HomeMy Public PortalAbout5304 LOMA AVE_Mechanical__ 76 A364- CE 818- 5-73
APPLICATION FOR PER IT
HEATING - VENTILATING - AIR CONDITIONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY) '
MAIL �-3
NO. TYPE OFAPPLIANCEOR EQUIPMENT FEE ADDR S
CITY TEL. NO. 6s-3
ABSORPTION UNIT, BTU yr
CONTRACTOR
AIR HANDLING UNIT, CFM
ADDRESS
BOILER, BTU CITY ill V TEL. NO.
COMPRESSOR, BTU STATE LIC.
LICENSE NO. CLASS
VENTILATION SYSTEM DISTRICT NO. GROUP ZONE CESS ED BY
EVAPORATIVE COOLER 9 j
FURNACE: FAU GRAVITY INSPECTION RECORD
FLOOR—B-TU
HEATER: SUSPENDED UNIT_ Od
WALL
n..
O
' U
O
V
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Plan check fee 25% of above. See reverse. _
Z
PEWMIT ISSUING FEE $ s 00
.TOFAL FEE (j
PLAN CHE . 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, VENTI- APPROVALS DATE INSPECTOR'S SIGNATURE
LATING, AIR CONDITIONING r '
ROUGH - oJ�f ��� 7/ M.
� �
Ibi
1 HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9, DIVISION 3, OF THE BUSINESS AND PROFESSIONAL r
CODE OF THE STATE OF CALIFORNIA,' FINAL SIGNATURE PERMIT VALIDATION cK. o. cnsH
Of
OF PERMITTEE -
9 ..
PLAN CHECK VALIDATION CK. M.O. CASH
0 01 4'c'!MAY 15 4'1 D '8.0 0 ®�8
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORKERS'COMPENSATION DECLARATION 76A364C- p �p r� �/�
CE-818 (2-80) APPUCi"iT�®A�1 "�®IhS •�EIfYYV T
l •hprreby',affir-. that I "have-a certificate of.consent
iture,-sure, of Workers'Compensation Insurance,or H��.TIFVG�NEYdTIL�TI,WG-�+IEa G��D1.rIC1ibIWw
a certified copy thereo_ f(Sec. 3800,I ali.,C.) - �
720 80=$ State -Fund
Policy No. o�i any _CQUNTY-OF LOS ANGELES BUILDING ARID SAFETY:
E]'Certified copy is hereby furnished. _
2 Certified copy is filed with the county building inspectionF G .
depa e`n+�, FOR''I�RP'LI•CANTTOFILL`.IN, BUILDING ' 5304 N. Loma, _
Data �5 _ (PRINT OR TYPE ONLY) ADDRESS
Applicant-� .
�� LOCALITY Telllple �ilty .
iCERTIFICATE OF EXEMPTION FROMlVOA. Ei.S' NO TYPE OF APPLIANCE OR EQUIPMENT'a'• FEE",—
t:
• �• 'COMPENSATION INSURANCE � � � � 'NEA`REST __ - � - - •' �,
•
:(Thi" Section, need not be completed.lf the .work involved 'ABSORPTION UNIT,=BTU' GROSS-ST,., - -- - -
O-
'by,,the permit is for_.one•hundred dollars ($100) or less:)'' oisTRicT ivo. aRocEss o ev.. ,,. , U .
• I`certify that in theperformance of•the,�aork',for which this AIR HANDLING UNIT,CFM •o �
permitis issued, I shall not i mploy any perS6i in•any manner i ,
` so as;fo become subject to the Workers' Oompensation Laws..', BOILER, BTU
_ - —
APPROVALS—. DATE i SP R'S SIGNAT IRE" IU `
Date Applicant • 1. 4-p' ROUGH
COMPRESSOR, BTU '"
NOTICE TO:APP•LICANT; If, after making this Certificate of`: VENT-LATION SYSTEM Z
Exemption, you.zShoul'd• become subject'to the.Workers' , ., FINAL
Compensation,`provisions"of the Labor Code, you must forth'- EVAPORATfVE,COOLER VALIDATION
with comply, With` such provisions or this permit shall be ,
deemed revoked.
