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76A364-CEBI8-1/70 APPLICATION FOR PERMIT
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HEATING - VENTILATING - AIR CONDITIONING ,
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS /lP
Awe. ona4o
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPERINTENDENT OF BUILDING NEAREST
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FOR APPLICANT TO FILL IN OWNE
(PRINT OR TYPE ONLY)
MAIL
NO. TYPEOFAPPLIANCE•OR EQUIPMENT FEE ADDRE (pJ(O i
CITY. TEL. NO����� J
ABSORPTION SYSTEM, BTU "
CONTRACT R
AIR HANDLING UNIT, CFM
ADDRES
BOILER, HORSEPOWER CITY' ` /O' TEL. NO.
COMPRESSOR, HORSEPOWER DLIC
ICE SE N p2(QG ✓ CASS O
VENTILATION SYSTEM DISTRICT NO. CLASS I GROUP I ZONE I PROCESSED BY
EVAPORATIVE COOLER 1 C
,( FURNACE: FAU72 RAVITY INSPECTION RECORD
J FLOOR BTU V:.
HEATER: SUSPENDED-UNIT-
WALL
USPENDED UNIT_WALL
e
C
C
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NEW—ADDITION— PERMIT $ 3 00
ALTER REPAIR— TOTAL FEE $
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A3ERMIT.VALIDAT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE
WITH ALL ORDINANCES AND LAWS REGULATING HEATAPPROVALS DATE INSPECTOR'S SIGNATURE
LAYING,AIR CONDITIONING.
UGH
I HEREBY CE THAT 1 AM NOT ACT INOF CHAPTER 9, DIVISIO 3, OF TXE BUSI ESS N PRNAL ' �CODE OF THE STATE 0 CALIFORNIA.SIGNATURE JACK R. ALLEN SUP VISING MECHANICAL ENG'R.
OF PERMITTE VALIDAS RK. M.O. CASH
PLAN CHECK VALIDATION Q,
SEE BACK OF APPLICATION FOR COMPLETE FEE SCHEDULE
WORKERS'COMPENSATION DECLARATION 76A364C
I hereby affirm that 1 have if certificate of consent to self CE-818 (2-80) APPLICATION FOR PERMIT
insure, or a certificate of Workers'Compensation Insurance,or HEATING-VENTILATING-AIR CONDITIONING
a certified cop thgreo (Sec. 3800,Lab.C
Policy No.;// Company' /r s r
❑ Certified cods hereby furnished. ' COUNTY OF LOS ANGELES BUILDING AND SAFETY
LJr
Certified f:opy is filed with the count>•building ins p tion t BUILDING
d par` tmen�'I f; �b FOR APPLICANT TO FILL IN ADDRESS
Date y Applicant ' (PRINT OR TYPE ONLY)NO, TYPE OF APPLIANCE OR EQUIPMENT FEE LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE NEAREST a
(This section need not be completed if the Work involved ABSORPTION UNIT, BTU CROSS ST. C
by the permit is for one hundred dollars ($100) or less.) DISTRICT NO PROCESSED BY U
AIR HANDLING UNIT,CFM f. UJ
1 certify that in the performance of the work for which this � ,J •' •� .,�
Permit is issued, I shall not employ any person in any manner `
so as to become subject to the Workers'Compensation Laws. BOILER, BTU LL
O APPROVALS DATE INSPECTOR'S SIGNATURE }
Date Applicant COMPRESSOR, BTU ^t 1 cc
ROUGH Q
NOTICE TOI`APPLICANT: If, after making this Certificate of VENTILATION SYSTEM
Exemption, you should become subject to the Workers' FINAL d
EVAPORATIVE COOLER
Compensation provisions of the Labor Code, you must forth-
with comply with such provisions or this permit shall be VALIDATION w
deemed revoked. /
FURNACE: FAUft,4V.
