HomeMy Public PortalAbout6218 LOMA AVE_Mechanical__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF,PUBLIC WORKS 9701 LAS TUNAS ME 0508 0709210006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 5904 LT: 268 6218 LOMA AV
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917801634
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LONGDEN
15384-011-001 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, C1
1 102 COMPRSR < 100 KBTU 2.00 COM 54.00
TENANT: 108 FURNACE/HEATER <100 2.00 UNI 54.00 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
120 FIREPLACE < 100 KBTU 1.00 APL 27.00 109/21/07 SR 03/19/08
I 130 AIR INLETS/OUTLETS 15.00 UNI 65.25 1 1
OWNER: TEL. N0: 141 VENTILATION FAN 3.00 FAN 47.25 JFL DATE.1 FIB
fr/� Y: CODE:
CHIN GENNA (626) 580-6238- TOTAL FEES 275.25
16218 LOMA AV
ITEMP 917801634 IDESCRIPTION OF WORK ki
I INSTALL AIR CONDITIONING AND HEATING SYSTEM
APPLICANT: TEL. NO:
CHIN (626) 580-6238-
16218 LOMA AVE. ISPECIAL CONDITIONS:
TEMPLE CITY CA 91780
CONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE
1AIR CARE MECHANICAL CO. (626) 442-6792- 1 1
18143 CELITO DR LIC. NOIFAU/WALL FURNACE I
IROSEMEAD CA 91770 516562 C20. *I I I I
COMBUSTION AIR OPENINGS
(ARCHITECT OR ENGINEER: TEL. NO: IDUCT WORK I I I
ILUK, SAMUEL (626) 858-0438- I I
1527 N AZUSA LIC. NO: IAC/COMPRESSOR -
1#309 NONE I I 1
COVINA, CA 91722 _ 1 ITHERMOSTAT I
1
IFIRE DAMPERS 1 1
-I I ISMOKE DETECTION DEVICES 1
ICOMMERCIAL HOOD
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I* ADDITIONAL DATA ON FILE 1 I I 1
IREPORT ID: DPR264 ROUTE TO: BS0508 1 I 1
I I I I I I
WORKER'S COMPENSATION DECLARATION 46DPW 9,69 APPLICATION FOR PERMIT LIME GREEN
76A3
I herel3y affirm'Mat I have a certificate of consent to self insure, 76A364C
or a cz�tificate of Worker's Compensation Insurance, or a certified HEATING -VENTILATING-AIR CONDITIONING
copy thereof(Sec. 3800 Lab.C.)
Policy No. Company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS BUILDING AND SAFETY DIV.
❑ . .Certified copy is hereby furnished.
❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN BUILDING
ADDRESS ��O G oyg
department. (PRINT OR TYPE ONLY)
Date ApplicantLOCALITY e -
NO. TYPE OF APPLIANCE OR EQUIPMENT FEE
CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST
CROSS ST.
COMPENSATION INSURANCE
ABSORPTION UNIT,BTU ASSESSOR
(This section need not be completed if the work involved by the MAP BOOK PAGE PARCEL
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 p
become subject to the Workers'Compensation Laws.
COMPRESSOR,BTU
' - APPROVALS DATE INSPECTOR'S SIGNATURE
Date Applicant VENTILATION SYSTEM
NOTICE TO APPLICANT: If, after making this Certificate of ROUGH
Exemption,you should become subject to the Workers'Compensation EVAPORATIVE COOLER
provisions of the Labor Code, you must forthwith comply with such FINAL161-021,"3,-
provisions or this permit shall be deemed revoked. FURNACE: FAU GRjVyFjY /�
LICENSED CONTRACTORS DECLARATION FLOOR BTU *tf�� a OD VALIDATION
I hereby affirm that I am licensed under provisions of Chapter 9 HEATER: SUSPENDED UNIT
(commencing with Section 7000) of Division 3 of the Business and WALL
Professions Code;and my license is in full force and effect.
�► DO
License Number Lic.Class S O O
a
Contractor Daten 0
ElI am exempt under Sec. Plan Check fee O`
Q
BAP.C.for this reason PERMIT ISSUING FEE $ / 0
H
Date: TOTAL FEE /�' D p LLJ
d
Signature
PLAN CHECK APPLICANT (n
OWNER-BUILDER DECLARATION Z
I hereby affirm that I am exempt from the Contractor's License Law NAME At& ' -
for the following reason (Section 7031.5, Business and Professions =
Code):
❑ ADDRESS
I, as owner of the property, or my employees with wages
as their sole compensation, will do the work and the CITY TEL.NO. `j f ip 5,D3,
structure is not intended or offered for sale (Section 7044, L-
TTS
Business and Professions Code). OWNER j. I I i=
❑ I, as owner of the property, am exclusively contracting 4%6��MAIL l(j I-i
with licensed contractors to construct the project (Sec- ADDRESS 1(1 Z_,PA 1- _
TAL 45= 00
tion 7044, Business and Professions Code). K 45. 0i{
CITY m,/ G�i TEL.NO. a� .i�3 `s� F {
CONSTRUCTION LENDING AGENCY 4 / f),N
I hereby affirm that there is a construction lending agency for , - t� •Ilt-`'
the performance of the work for which this permit Is issued CONTRACTOR
(Sec.3097,Civ.C.).
ADDRESS It!I'{i f- li IL{
Lender's Name - —'
CITY TEL.NO. O i �All 1-A:L-?
Lender's Address STATE LIC.
I certify that I 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
representati s of this County to enter upon the above-mentioned
propert Inspection purpos SEE REVERSE FOR EXPLANATORY LANGUAGE
SI URE OF APPLICANT OR DATE