HomeMy Public PortalAbout9516 LEMON AVE_Mechanical__ �� f�f�p e� f�,p FOR
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V-:)RKLiia•CON`PLNSiITION DS CLARATION CEA 818 (2-80) A I� Il— L� C/� T�O �1 Ir O R P E USS�vlf� U
1,4lereby farm that I have a certificate of consent to self
.,imre, cr,!certificate of Workers'Compensation Insurance,or HEATING-VfENTIL.ATING-AlR CONDITIONING
a certified copy thereof(Sec. 3800,Lab C.)
Policy No.—Company COUNTY OF LOS ANGELES BUILDING AND SAFETY
E] Certified copy is hereby furnished.
Certified copy is filed with the county building inspection BUILDING
department FOR APPLICANT TO FILL IN ADDRESS 5 '6171 e AJ
Date a
Applicnt (PRINT OR TYPE ONLY)
• LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NO. TYPE OF APPLIANCE OR EQUIPMENT FEE /
COMPENSATION-INSURANCE NEAREST `
(This Section need not be completed if the work involved ABSORPTION UNIT, BTU CROSS ST ; a / ` / a
oy the permit is for one hundred dollars ($1.00) or less.) DISTRICT NO PROCESSED BY OU
I cerfify that in the performance of tpe work for which this AIR HANDLING UNIT,CFM �
permit Is issued, 1 shall not employ any pers(,^,in any manner ✓ ' V 0
so as to become ;ub;ect to thir Work .s C. pensation Laws BOILER, BTU
`1Q APPROVALS DATE INSPEC OF SIGNATURE V
Date-I 1. 1pphcant � COMPRESSOR, BTU / °i� /v V" ROUGH rj�� - _ a
NOTICE TO APPLICANT. If, �/teC making this-Certificate of VENTILATION SYSTEM / In
Exemption, you should become subject to the Workers' FINAL Z
Compensation provisions of the Labor Code, you,must forth- EVAPORATIVE COOLER VA LIDATION
with comply with such provisions or this permit shall be
deemed revolted. FURNACE- FAU GRAVITY ,l
LICENSED CONTRACTORS DECLARATION r FLOOR BTU_ L(;LL✓1 IU QU
I hereby affirm that I am licensed under provisions of Chapter HEATER SUSPENDED UNIT
9 (commeris ing with Section '1000)of Division 3 of the Busi- WALL
ness and Professions Code,and my license is in full force and
effect- �J r 1�3—
License Number__I �Lic Class_
Contractoi�r�!` �C ''Date �/�
ElI am exempt from the licensing requirements as I am a .3"Q 5 Q c=i
licensed architect or a registered professional engineer Plan check fee 25%of above. ` �� 2 4=8 4
acting in my professional capacity (Section 7051, Bus-
mess and Professions Code) PERMIT ISSUING FEE$ l() �Q
Lic.or Reg.No_ Date TOTAL FEE—,3
EE 3—0.
HOME OWNER-BUILDER DECLARATION PLAN CHECK APPLICANT
I hereby aftitm that I am exempt from- the Contractor's NAME �f-�y -A 2 CCpq -5 7-.,e—u C 7>4i?IV t
License Law for the feliowing ieason (Section 7031 5, Busi-
ness and Professions Code): ADDRESS C A6 101Q//V) /2.-0 S k�_
El 1, as owner of the pros erty, will do the work(Section
the rr TEL NO
structure is not intended or offered for sale Section CITY (_
7044, Business and Professions Code).
1, as owner of the property, am exclusively contracting OWNER �2 �AJ S•L► 0-. '
with licensed contractors to-construct the project MAIL
(Section 7044,Business and Professions Code). ADDRESS
CONSTRUCTION LENDING AGENCY CITY ,L. TEL.NQ2$r-
I hereby affirm that there is a construction lending agency CONTRACTOR S
_ 92 (200)
for the performance of the work for which this permit is `J/�L/ C_
issued(Sec 3097,Civ.C)
Lender's Name ADDRESS
Lender's Address CITY TEL. NO.
1 certify that I have read this application and state that the STATE LIC. %
above information is correct.I agree to comply with all County LICENSE NO �G f CC SS �J
ordinance and State laws regulating Heating, Ventilating and
Air Conditioning, .i d hereby authorize representatives of this SEE REVERSE FOR EXPLANATORY LANGUAGE
Cq;FF
to/q. upon the above-mentioned property for
in .Se b .'ermittee D to - r
I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 0811030006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0468 EXT
ILEGAL ID I FEES PAID 1 i BUILDING ADDRESS I
ITR. 12706 LT: 1 I 9516 LEMON AV I
I IFEE DESCRIPTION QUANTITY DOM AMOUNT 1 TEMP CA 917801304 I
(ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET TEMPLE CITY
15382-022-017 101 PERMIT ISSUANCE FEE 27 75 I THOMAS PAGE 596 GRID J1 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 I
I 130 AIR INLETS/OUTLETS 12 00 UNI 52 20 111/03/08 SR 05/02/09 1
I 147 ALTER EXIST DUCT SYS 1 00 SYS 27 00 1 1
(OWNER TEL. NO I TOTAL FEES 160 95 IFINAL DATE FINAL CODE
�/'Y/
(LONG, PATTIE (626) 446-1025- 1
19516 LEMON AV 1 1
ITEMP 917801304 I IMXCRIPTION OF WORK
1
I i IREMOVE EXISTING & INSTALL NEW 3 TON HVAC SYSTEM
I
1APPLICANT TEL NO 1 1 I
ICOMFORT ZONE INC (626) 963-8383- 1 1 I
1144 #B VALENCIA 1 ISPECIAL CONDITIONS
IGLENDORA CA 91741 1 1
I I I I
ICONTRACTOR TEL NO I 1APPROVALS DATE INSPECTOR SIGNATURE 1
ICOMFORT ZONE, INC (626) 963-8383- 1 1 1 1
IP 0 BOX 594 LIC NO 1 I FAU/WALL FURNACE
1144 #B VALENCIA 760955 C20 1 I I
1GLENDORA, CA 91741 1 1COMBUSTION AIR OPENINGS 1 I I
(ARCHITECT OR ENGINEER TEL NO1 IDUCT WORK I I I
_ Ir 1 I
LIC NO i iAC/COMPRESSOReW
I I THERMOSTAT
I I I
1 1FIRE DAMPERS 1 1
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ISMOKE DETECTION DEVICES I 1
ICOMMERCIAL HOOD I 1
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I IREPORT ID• DPR264 ROUTE TO: BS0508
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