HomeMy Public PortalAbout6463 LOMA AVE_Mechanical__ rt
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ME 0508 9811090005
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (818) 285-0488 EXT:
LEGAL ID• FEES PAID BUILDING ADDRESS:
TR: 12504 LT: 34 6463 LOMA AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801332
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
5382-018-021 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H1 LOCALITY: TEMPLE CITY
02 COMPRSR < 100 KBTU 1.00 COM 27.00
TENANT: 08 FURNACE/HEATER <100 1.00 UNI- 27.00 'ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 81.75 11/09/98 UT 11/09/99
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
HARD FRANCES C (626) 287-3033-
6463 LOMA AVyl l
TEMP 917801332 DESCRIPTION OF WORK
CHANGE OUT OF FURNACE AND AIR CONDITIONING
APPLICANT: TEL. NO:
E L PAYNE HEATING COMPANY (818) 988-8110-
SPECIAL CONDITIONS:
UKLES
CONTRACTOR:HEATING COMPANY TEL. N988-8110 APPROVALS DATE INSPECTOR SIGNATURE
23725 ROSCOE BLVD. LIC. NO FAU/WALL FURNACE
WEST HILLS, CA 91304 120228 C20
COMUSTION AIR OPENINGS
ARCHITECT OR ENGINEER: TEL. NO: DUCT WORK
LIC. NO: AC/COMPRESSOR
� THERMOSTAT
F
U
FLOSn ILI`� WN(0rI�0FIRE DAMPERS
.� li�l IU�I' L � SMOI:E DETECTION DEVICES
la 0COMMERCIAL HOOD
E N a, —
�I �r
�®d
REPORT 1D: DPR264 ROUTE TO: BS0508
s= ty .d WORKERS'COMPEC�a cer* DECLARATION APPLICATION FOR PERMIT
I hereby affirm thcr''I have a certificate of consent to self
insure, or a certificate of Workers' Compensation Insurance, -'-HEATING-- VENTILATING - AIR CONDITIONING
r a rtifi d co thereof Se 3@0 ,1 b 76A364C ,
WC +.- 03� �McER1G�AhP":HCO�IE ASSURANCECE-818(REV. 10/81) #40.302
Policy No. Company
Certified copy is hereby furnished.. COUNTY OF LOS ANGELESBUILDING AND SAFETY
. Certified'copy is filed with the county,builciing'inspec-, FOR APPLICANT TO FILL IN BUILDING L
tion department. ADDRESS 6463 N. Loma Avenue
E o- L. 1 PAYNE CO
Date 12-.12-84 _Applicant (PRINT OR TYPE ON LOCALITY 'Temple City
LY)
li
NO TYPE OF APPLIANCE OR EQUIPMENT, FEE
CERTIFICATE`OF EXEMPTION FROM WORKERS' ,: NEAREST
COMPENSATION INSURANCE CROSS ST. Las Tunas )
ABSORPTION UNIT, BTU oisiRici No. PRocesseb sv
(This section-need not be completed if the work involved by - .
the permit is for one hundred dollars'(5100)or less:) ;-
BTU
I certify that in the performance-of the work for which this ..^;_
, AIR HANDLING UNIT, CFM
` perm_it.is'issued, I shall not employ any person in any manner
so as•td become subject,to the Workers'COm pe,llSa110n Laws. BOILER, APPROVALS DATE •IN ECTOR'S SIGNATURE
Date Applicant 1 COMPRESSOR, BTU 1 0. 00 ROUGH i
NOTICE TO APPLICANT: If,.after making this•Certificate of VENTILATION SYSTEM FINAL
Exemption, you should become subject 'to the Workers=
Compensation provisions of the tabor Code, you'must forth- EVAPORATIVE COOLER VALIDA ION
with, comply with such provisions or this:permit shall be
deemed revoked. FURNACE:, F"AU X • G�4 ITY
LICENSED CONTRACTORS DECLARATION -- 1 FLOOR BTU `1 ,OOH. -1 O 00
I hereby affirm that I am licensed under provisions of Chapter 9 SUSPENDED UNIT # v
HEATER:. WALL with Section 7000) of Division 3.of the Business
and Professions Code,a'nd,my license is in full force and effect. ! 'o o 3 0,5.0
License Number 120228 Lic. Class-- C'-20 - ® U
E.' L. •PAYNE l2-12-84 0,0. ®.
Contractor Date' H
❑ 1 am exempt under Sec. _ 02 85 LU
Plan check fee
1, .-
B:B11.P.C. for;this reason'•
Date:':
' •. PERMIT ISSUING,FEE $ 10 0 _
TOTAL FEE. 3:0 _50
Signature
OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT"
_ 1-hereby affirm that I am exempt from the Contractor's License
Law for the following reason-(Section 7031.5;"Business and. NAME
Professions Code):
❑ I, as'owner of the-property, or my employees with ADDRESS
wages as their sole.compensation,will do the work and
the structure is not intended or offered for sale(Section CITY TEL. NO.
7044,,Business and Professions Code).
OWNER
❑ I, as owner'of the property, am exclusively contracting MS. Frances Hard
with licensed contractors to constructthe project (Sec- MAIL -
tion 7044, Business and Professions Code). ADDRESS ma Avenue
CONSTRUCTiON'LENDING AGENCY - CITYTEL. NO.
hereby affirm that there is a construction lending agency for Tem6, e 287-3033
the performance of the work for which this permit is issued CONTRACTOR P NEr COMPANY
(Sec: 3097, Civ. C.).
ADDRESS
Lender's Name 14823 Cal i fa Street
CITY TEL. NO. .793-.1,131 .
lender's Address-
STATE I'YS LIC. C-20 .
I certify that I have read this application and state that the LICENSE NO. -•1' O .CLASS
above information is correct. I agree to comply with all County'"
ordinan es and State laws relating to building,construction, ;
nd e author/ presentatives of this County to enter -
a v entioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY.LANGUAGE .
12-12-84
ignat e of App cant or Agent Dote