i FURNACE: FA �R�W��—
LICENSED'CONT_RACTORS DECLARATION 1 , FLOOR: BTU Cell lL
I•hereby affirm that I.ant licensed under provisiQris of Chapter., HEATER:. SUSPENDED UNIT "
9 (commencing with Section'7000) of Division 3 of•the Busi-" ;: -' WALL ;
.ness and Professions Cod6;and my"license is in full force,and
effect. '111 Inlets &o .outlets,
License Number—`-4-7-52,
umber 7 2`2.6 Lie.Clasi_ppC_-2p0
Contractor "E'1V. EY1�.7ate 10, 8-8.7 �..
a - R'8-2-9. p
I-am exempt from the licensing requirements as Ilam a
_ - licensed architect or a registered professional engineer FlanCheck fee 25%of above.: `' - - #;o, e o 8
'-acting in my professional•capacity (Seetion'7053,'Bus- ��'
iness and Professions Gbde). r t PERMIT ISSUINGTEE$ a -,o 7,0
Lie.or Reg.Nb. i Dates TOTAL FEE :a' o o 49.7 Q v
'HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT; !4 :1."O'5; 8. a
I ,hereby affirm, thaf' I'.am."exempt from the -Ciidtraetor's NAME
License Law for.the following reason'(Section 7031.5, Busi- .
ness and Professions Code): , ADDRESS aei,
`0 i; as owner of-the property, will do the work and`the - -
structure is .not intended of offered for sale-(Section CITY TEL=NO.•
7044, Business and Professions Code). "
OWNER-,, Joseph Bayer '2°829"2A ,
I, as owner of the property, am exclusively contracting * ,.,
with. licensed contractors to-construct the piaject $ -MAIL } #`• o o`o,m 8
(Section 7044, Business and Professions Code): ADDRESS same
CONSTRUCTION LENDING AGENCY CITY 'TEL:N0286- 48' :� ;e-<o (�Q ]5 ,
I hereby affirm That there is a construction lending agency }'
for the performance of the work'for which this` permit is CONTRACTORv1rOnlllerl ''il �S�TM!8'7
issued (Sec 3097,Civ.C;). 6 1 N.
Lender's Name ADDRESS . P� lar
Lender's"Address CITY �rg�� a.TEL. NO
6—
' - -8281
I certify that I'have read this application and state that the STATE J"J,'aae LIC.
above information is correct.I agree to comply with all County LICENSE NO. H 226 CLASS —G
ordinances and State laws regulating Heating,Ventilating and
Air Conditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
County to enter upon the above-mentioned properly for
inspe tion u ores.
Signa re o eermit ee Date '
' COUNTY-OF LOS ANGELES 0 . t TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0901070019
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
' PHONE: (626) 285-0488 EXT:
ILEGAL ID: IFEES PAID I BUILDING ADDRESS: 1
ON FILE 1 - 1 5304 LOMA AV I
IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: [ TEMP CA 917803001 I
(ASSESSOR INFORMATION NUMBER: I - I NEAREST CROSS STREET: 1
15388-008-024 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE-, 596 GRID: H4 LOCALITY: TEMPLE CITY, Cl
I 141 VENTILATION FAN 1-.00 FAN • 15.75 1 -
(TENANT: I TOTAL FEES 43.;50 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1
- 101/07/09 SR- 07/06/09 -
(OWNER: TEL. NO: 1 - IFINALFIN Y: CODE: 1
(BAYER, MARILYN (626) 286-5348- 1 � H� 4/yA/�I�(�yJ�
15304 LOMA AV - I - - /A DAT
ITEMP 917803001 1 _ ID SCRIPTS OF WORK
VENTILATION FAN FOR NEW BATHROOM -
(APPLICANT: TEL. NO:
[HOME CARE & DESIGN (888) 580-5557- 1 -
10680 W. PICO BLVD. (SPECIAL CONDITIONS:
ILOS ANGELES CA 90064 -
1 I I
ICONTRACTOR: TEL. NO: I [APPROVALS - DATE INSPECTOR SIGNATURE 1
IHOME CARE AND DESIGN (888) 580-5557- .
110680 W PICO BLVD LIC. NO IFAU/WALL FURNACE 1
ILOS ANGELES/CA/90064 820230 -
- ICOMBUSTION AIR OPENINGS 1
ARCHITECT OR ENGINEER TEL. NO: IDUCT WORK
LIC. NO: IAC/COMPRESSOR
ITHERMOSTAT
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- IFIRE DAMPERS I
- (SMOKE DETECTION DEVICES I 1 I
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1 i (COMMERCIAL HOOD I I I
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REPORT ID: DPR264 ROUTE T0: BS0508
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