LICENSED CONTRACTORS DECLARATION
FLOORBTU ITY,�_ / I—
I hereby affirm that I am licensed under provisions of Chapter HEATER: SUSPENDED UNIT
9 (commencing with Section 7000) of Division 3 of the Busi- WALL
ness and Professions Code, and my licepsg is in full fPrce and
effect. f ) J) .
f.i
License Number ���'� Lic.Class '' � �'�
Contractor ' ,;.':� ' IAC Date
❑ I am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer Plan check fee 25% of above.
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code).
Lie.or Reg.No. Date TOTAL FEE
HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
ereby affirm that I am exempt from the Contractor's NAME
se Law for the following reason (Section 7031.5, Busi-
nd Professions Code): ADDRESS
as owner of the property, will do the work and the
structure is not intended or offered for sale (Section CITY TEL. NO.
044, Business and Professions Code).
OWNER ✓�`,!, Il �j f 1 !i: t-
as owner of the property, am exclusively contracting
ith licensed contractors to construct the project MAIL [ (j �` • •
Section 7044, Business and Professions Code). ADDRESS
CONSTRUCTION LENDING AGENCY CITY TEL.NO. :
y affirm that there is a construction lending agency
performance of the work for which this permit is CONTRACTOR
'Sec. 3097,Civ.C.).
's Name ADDRESS
's Address ?
CITY ,' t'; TEL. NO. -
fy that I have read this application and state that the STATE J LIC. "
information is correct.I agree to comply with all County i LICENSE NO. /-' CLASS yrs/
•nces and State laws regulating Heating, Ventilating and
mditioning, and hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
to enter upon the above-mentioned property for
-ion purpos
re of Permittee mate
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1006150004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID I BUILDING ADDRESS: I
TR: 6561 LT: 526 BL: .001 1 9664 LAS TUNAS DR 1
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:] TEMP CA 917802139 I
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: KAUFFMAN
8587-021-015 IOW P.C. FEE $109.35 MIN 0.00 109.40 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl
101 PERMIT ISSUANCE FEE 27.75 I 1
TENANT: 143 COMM KITCHEN HOOD 1.00 HOO 65.40 (ISSUED ON: PROCESSED BY: PLAN BY:
GOLDEN DELI EXPRESS 170 PC INDIV COMM HOOD 1.00 HOO 252.90 06/15/10 SR
I I TOTAL FEES 455.45 1 I
]OWNER: TEL. NO: 1 [FINAL DATE FI Y: CODE:
]DO, TRIEM (626) 308-0803- I 1 I
1439 N. DELMAR AVE. I I I
ISGAB 917781393 I IDESCR PTION OF WORK
I I (TENANT IMPROVEMENT COMMERCIAL KITCHEN EXHAUST HOOD
(APPLICANT: TEL. NO: I I I
[DEL ROSARIO, ARCHE (626) 288-6898- I I I
1573 MONTEREY PASS RD I ISPECIAL CONDITIONS:
(MONTEREY PARK 91754
I I
(CONTRACTOR: TEL. N0: I (APPROVALS DATE INSPECTOR SIGNATURE
1EVERSTRONG CONSTRUCTION INC. (626) 448-7878- 1 I
11839 DURFEE AVENUE LIC. NO I IFAU/WALL FURNACE I I ]
IS. EL MONTE, CA 91733 721681 B I I I I
I 1 (COMBUSTION AIR OPENINGS I I I
ARCHITECT OR ENGINEER: TEL. NO: 1 IDUCT WORK I I I
GARY WANG AND ASSOCIATES (626) 288-6898- I 1 I I I
1573 MONTEREY PASS ROAD UNIT C LIC. NO: 1 IAC/COMPRESSOR
(MONTEREY PARK, CA 91754 NONE I I I 1
THERMOSTAT
IF RE DAMPERS I I I
(SMOKE DETECTION DEVICES
I iCOMMERCIAL HOOD 1-NI I
I I I U0 I a1 W I
I I I I I I
I I I ] I I
:(REPORT ID: DPR264 ROUTE TO: BS0508 1 I I I
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