended or offered for sale (Section' _ _
7044, Business and Professions Code). _ # 0 -004 1
OWNER _Mr, and Mrs, E. Losc-ialpo
I,_as owner-of the property, am exclusively contracting `
with licensed contractors to construct , the project MAIL - 2 °,2 7,0 0
(Section 7044, Business and Professions Code) ADDRESS _17042' L i ve_Oak_Avenue -
27,0 015
CONSTRUCTION LENDING AGENCY CITY ' Arcadia TEL. NO 7 :
I hereby affirm that there is a construction lending agencyT -�i Os-0 2'1 8'-8 1
for the performance of the work for which this permit is I CONTRACTOR, E; L. PAYNE COMPA Y - "
issued (Sec. 3097,Civ.C) r
Lender's Name ADDRESS' `
1-6.6_W_._L_i ve=r Qa k-Av� i�l e61.1.8 .
Lender's Address CITY TEL.NO.
' Arcadia, 793: 1 131
I certify that I have read this application and state that the STATEo LIC,
above information is-correct.I agree to comply with all County LICENSE NO 120228_ CLASS C-2O
ordinances and State laws regulating Heating, Ventilating and- .n,•1, t . -- , " . - '
Air Conditioning, and hereby a horize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE -
County
ANGUAGE -
Coere
nter upon thr above-mentioned property for
ras �oses
_ell d9 2-4-81 - -
iermitt Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0711140009
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
(LEGAL ID FEES PAID BUILDING ADDRESS 1
ON FILE I 1 10420 LIVE OAK AV E I
I IFEE DESCRIPTION _ QUANTITY UOM AMOUNT.( ARCD CA 910078462 I
(ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET I
18586-013-035 101 PERMIT ISSUANCE FEE 27 75 I THOMAS PAGE 597 GRID D3 LOCALITY- TEMPLE CITY, Cl
1 102 COMPRSR < 100 KBTU 1 00 COM 27 00 I 1
ITENANT - 108 FURNACE/HEATER <100 1 00 UNI 27 00 (ISSUED ON PROCESSED BY PLAN BY- EXPIRES ON 1
1 TOTAL FEES 81 75 111/14/07 SR 05/12/08 1
I I I I
(OWNER TEL NO 1 IFINAL DATE FIN BY CODE
IDU, VAN (626) 378-2140- I
1714 PLYMOUTH ROAD I 1
ISAN MARINO, CA 91108 1 IDE CRIPTION OF WORK 1
I I ICHANGE OUT AIR CONDITIONING AND HEATING SYSTEM
1
(APPLICANT TEL NO 1 I
ISAME AS OWNER - I I I
I I ISPECIAL CONDITIONS _ 1
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ICONTRACTOR TEL NO I 1APPROVALS DATE INSPECTOR SIGNATURE 1
ISAME AS OWNER - I I I
LIC. NOi FAU/WALL FURNACE �.}�
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I I ICOMBUSTION AIR OPENINGSX1I I I
(ARCHITECT OR ENGINEER: TEL NO IDUCT WORK I I I
LIC NO 1 IAC/COMPRESSOR I /
1�
I ITHERMOSTAT I '
I I I I I I
I - IFIRE DAMPERS I 1
1 ISMOKE DETECTION DEVICES I
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I I (COMMERCIAL HOOD I I I
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